Everything you need to know about coeliac disease (and whether you really have it)

By Jason Tye-Din, Postdoctoral Scientist at Walter and Eliza Hall Institute.  Originally published on 'The Conversation' blog on 7th May 2012.

Disclosure Statement

Jason Tye-Din is affiliated with The Walter and Eliza Hall Institute and The Royal Melbourne Hospital. He receives funding from the NHMRC. He consults for ImmusanT Inc. and is co-inventor of patents related to the use of gluten peptides in diagnostics and therapies for coeliac disease.

The Conversation provides independent analysis and commentary from academics and researchers.

Founding and Strategic Partners are CSIRO, Melbourne, Monash, RMIT, UTS and UWA. Members are Deakin, Flinders, Murdoch, QUT, Swinburne, UniSA, UTAS, and VU.
 

Thinking of jumping on the gluten-free bandwagon? Better think again. 

The Neolithic Revolution introduced a whole range of new foods and proteins into the human digestive tract. But this phenomenal change created the perfect conditions for the rise of coeliac disease.

While most proteins were readily consumed, some people’s immune systems struggled to tolerate others. Wheat was the first cereal to be widely domesticated, and in the case of the gluten protein from wheat, the result of this struggle was coeliac disease.

When people with coeliac disease consume gluten, an abnormal immune reaction occurs causing inflammation and damage to the small bowel lining. This impairs absorption of nutrients and can lead to a wide range of symptoms and medical complications.

Ancient condition, 20th century treatment

The second century Greek physician Arateus is credited with coining the term coeliac disease, or “koiliakos”, after the Greek word koelia (abdomen), to describe patients suffering typical symptoms of diarrhoea, weight loss and anaemia.

Wheat was finally identified as the culprit of the reoccurring health problems. Joana Hard

Reports from the 19th and 20th century reveal considerable suffering and mortality associated with coeliac disease, particularly in infants. An effective treatment didn’t arise until the middle of the 20th century, when gluten was identified as the culprit.

The discovery was fortuitous – a wartime bread shortage led Dutch paediatrician Willem Dicke to observe improved health in children with coeliac disease, and note their relapse shortly after food drops of bread returned wheat back into their diet.

The work of Australian physician Charlotte Anderson established it was the gluten component of wheat (and also rye, barley and oats) that caused coeliac disease. It was the 1950s and the age of treatment with a gluten-free diet had begun.

Prevalence and the reasons why

Far from being a medical rarity, coeliac disease is very common today, affecting more than one in 100 Australians. And in the last half century, it has become approximately twice as common every two decades, similar to the rise in other immune diseases, such as type 1 diabetes.

The increased prevalence of the disease may be due to hyper-conscious hygiene practices.

Why the prevalence is increasing remains unknown, but a variety of environmental factors and the “hygiene hypothesis” have been proposed.

Today, people are typically diagnosed in adulthood and are mostly female. Alarmingly, 80% of Australians with coeliac disease remain undiagnosed. This is because symptoms are wide-ranging and largely non-specific. And coeliac disease still remains “off the radar” for many doctors.

Many symptoms but simple diagnosis

In people with coeliac disease, gluten causes widespread inflammation not limited to the bowel. Patients are commonly troubled by gut upset (such as bloating, abdominal pain, diarrhoea and/or constipation), lethargy, anaemia, and nutrient deficiencies, such as low iron. They can also suffer loss of fertility, migraine headaches, abnormal liver function, arthritis and autoimmune diseases, such as type 1 diabetes and autoimmune thyroid disease.

Bones are more likely to be thinned out (osteoporosis) and patients can develop certain cancers, such as lymphoma. The good news is that early diagnosis and treatment can greatly reduce the chances of these complications.

A blood test is a simple way to indicate whether you may have coeliac disease.

A simple blood test is used to screen for coeliac disease, although making a definite diagnosis requires demonstrating the characteristic small bowel changes of flattened and inflamed lining (“villous atrophy”) under the microscope. Small bowel samples are readily obtained by gastroscopy, a ten-minute procedure performed under sedation that introduces a flexible instrument via the mouth into the small bowel to allow samples to be taken.

It’s vital that a gluten-free diet isn’t started before testing for coeliac disease, as this can cause false negative results.

