Primary care nurses are no strangers to the management of long term conditions. From asthma to diabetes, these conditions are the staple of general practice. However, a recent case highlights a common condition with potentially fatal consequences: food allergy.
The issue has come to the fore recently because of the tragic case of Amy May Shead. The TV producer 26 at the time, travelled to Hungary and she ordered a meal in a restaurant, having made known to staff her dietary requirements, including showing the waiting staff an allergy information card printed in the local language stating that she suffered a potentially fatal allergy.
Amy experienced a catastrophic anaphylatic reaction after the first bite of food. The reaction was so severe that Amy suffered a cardiac arrest. She had sustained a severe brain injury, her brain had been starved of oxygen for six minutes.
This tragedy highlights the need for food allergy awareness for the public, and the role of primary care nurses in educating them. A Food allergy is an adverse immune response to a food. It can be classified into IgE-mediated and non-IgE-mediated reactions. Many non-IgE reactions, which are poorly defined both clinically and scientifically, are believed to be T-cell-mediated. Some reactions involve a mixture of both IgE and non-IgE responses and are classified as mixed IgE and non-IgE allergic reactions.
Food allergy may be confused with food intolerance, which is a non- immunological reaction that can be caused by enzyme deficiencies, pharmacological agents and naturally occurring substances.
It is estimated that 21 million people in the UK live with allergic disease. Additionally, recent research showed that there has been a 33% increase in hospital admissions due to allergy in the last five years, and a 19% increase due to anaphylaxis.
Amena Warner, Head of Clinical Services, Allergy UK said “Growing awareness and understanding of allergic disease will, of course, drive better and more accurate diagnoses. However, we do know that allergic disease is increasing and ongoing research will help us to understand the reasons behind this increase.
A recent study surveyed 1146 people with allergies on the effect the condition had on their lives. They found that there was confusion over the symptoms of allergic reactions, with 23% mistaking facial weakness for an allergic reaction, while 15% thought pain down the arm was a symptom. It also highlighted a lack of awareness surrounding anaphylactic shock, with 44% of people saying that they did not know about the condition, despite the fact that it can be life-threatening. The research also found that 44% of respondents ‘lived in fear’ of the potentially deadly allergic reactions.
Ms Warner added: ‘Modern lifestyles, our tendency to spend more time indoors and under use of our natural immune systems may all play their part. Increasing awareness and recognition among frontline healthcare professionals of allergic disease is, of course, crucial, so that people who do suffer from symptoms suggestive of allergy can get the right diagnosis and treatment to improve quality of life for what can potentially be a serious and debilitating condition.’
There was a 12 % increase in the total cost of prescriptions for nutritional supplements and paediatric milk intolerance between 2013 and 2014, demonstrating the pressures that food intolerance puts on the finances of primary care.
Primary nut allergy affects over 2% of children and 0.5% of adults in the UK. According to research, Infants with severe eczema and/or egg allergy have a higher risk of peanut allergy. Primary nut allergy presents commonly in the first five years of life, often after the first known ingestion with typical rapid onset IgE-mediated symptoms.
According to NICE, most allergy care takes place in primary care. People with a clear diagnosis, and mild but persistent symptoms, are usually managed in general practice without referral to a specialist service. Some people with allergies, and the parents or carers of children and young people with allergies, also buy over-the-counter medicines from community or high-street pharmacies.
The clinical diagnosis of primary nut allergy can be made by the combination of a typical clinical presentation and evidence of nut specifc IgE shown by a positive skin prick test (SPT) or specific IgE (sIgE) test. Pollen food syndrome is a distinct disorder, usually mild, with oral/pharyngeal symptoms, in the context of hay fever or pollen sensitisation, which can be triggered by nuts. It can usually be distinguish clinically from primary nut allergy.
Cases as severe as Amy May Snead are thankfully rare, but the number of people with allergies is increasing. Patients will have to be ever more vigilant, and nurses have a vital role in educating them.