The rise of allergies

It was a Saturday afternoon and my wife Cindy and I were at a Chinese yum-cha restaurant with our extended family, including our six-monthold daughter Olivia. The dumplings had all been devoured and it was time for dessert. One of the delicacies at the yum-cha restaurant was an egg tart. We fed a bit of one to Olivia. We were introducing her to a range of solid foods at the time and thought nothing of giving her a piece. But just a few minutes later my motherin-law noticed a new rash over Olivia’s lips. The rash then spread all over her face, and she started to become wheezy. She looked quite uncomfortable, and I thought that she might be in pain. We all rushed over to her— myself, Cindy, my brother-in-law, his girlfriend and both grandparents. The waitresses even came over to see what was going on. In the middle of the cacophony, I heard a voice yell out: ‘Is there an EpiPen ® ?’ That panic-stricken voice was mine.

I am a qualified medical specialist, but in this situation I was absolutely powerless. I had no access to any medical resources, and there was no EpiPen ® in the restaurant. For a few terrifying moments, I watched as my daughter’s reaction escalated, my own heart pounding as my worst fears as a parent were realised.

We rushed her into the car to take her to the nearby hospital, but mercifully her reaction began to subside. As we drove, she did not become

Allergic diseases are increasing on an unprecedented scale in both developed and developing countries around the world. According to the Australasian Society of Clinical Immunology and Allergy (ASCIA), almost 20 per cent of the Australian population has an allergic disease. That’s almost one in five people— a staggering figure.

One in nine Australians— or an estimated 2.7 million people— had asthma in 2017–18. Nearly one in five Australians— or approximately short of breath nor did her face swell up. When we got to the emergency department, Olivia was assessed as stable and discharged with advice to follow up with an allergy specialist.

Without a doubt, this was one of the most harrowing and distressing events in my life to date. You may also have experienced such an event too. Your child may have a severe allergy or a mild one. Maybe you have an allergy yourself and are concerned about your kids’ risk of developing one. Perhaps you are planning a family, pregnant or hoping to expand your family, and you are aware of the increasing rate of allergies and want to know what you can do to reduce the likelihood that your baby will have one. Whatever the case may be, as a doctor and a parent I can sympathise with the feelings of fear, anxiety and disempowerment that you are probably feeling in the face of the scourge of allergies. I’m here to tell you that you are not alone. I’ve written this book to provide you with an arsenal of information about the practical things that you can do during pregnancy and birth, and on into your baby’s infancy and early childhood, to help prevent allergies developing. A new wave of science has brought fresh understanding about the link between allergies and the gut that every parent concerned about allergies should know about.

Dr Vincent Ho 4.5 million people— suffered from hay fever (allergic rhinoconjunctivitis) in 2014–15. Eczema occurs in around 20 per cent of babies, and its prevalence is increasing worldwide.

We also know that it’s kids who are experiencing the most severe allergies. In Australia, for young children aged between zero and four years of age, there was a 5.5-fold increase in anaphylaxis from 1994 to 2005. Food allergy is rampant and affects around 10 per cent of babies up to twelve months old.

In fact, Australia has the highest rate of confirmed food allergy in the world. The HealthNuts study based in Melbourne assessed over 5000 infants and in 2011 found that 9 per cent of one-year-old Australian babies had an egg allergy. The good news is that 80 per cent of babies will outgrow their egg allergy within a few years. Even those who suffer from severe reactions are still likely to outgrow an egg allergy, with only a very small proportion keeping the allergy for life. A peanut allergy, on the other hand, is almost the opposite— only 20 per cent of children grow out of their allergy.

The allergy problem is only going to get worse. ASCIA predicts that by 2050, the number of Australians affected by allergic diseases will be an astounding 7.7 million.

From my own experience on the ground, I know that the situation is bad. Waiting times for allergy clinics at public hospitals have blown out to many months, and even in the private sector there are huge waiting lists for testing, diagnosis and treatment.

Many of my immunology colleagues have told me that they already have enough work to keep them going until retirement, as there is no shortage of children needing testing and ongoing management. Many of these children will become adults with chronic allergies.

What causes allergies?

Are we just not dirty enough anymore?

I feel pretty lucky to have had no allergies or major medical issues in my life so far. My mum often reminds me that when I was a toddler I was always playing around in the dirt in our backyard. Apparently I even used to eat ants. Mum believes that contact with ‘dirt and bugs made you strong’, and I’ve always wondered if there might be some truth to that.

Scientists have proposed the hygiene hypothesis as a way to explain the rising prevalence of allergic diseases. This is the theory that early-childhood exposure to particular microbes (germs) protects kids against the development of allergic diseases. Lifestyle changes in industrialised countries— more sterile urban environments; more time spent indoors— have resulted in less exposure to microbes, especially for children. This has meant fewer infections, but it is also associated with a rise in allergies.

In other words, we’re not being exposed to the kind of bacteria that we once were, so our bodies aren’t learning how to fight certain diseases. It seems like my mum was right— playing in the dirt as a kid is good for you.

The story of the hygiene hypothesis is a fascinating one.

In 1989, Professor David Strachan, a London epidemiologist (a scientist who studies diseases within specific populations of people), published the results of a survey of more than 17,000 British children exploring the increased incidence of hay fever in post-war Britain. A curious pattern emerged in the data: the more elder siblings a child had, the less likely he or she was to develop eczema by the age of one and hay fever by the age of 23.

Professor Strachan believed the older children were passing some protective effect on to their younger siblings, and that this special protective effect was exposure to microbes. This earlychildhood exposure to particular microbes affected the development of the younger siblings’ immune systems, which protected them against allergies.

The catchy title of Professor Strachan’s paper was ‘Hay fever, hygiene, and household size’. Funnily enough, the word ‘hygiene’ was only used in the title of the paper and nowhere else in the text. Despite this, the media and scientific community zeroed in on the idea that we’re simply not dirty enough anymore. But how exactly does this work? And why are some microbes ‘good’ for us but not others?

This is an edited extract from The Healthy Baby Gut Guide by Dr Vincent Ho, Allen and Unwin, RRP $29.99, available now.