Genes and the environment

Coeliac disease shares certain predisposing genes with autoimmune diseases, such as type 1 diabetes (which explains why these conditions often occur together). These genes control how the immune system “recognises” and responds to foreign proteins and are fundamental for disease to develop.

But genes alone are not enough to cause coeliac disease and environmental factors are thought to play an important role in “triggering” disease in those with genetic susceptibility. Some factors appear to increase coeliac disease risk (such as rotavirus infection in infancy) while some may reduce the risk. Breastfeeding at the time gluten is introduced to an infant, for instance, may protect against developing disease.

The challenge of gluten-free diets

Excluding all dietary sources of gluten from wheat, rye, barley and oats allows the small bowel damage to heal and symptoms to resolve – but it’s far from easy. Wheat flour, the most common and significant source of gluten, is found in many foods, such as bread, breakfast cereals, cakes, biscuits, pasta, pastries and pizzas.

People with coeliac disease have to learn how to pass up the pastries.

There are also “hidden” sources of gluten found in sauces and processed foods and less obvious items, such as malted foods and beer. While gluten-free alternatives are increasingly available, they’re much more expensive and generally much less palatable – anyone who has ever tried gluten free bread will know how dense and crumbly it is!

Compounding its complexity, cost and poor palatability, the gluten-free diet needs to be very strict to work – even small amounts of gluten (about 50 milligrams – less than 1/100th of a slice of bread) can cause bowel damage.

That’s why patients need to be obsessive about excluding gluten – for people with coeliac disease the gluten free diet is not a fad but a serious medical treatment.

Is gluten free for everyone?

It’s hard to miss the ever-expanding sections of supermarkets dedicated to selling gluten-free food and many restaurant menus list gluten-free options. The gluten-free food industry is booming, with a global market projected to well exceed US$4 billion over the next three years.

Interestingly, a recent market survey commissioned by Coeliac Australia indicates that approximately 10% of Australians are currently following a strict or significantly reduced gluten diet. This is ten times greater than the total number of Australians thought to have coeliac disease.

A gluten-free diet isn't all that tasty, and not necessarily the healthiest option.  

It’s likely that alternative health practitioners, disease advocacy groups, proliferating internet blogs and forums, and the gluten-free food industry are directly or indirectly fuelling the mounting public perception that a gluten-free diet is intrinsically “healthy” or suitable to treat a variety of symptoms and illnesses.

But medical evidence to support undertaking a strict gluten-free diet outside of coeliac disease is minimal. If people do choose to follow a gluten free diet, it’s medically important that coeliac disease is excluded first so that testing isn’t compromised – a missed diagnosis of coeliac disease can be disastrous for long-term health.

While many people feel their symptoms might improve on a gluten-free diet, this doesn’t necessarily mean they have coeliac disease. Nor does it mean a gluten-free diet is the most appropriate treatment for them.

Many cases of perceived wheat or gluten intolerance reported by patients is not due to gluten itself but intolerance to the wheat’s carbohydrate component (fructans). For some, a diet reducing fructans and other fermentable carbohydrates, a low FODMAP (fermentable oligo-, di-, mono-saccharides and polyols) diet can be a more effective and appropriate treatment than going gluten free.

Awareness, diagnosis and management

Inadequate and delayed diagnosis of coeliac disease remains a major problem in our community so improving awareness and testing is a major goal to reduce the burden of this disease.

Excitingly, there’s been significant progress in understanding the genetic and immunological basis for why gluten is toxic in people with coeliac disease. Immune cells called T cells are the key mediators of damage in coeliac disease. These T cells are stimulated to cause damage by specific gluten fragments, which have now been identified.

Such insights are allowing a variety of potential treatments for coeliac disease to be explored, some of which will supplement and some of which could one day replace the gluten-free diet altogether.

This article was originally published at The Conversation. Read the original article.

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The Meaning of Advent

by Emma Copleston-Trent - Healthy Shelf Partner

For me Advent means a special treat in the form of a chocolate a day to count down to Christmas.  But recently I started to wonder how this fun tradition began, what did it actually represent?  So I decided to do a little digging...

The tradition of Advent celebrations date back to the 4th century, when some Christian churches began a ritual of fasting for a period of time to prepare for the big feast they held for what later became known as Christmas Day.  In the beginning each branch of the church had its’ own interpretation of how long this fasting and preparation was to last.  But over time those that followed Western Christianity came to accept that Advent begins on the fourth Sunday before Christmas, which is the Sunday that falls from November 27 to December 3 inclusive, and ends on the 24th of December.  In Eastern Orthodox churches Advent begins on the 15th of November and runs for 40 days.

