World Allergy Week 13-19 June 2021

World Allergy Week is an event organized by the World Allergy Organization to improve allergy awareness worldwide.

This year, 13 – 19 June 2021, we will focus on Anaphylaxis, to be aware of the condition, be prepared to make the diagnosis and treat according to guidelines to save lives. During the COVID-19 pandemic, we have learned how important awareness of a condition and its treatment modalities are. We have also been confronted with the tremendous fear factor of “not knowing” if this condition will be fatal for my loved one and will the correct medication be available and administered?

Anaphylaxis is defined as a “severe, life-threatening systemic hypersensitivity reaction. Characterised by a rapid onset, potentially life-threatening airway, breathing or circulatory impairment, usually associated with skin and mucosal changes, but it can be without. The gastro-intestinal tract might also be affected in some patients.

The most common causes of anaphylaxis are foods, medication, and insect stings. In SA, the most common trigger is bee venom allergy but reactions to food allergens are in the increase, according to Prof Levi, CEO of the Allergy Foundation of South Africa (AFSA). This rise in incidence of food allergies worldwide is referred to as the “second wave’ of allergic condition increase. The first wave was a decade or two ago with the sudden increase in Allergic Rhinitis and Asthma in the world.

Common food triggers include nuts, peanuts, sesame seeds, fish, shellfish, eggs, and milk. This would be affected by the culture of the population a s well as the location. Studies have shown that even in the same population and genetic pool, environment factors can influence the development of food allergies. Asian people immigrating to Australia had more children with food allergies if the babies were born in Australia versus born in Singapore.

With this rise in food allergies, comes more research and new tests and methods to interpret results are constantly being discussed and challenged. Immunotherapy to desensitise for food allergies such as peanut are being trailed and one product for peanut allergy is now available in the USA. The negative aspect would then be, with this increase comes an increase in anaphylaxis due to food allergy.

Medication such as anti-inflammatory drugs (NSAIDs), anaesthesia drugs, radiocontrast media used in the X-ray department and antibiotics would be amongst the triggers in a hospital setting, not forgetting latex as a possible culprit!

There are risk factors for anaphylaxis such as noncontrolled asthma and co-factors including exercise, alcohol, acute infections and NSAIDs. The latter will explain why patients and doctors battle to identify a specific food if it does not always cause a reaction. A detailed food history over time would solve this mystery like a Sherlock-Holmes would solve a crime investigation! Allergy testing would be of essence to confirm the diagnosis and to avoid unnecessary avoidance and fear. Desensitisation can be done for bee venom allergy.

Exercise-induced-anaphylaxis is not common, it is however an important diagnosis to be made as it can happen to an athlete/sports person in a remote area leaving them without adrenalin or nearby medical assistance. Wheat and peanuts are the most common triggers for this condition, but sesame seeds and other nuts have been reported as possible triggers.