Food allergy sufferers miss out on services, says study
8th of April
A lack of data on food allergies means that many food allergy sufferers are missing out on hospital services, according to a new study published in the New Zealand Medical Journal*.
“One of the problems of having no food allergy data in New Zealand is that it hinders medical services,” said Associate Professor Rohan Ameratunga, one of the study’s authors and an allergy specialist at Auckland Hospital.
The study stated there are no national guidelines for the provision of allergy services, so district health boards take an ad hoc approach, including the availability of specialists and the purchase of laboratory tests.
Because of the limited services, many patients with complex allergic disorders have to fly long distances for diagnosis and treatment, often at their own expense.
Access to laboratory tests in some parts of the country is also restricted. In Wellington, for example, patients of private specialists are required to pay for laboratory tests.
Children with a potential to outgrow food allergy need to be reviewed regularly so they aren’t confined to an unnecessarily restricted diet. Adults also need to be reviewed regularly, particularly if they have just experienced a severe reaction, the study said.
“One of the big problems of having no data on food allergies in New Zealand is that we have had to assume that we are similar to other countries. However, our ethnic make-up is different to that of other countries and our food consumption patterns may also be different,” Dr Ameratunga said.
According statistics from Europe and the US, food allergy affects between 6 and 8 per cent of children and between 2 and 4 per cent of adults.
Any food can cause an allergic reaction, but eight foods are responsible for 90 per cent of reactions: milk, eggs, peanuts, tree nuts, fish and shellfish, soy and wheat.
Symptoms can include hives, itching, swelling, vomiting, diarrhoea and nausea. In some cases, it can cause potentially life-threatening symptoms, called anaphylaxis, either by breathing difficulties and/or a sudden drop in blood pressure.
A lack of food allergy prevalence data has a significant effect on the ability to build a case to lobby Pharmac to fund adrenaline auto-injectors, the study said.
Currently adrenaline auto-injector devices, the primary treatment for acute anaphylaxis in the community, are not publicly funded in New Zealand. Ensuring an up-to-date supply of this life-saving medication (which has a shelf-life of 12-16 months) can place an unacceptably high financial burden on families with severe food allergy.
“Because we don’t know the prevalence of food allergy in New Zealand, Pharmac is unaware of the true numbers of those who are at risk of anaphylaxis, and the district health boards are also unaware of the community’s needs.”
“This also extends to schools and preschools, where it has been left to each individual organisation to devise their own approach to dealing with children with food allergies,” Dr Ameratunga said.
The ad hoc approach may place some students at increased risk of reactions while attending school.
The study pointed out that better epidemiological data may assist health boards in prioritising the need for allergy/immunology services and ensure robust coordination and continuity of care across primary, secondary and (where necessary) tertiary care services. Tertiary hospital-based multidisciplinary teams would ideally include specialist allergists, nurses, dietitians, and facilities for food challenges and immunotherapy.
Allergy New Zealand, the Australasian Society for Clinical Immunology and Allergy, Australian Laboratory Services, Nutirica and William and Lois Manchester Trust provided unrestricted educational grants.
For more information and for case studies to interview, contact Inga Stünzner, Allergy New Zealand, Phone 09 623 3912, Email firstname.lastname@example.org.
* Christine Crooks, Rohan Ameratunga, Greg Simmons, Penny Jorgensen, Clare Wall, Maia Brewerton, Jan Sinclair, Richard Steele, Shanthi Ameratunga, “The changing epidemiology of food allergy — implications for New Zealand”, The New Zealand Medical Journal, 4 April 2008, Vol 121 No 1271; ISSN 1175 8716