Originally Advent was a preparation for Epiphany and not in anticipation of Christmas.  Epiphany celebrates the manifestation of Christ by remembering the visit of the wise men and, in some traditions, the Baptism of Jesus.

Later, in the 6th century, St. Gregory the Great was the first to associate this season of Advent with the coming of Christ.  Originally it was not the coming of the Christ-child that was anticipated, but rather the Second Coming of Christ.

By the Middle Ages the church had extended the celebration of Advent to include the coming of Christ through his birth in Bethlehem, his future coming at the end of time and his presence among us through the promised Holy Spirit.  Many modern-day Advent services include symbolic customs related to all three of these "advents" of Christ.

There are many different customs and symbols related to Advent, but some of the best known are Advent Calenders, Advent Candles, Advent Wreaths and Advent Colours.

Advent Colours

The colours of Advent are purple, pink and white.  Purple has traditionally been the primary colour of Advent, symbolizing repentance and fasting.  Purple is also the colour of royalty, demonstrating the anticipation and reception of the coming King celebrated during Advent.  Today, however, many churches have begun to use blue instead of purple, as a means of distinguishing Advent from Lent.

Pink (or rose) represents joy and reveals a shift in the season away from repentance and toward celebration.

White represents purity; Christ as the sinless, spotless, pure Saviour.  It also represents the belief that those who receive Christ as Saviour are washed of their sins and made whiter than snow.

Advent Wreath

An Advent Wreath is a circular garland of evergreen branches representing eternity.  Set on the branches of the wreath are four candles: three purple candles and one pink candle.  In the centre of the wreath sits a white candle.  As a whole, these candles represent the coming of the light of Christ into the world.  During the season of Advent one candle on the wreath is lit each Sunday as a part of the Advent services.

On the first Sunday of Advent the first purple candle is lit.  This candle is typically called the "Prophecy Candle" in remembrance of the prophets, primarily Isaiah, who foretold the birth of Christ.  This candle represents hope or expectation in anticipation of the coming Messiah.  Each week on Sunday, an additional candle is lit. 

On the second Sunday of Advent the second purple candle is lit.  This candle typically represents love.  Some traditions call this the "Bethlehem Candle," symbolizing Christ's manger.  On the third Sunday of Advent the pink, or rose-colored, candle is lit.  This pink candle is customarily called the "Shepherds Candle" and it represents joy.  The fourth and last purple candle, oftentimes called the "Angels Candle," represents peace and is lit on the fourth Sunday of Advent.  On Christmas Eve, the white centre candle is traditionally lit.  This candle is called the "Christ Candle" and represents the life of Christ that has come into the world.   

Advent Candle

Believed to have originated in Germany, an Advent Candle is a candle marked with the days of December up to Christmas Eve.  It is typically used in a household rather than a church setting.  Each day in December the candle is burnt down a little more, to the mark for the day, to show the passing of the days leading up to Christmas.  It does not strictly mark the days of Advent, but rather the calendar date.  Some households will make a Christmas decoration out of sprigs of evergreen and Christmas ornaments, with the candle at its centre; others will simply put it in a candlestick.  It is usually burned at the family evening meal each day.

Advent Calender

An Advent Calendar is a special calendar which is used to count or celebrate the days of Advent in anticipation of Christmas.  Some calendars are strictly religious, whereas others are secular.  Despite the name, most commercially available Advent Calendars begin on December 1.

Today, many Advent Calendars take the form of a large rectangular card with "windows" of which there are often 24; one for each day of December leading up to Christmas Day.  One is opened every day during Advent.  In many of these calendars each window opens to reveal an image, a poem or a yummy piece of chocolate.

The first known Advent Calendar was handmade in 1851 and the first printed Advent Calendar was produced circa 1902.  Gerhard Lang was certainly the progenitor of today's calendar.  He was a printer in the firm Reichhold & Lang of Munich who, in 1908, made 24 little coloured pictures that could be affixed to a piece of cardboard.  Several years later he introduced a calendar with 24 little doors.  He created and marketed at least 30 designs before his firm went out of business in the 1930s. 

