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NT COMMENTARY - Children's allergies are on the rise

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VOL: 99, ISSUE: 03, PAGE NO: 43

Jamil Khair RGN, RSCN, DipCD is clinical nurse specialist - paediatric gastroenterology and nutrition, St Bartholomew's and the London NHS Trust

Having decided that I needed a deeper understanding of food allergy, I buried myself in a mountain of weighty medical texts, and reams of printouts from the Pubmed internet search engine and came to one conclusion: anyone who claims to have a clear understanding of childhood food allergy has probably not read widely enough.

Having decided that I needed a deeper understanding of food allergy, I buried myself in a mountain of weighty medical texts, and reams of printouts from the Pubmed internet search engine and came to one conclusion: anyone who claims to have a clear understanding of childhood food allergy has probably not read widely enough.

This statement is easily supported by the impressive lack of consensus in the literature - particularly the terminology. Intolerance, idiosyncrasy, sensitivity, hypersensitivity and allergy are just some of the terms used to describe an abnormal, adverse, organic reaction to a specific food or food ingredient. There are additional terms for non-organic (psychological or psychosomatic) food intolerance or avoidance. The clinicians who treat these children rarely even agree with colleagues within their own specialty, be it gastroenterology, immunology, or dermatology.

As nurses, what do we really need to know? True immune-mediated food allergy does exist. The severest form is immunoglobulin-E mediated and can cause an immediate anaphylactic reaction within one hour of eating specific food allergens, such as peanut protein. Other types cause a delayed reaction and include such conditions as intolerance to protein in cow's milk and coeliac disease. Most countries now report a much greater incidence of food allergy in children than adults and an increase in reported cases in recent years. It is unclear whether this is due to increased awareness, changes in the environment causing changes in gut flora, or a change in eating habits.

Nurses who care for these children should appreciate that all forms of food allergy or intolerance are worrying and difficult to manage for parents and carers. Parents who have witnessed their child having a severe anaphylactic reaction need support and reassurance. Above all, they need practical advice on how to manage their child's nutrition while avoiding contact with the offending allergen and providing a normal childhood.

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