The use of Advent Calendars disappeared during World War II, apparently to save paper.  After the war, Richard Sellmer of Stuttgart resurrected the commercial Advent Calendar and is considered responsible for its widespread popularity today.

References
 

Christianity.about.com
 

Wikipedia (Advent)
 

The Season of Advent; The Voice
 

Advent Wreath image © Mary Fairchild
 

Advent Candle image © Joel Bez
 

MooFree Dairy Free Advent Calendar © MooFree

Christmas U-B-Safe 1 Competiton!

We’re giving away a U-B-SAFE1 (RRP $58.00) to help keep you safe from the sun this summer and just in time for Christmas! 

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Gain more entries by reviewing products on Healthy Shelf, signing up to receive our quarterly e-Newsletter and commenting here on our Healthy Shelf Blog.  The person with the most entries by midday (Perth, WA time) on Sunday the 11^th December 2011 wins!

 

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Sign up for our quarterly e-Newsletter by emailing us with your request at mail@healthyshelf.com.au and earn a whopping 10 entries into the U-B-SAFE 1 Competiton! If you are current subscriber to the Healthy Shelf Newsletter you’ll automatically receive 10 entries into the U-B-SAFE 1 Competition when you enter, giving you a great head start! 

Each comment you leave on our Healthy Shelf Blog, whether you are a follower of our blog or or not, will earn you 1 extra entry into the U-B-SAFE 1 Competition!  So check out the great articles we have and let us know your thoughts on them, it's that simple!  Comments do not have to be postive, but must not contain inappropriate language or spam and be a true comment on the relevant post.  We will not accept generic or copy-paste entries.

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The serious full-body impact of allergies - News article

by Marnie McKimmie, The West Australian October 3, 2011

The true burden of hayfever is well known to those who fall victim to it each spring.

But it has long been trivialised as merely inconvenient by the 60 per cent or so of the population who escape this allergic reaction that is not just confined to the nose, but can also cause widespread irritation in airways and spread inflammatory products around the entire body via the bloodstream.

Too often it is not taken seriously, says WA paediatric allergist and immunologist Professor Susan Prescott.

Hayfever, medically known as allergic rhinitis, affects people in various ways, ranging from only mild with occasional symptoms to being a source of long-standing and major discomfort with the ability to significantly interfere with quality of life, productivity and performance at work or school.

Some sufferers may even be mislabelled with other conditions or end up with increased dental problems caused by constantly breathing through the mouth.

"When nasal blockage is significant, it can lead to obstructed breathing during sleep," Professor Prescott says.

"Periods of reduced oxygen supply can lead to chronic tiredness and problems concentrating during the day. In children, it can affect school performance, behaviour and attention span and can lead to mislabelling with 'attention deficit disorder'.

"Chronic allergic rhinitis can also be associated with other local problems such as ear infection, hearing problems, sinus infection, nasal polyps and even dental problems due to chronic mouth breathing."

Now there is emerging evidence that allergic rhinitis, often linked to lower airway inflammation and asthma, may be associated with other, more generalised effects of systemic inflammation, reports Professor Prescott in her new book The Allergy Epidemic - A Mystery of Modern Life.

"Although inflammation is most obvious in the nose or the chest, there is growing evidence that allergic rhinitis and asthma may have effects much further a field," she writes in the book.

"One of my Canadian collaborators has elegantly demonstrated that inflammatory products ,including cytokines and other mediators, released from the airways during an allergen challenge circulate through the blood to stimulate immature cells in the bone marrow. This leads to the release of showers of new inflammatory cells that enter the blood stream and come back to sites of inflammation, adding fuel to the fire.

"It is possible, but not confirmed, that this also contributes to inflammation in blood vessels and increased risk of cardiovascular disease.

"In support of this idea, higher rates of heart disease have been associated with allergy in both animal and human studies. Interestingly, treatment of airways inflammation, with inhaled steroids, has also been shown to reduce the risk of heart disease.

"This highlights the potential for events at a local site to fuel inflammation in other parts of the body, but more research is needed to determine the significance of this."
Already hayfever is considered to be a major contributor to Australia's estimated financial cost of allergies which was $7.8 billion in 2007.

Find Dr Susan Prescott's book "The Allergy Epidemic - A Mystery of Modern Life" on  your Healthy Shelf today. 

Hayfever misery well known to expert - News article

by Marnie McKimmie, The West Australian October 3, 2011

Can't breathe? Can't sleep? Can't concentrate? Headaches? Always tired? Itching? Sneezing? Snoring? Nose running? Dark rings under the eyes? Bad breath? Dry mouth? Embarrassed and self-conscious? Bad behaviour and learning difficulties?

One of the many who have fallen victim to these chronic hayfever symptoms, and had to battle on regardless, is WA's paediatric allergist and immunologist Susan Prescott.

In her new book, The Allergy Epidemic - A Mystery of Modern Life, she describes her first memory of her "unbearable" hayfever, saying growing up in WA's Wheatbelt she was among the allergy epidemic's first big wave.

Now based at Princess Margaret Hospital and the University of WA and considered a leading expert in the field of early immune development, she also makes the warning that its debilitation, health impact and cost to the community is still greatly underestimated.

"As a child, my teachers were always telling me to close my mouth and 'stop catching flies'," she says in her book.

"But they didn't seem to understand that I could not breathe any other way. At least not in the pollen season. Or around cats. Or dust. Sometimes it was almost unbearable."

Prescott's hayfever has improved with age and advancements in medication. She still uses a steroid nasal spray during her "trouble patch" which is in spring.

Knowing first hand the impact of the allergy and having spent decades treating WA children, and leading international allergy research, Prescott's book is a bid to understand why allergy rates worldwide continue to soar.

It covers a wide range of complex issues in an easy-to-understand format.

Topics include: Why is allergic disease increasing so rapidly, especially in young infants? What are the environmental factors? What is going wrong with the immune system and can we prevent it? What are the current treatment options for allergies? What is epigenetics? Where is the research headed?

Published by UWA Publishing, it is available from this month, with all the author's proceeds going towards allergy research.

Find Dr Susan Prescott's book "The Allergy Epidemic - A Mystery of Modern Life" on  your Healthy Shelf today.

Lifestyle trigger to allergy epidemics - News Article

by Marnie McKimmie, The West Australian October 3, 2011

The puzzling 20- to 30-year lag between the wave of hayfever that gripped the world and the recent wave of food allergies has experts questioning whether the allergy epidemic is partly driven by an "amplifying effect" across generations.

With alarming food allergies now appearing within months of birth, it suggests the factors driving this new epidemic are operating very early in development, most likely in pregnancy, says leading WA paediatric allergist and immunologist Susan Prescott.

"Every mother provides the first environment for her foetus," Professor Prescott said. "Her immune system directly influences the developing foetal immune function. It is already very clear that allergic mothers directly increase the risk of allergy in their babies, so the dramatic rise in maternal allergy is another compounding factor in the allergy epidemic.

"One question is, 'Has there been another wave of environmental changes that is driving this more recent epidemic?' Or is it that you have got a continuing modernising environment overlaying the maternal allergy itself? So it's not just mum's genetics, it's her expression of disease. If she has got a more inflammatory state, she might have a direct influence on the baby's immune system just by her being allergic."

Professor Prescott said it was almost certain that today's rising allergy to common foods such as milk and eggs, that had been consumed by humans for 1000 years, was directly because of a sudden change in our modern way of life.

It was possibly a yet-to-be- identified damaging combination of environmental factors that had emerged over the past 10 years, she said.

Environmental factors under investigation and suspected of triggering allergy-causing inflammation range from pollutants such as cigarette smoke, traffic fumes and pesticides, to a lack of sunlight, physical activity and fruit and vegetables, and a "too clean" environment.

However, researchers were also starting to wonder if it might possibly be that modern environmental changes that had affected the immune system of the hayfever-prone mother were then further altering the immune gene expression in her developing foetus.

Beginning research into this area, some researchers suspected this "amplifying effect" might be partly the reason why today's alarming food allergy wave was far more severe, seeing babies showing signs of allergic disease within a few weeks of birth and those under one-year-old having life-threatening anaphylactic reactions.

Australia has one of the highest allergy rates in the world. Ten per cent of one-year-olds now have a food allergy and in the past decade there has been a five-fold rise in anaphylactic food allergies in preschoolers.

When this younger generation reaches adulthood, the burden of allergic diseases is expected to increase even more. They are at greater risk of developing hayfever and other allergies.

"The problems we are seeing today, they just did not exist like this in the past," Professor Prescott said.

"We see allergic disease much younger in babies and more severe. We are seeing more cases of anaphylaxis in the under one-year-olds from food. And on top of that, we are seeing that they are less likely to grow out of it than they used to be.

"It is all really adding up to an enormous and growing burden. And we do not know what is in store for this generation as they grow up.

"At this stage, we cannot explain the secondary rise in food allergy and why this has been delayed so long after the asthma and hayfever epidemic. One thing is clear, the environmental pressures that are causing this rise in infant allergy must be acting very early in life, even before birth. And it may be no coincidence that this food allergy epidemic is affecting the children of the hayfever generation."

Based at the University of WA and Princess Margaret Hospital, Professor Prescott's research team had shown how pregnancy changed maternal immune response and that allergic mothers had lower Type 1 responses to foreign foetal antigens compared with non- allergic women.

"This means there are likely to be differences in the 'immune environment' experienced by the foetus, which could influence its patterns of development," Professor Prescott said.

Her team had found that even at birth, allergic children displayed differences in the internal machinery of their T cells, with reduced levels of certain proteins involved in the ability to respond to signals.

"This might hold promise as a possible predictive test, however, prediction is of limited value until we can do something to prevent disease," she said.

Professor Prescott saw the allergy epidemic as a flow-on effect from disturbing the natural balance of our environment. Looking at trying to determine exactly what were the environmental factors driving it, she said it was hard to pin the blame on any one factor.

Increasing "hygiene" had been a lead candidate, she said, but many other factors were known to have immune effects, such as modern environmental pollutants, reduced sunlight exposure and lower vitamin D levels caused by more screen-time and indoor activities and modern dietary patterns which promoted inflammation because of the lower levels of fresh fruits, vegetables, fibre and omega-3 fats.

"There are so many things that have changed and it is very hard to prove which one if any," Professor Prescott said.

"It is most likely to be a combination of factors."

Ultimately, the goal was to help prevent allergic disease through the same pathways - including focusing on the optimal condition in the womb for a developing foetus and the genes that were most vulnerable to environmental effects.

For now, the best advice to pregnant mothers was to avoid cigarette smoke - a definite adverse exposure - and breastfeed for general good health. Food avoidance in non-allergic babies had been scrapped as an allergy-prevention strategy, with current notions being that the immune system learnt a food was harmless by a baby eating it early in life and regularly.

 
More research is needed to confirm this and there are several Perth studies aiming to determine if earlier introduction of allergenic foods such as egg will actually reduce the risk of food allergy. Families interested in participating can contact Professor Prescott's researchers on 9340 8834.

Find Dr Susan Prescott's book "The Allergy Epidemic - A Mystery of Modern Life" on  your Healthy Shelf today.

Mouth Drop Brings Releif - News Article

by Marnie McKimmie, The West Australian October 3, 2011

Avoidance is always the first rule of allergy control but since pollens can be carried vast distances in the strong spring winds, spreading across suburbs, pollen immunotherapy is the best option for those with significant hayfever symptoms, according to leading WA paediatric allergist and immunologist Susan Prescott.

Immunotherapy, which aimed to induce a lasting immune tolerance through gradually giving increasing doses of the allergen over an extended period, starting at extremely low levels, was the only potential curative treatment for allergic disease, she said.

There was now strong evidence that it could not only be effective in the treatment of both allergic rhinitis (hayfever) and allergic rhinoconjunctivitis (eye and nose allergy) but also help control asthma and eczema in the same patient. Preliminary evidence also indicated it might even reduce disease progression from hayfever to asthma and reduce the development of new sensitisations.

She said that in the past a lack of awareness in both the medical profession and the public about the availability of this treatment option had seen suitable patients "falling through the cracks" and not being assessed and referred. It was traditionally given by injection and had been in use for more than 100 years, well before the allergy process was understood.

However, immunotherapy now attracted more attention, she said. This included sublingual immunotherapy, allowing the treatment to be given by tablets or drops placed under the tongue. This had grown in popularity in WA over the past few years since its introduction but was still more expensive and often not readily available through the public hospital system.

"Unlike other medications, immunotherapy targets and suppresses the underlying Type 2 allergic immune response," the professor said.

"By addressing the immune problem that causes allergies, it is the only treatment that can alter the natural history of disease."

The decision to use immunotherapy is based on weighing up an individual's "burden of disease" against the "burden of the treatment", she says in her new book, The Allergy Epidemic - A Mystery of Modern Life.

Immunotherapy is considered a good treatment option in hayfever patients who have moderate, severe or persistent disease and still have symptoms after trying symptomatic treatments, such as antihistamines and nose sprays.

However, patients who suffer from severe, unstable asthma should not consider it.

Available for most common inhaled allergens and with proven benefits in patients sensitised to grass and tree pollens, house dust mites, moulds and some animal dander, the best candidates are those who are sensitised to only a few allergens.

Immunotherapy began, Professor Prescott said, with an up-dosing schedule followed by a maintenance period of three to five years.

"Although patients can be quite quickly 'desensitised', this may not be lasting unless there is continued long-term exposure," she said.

"A more permanent tolerance is driven by changes in underlying cellular immune function, with induction of regulatory T cells and suppression of the Type 2 allergic T cell response."

Studies on immunotherapy side-effects show moderate reactions such as rhinitis, mild asthma or hives are estimated to occur in one in 1500 injections. More severe reactions are rare, with anaphylaxis occurring about once per million injections.

In comparison, oral immunotherapy for food allergy, Professor Prescott said, was still considered "very dangerous" and experimental because of the significant safety concerns.

But there was hope that standardised protocols could eventually be determined and set for clinical practice.

THE TREATMENT
Antihistamine tablets. Providing relief for mild and intermittent symptoms, these tablets are widely available without a prescription and block histamine receptors to reduce symptoms. New generation “non-sedating” antihistamines are preferable to older preparations which can cause drowsiness and significantly impair performance, learning and concentration.

Nasal steroid sprays. Those with more persistent, moderate or severe symptoms are usually prescribed nasal steroid sprays effective at suppressing nasal inflammation. The sprays are not designed to provide “instant relief” and need to be used regularly over a period of time to achieve the best anti-inflammatory result. It may take a month to see an improvement. Considered safe for adults and children and not having an impact on growth, they can be used long term without damage to the lining of the nose. Some people experience local irritation and dryness but this can be reduced by saline drops. Newer-generation nasal steroids have also been designed so their absorption is minimal when swallowed with nasal secretions.

Eye drops. Antihistamine eye drops are effective for controlling eye symptoms. New “anti-leukotriene” tablets used in asthma may also have some benefit and work by blocking the action of leukotriene inflammatory products.

Decongestants. Do not play a role in the long-term management of hayfever. These nasal sprays, tablets and syrups are mainly for short-term( use for viral infections and upper respiratory tract infections. They may( cause chronic damage to the lining membranes of the nose if used for long periods of time. Often hayfever patients suffer “rebound congestion” when stopping these medications and this can be worse than their hayfever symptoms.
Source: The Allergy Epidemic — A Mystery of Modern Life by Professor Susan Prescott

Taking Time Out

by Linda

Recently our family packed up the car and took off on a camping adventure to the Perth Hills Camp Site in the Beenlu National Park.  For the cost of $54 we got a camp site for three nights, with access to an outdoor camp kitchen that was powered and equipped with a fridge and hot running water.  The camp sites’ bathrooms and toilets got a 10 out of 10.  The shower was hot and the toilets clean and free from spider webs.  It was about a 50 minute drive from Wanneroo to get to the camp site, but it felt like we were miles away down south without the tedious hours of driving. 

It was very refreshing to be sitting amongst the trees, the camp fire burning, watching the boys roast their marshmallows on a stick they had collected on their bush walk that day.   The camp site has a walking trail that loops around the bush to a look-out over the Mundaring weir.  For my five year old this was a very exciting adventure, leading us through the bush looking for the next symbol to let him know which way to go.   We saw a kangaroo, had many encounters with the bird life and, although we did not see the possums, we heard some very excited kids at night who had.

On our next visit we will bring our own wood as we found it rather expensive to buy from the camp site.  And it is illegal to collect your own wood from the surrounding bushland.

This trip has been a welcome reminder of how important it is to take breaks and I’m looking forward to the next trip.  I’m not planning on leaving it as long this time.  Taking a break has been a great recharge of the batteries and created some great memories.

www.dec.wa.gov.au/campgrounds