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Vivienne is among a growing number of Australians navigating these food risks
Vivienne Lai's daughter Emilia lives with food allergy - and she's not alone. With allergic diseases on the rise in Australia, new research has revealed the number of infants with cow’s milk and cashew allergies for the first time.
Published 24 August 2023 5:43am
By Emma Brancatisano
Source: SBS News
Image: Vivienne Lai and her husband Viet with daughter Emilia, who lives with multiple allergies. (Supplied / Vivienne Lai)
In her first year back to work after having her daughter Emilia, Vivienne Lai remembers getting regular calls from daycare.
“I was getting a call every other week saying that she had reacted to something, and that would just throw my day off whenever I got that call,” she told SBS News.
Emilia, or Emmy, is now two-and-a-half and has several diagnosed allergies: peanuts, cow’s milk, eggs, cashews and pistachios.
Lai says her daughter’s journey has been “different to most” as she experienced delayed allergic reactions.
“She was able to tolerate these allergens, initially, for the first few months of her life. It wasn’t until just before she turned one that we discovered she was reacting to them,” she said.
“When the reaction came out of the blue, it was a shock, and cause for frustration and concern.”
Vivienne Lai with her husband Viet and daughter Emilia. Source: Supplied / Vivienne Lai
Typically, Emmy experiences hives around her mouth, chest and back, with more severe reactions including swelling of her hands or feet.
Thankfully, she has not yet suffered from anaphylaxis, which is the most severe type of allergic reaction that requires immediate treatment. And, things seem to be getting better.
But it’s an experience Lai describes as “scary” and “anxiety-inducing”.
“It does seem like it’s becoming a little bit more prevalent,” she said. “It’s just one of those things we have to navigate.”
Research reveals new food allergy rates among infants
New research released on Thursday has revealed for the first time the number of infants in Australia who are living with cashew and cow’s milk allergies.
According to two studies led by the Murdoch Children’s Research Institute in Melbourne, 1.4 and 1.3 per cent of 12-month-olds have cashew and cow’s milk allergies respectively. This compares to previous research which found 3.1 per cent of infants have a diagnosed peanut allergy.
Both studies surveyed just over 1,900 infants in that age group, and were supported by the Centre for Food Allergy Research.
The cashew allergy research was led by Dr Tim Brettig, a Murdoch Children’s Research Institute senior study doctor and paediatric allergist and immunologist at MACCS Medical Group in Melbourne.
He said the findings reinforced the belief that cashew allergy, like most food allergies, is thought to develop early in life.
“Traditional methods would have been to introduce nuts later in life. We now know from several studies that early introduction is associated with decreased rates of allergy,” he said.
“For parents or healthcare professionals, we can use that evidence to inform our clinical practices as to how we approach children with food allergy and management.”
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Why are food allergies on the rise?
Murdoch Children’s Dr Victoria Soriano, who led the second study, said both cow’s milk and cashew are known to be among the most common food allergies in infants and young children, with prevalence varying between countries.
“However, there was no recent data on the prevalence of proven milk and cashew allergy in Australia, making these findings important for future research into how we might be able to prevent them,” Soriano said.
‘Definitely not rare now’: The rise of food allergy in Australia
Allergic diseases are among the fastest growing chronic conditions in Australia, affecting about one in five people, according to the National Allergy Strategy developed by Australasian Society of Clinical Immunology and Allergy (ASCIA) and peak advocacy body Allergy & Anaphylaxis Australia (A&AA).
This can include food, insect and drug allergies along with allergic asthma, allergic rhinitis (hay fever) and eczema.
By 2050, the number of people affected by allergic diseases in Australia is predicted to increase by 70 per cent to 7.7 million, a 2013 ASCIA report states.
Maria Said, chief executive of A&AA and director of the National Allergy Council, said food allergy has also increased in prevalence over the last two decades.
“It was rare in the 1990s. It’s definitely not rare now. There is a child with food allergy in every classroom,” she said.
Brettig agreed. “We’re finding increased rates of food allergy in a lot of developed or first world countries, particularly those with a Western culture,” he said.
About one in ten infants in Australia have a proven food allergy, according to studies led by National Allergy Centre of Excellence researchers, which is the peak allergy research body. This is one of the highest incidences across the world.
It affects one in 20 children aged 10 to 14 years and one in 50 adults.
What’s behind the rise in food allergy?
The short answer is we don’t know.
“We have some ideas as to what might be influencing the increase in allergy - we think it’s a combination of environmental factors, for example vitamin D intake,” Said said.
Brettig’s research found eczema and a peanut allergy were linked to having a cashew allergy.
Soriano identified that, along with eczema, those infants with a family history of food allergy and parents born in East Asia were more likely to develop cow’s milk allergy.
Brettig said research is looking at whether controlling these risk factors and environmental exposures can reduce allergy rates.
“But it’s yet to be proven at this stage,” he said.
Lai’s daughter Emmy has been involved in a trial, led by the Population Allergy Group at the Murdoch Children’s Research Institute, which aims to determine if vitamin D supplementation leads to a reduction in food allergy.
Emmy was one of 2,700 infants enrolled between six and 12 weeks old. Each child was given a vitamin D drop every day ahead of an allergy test at the age of one.
The results are expected to be published later this year.
How are foods labelled in Australia?
Most food allergies are caused by peanuts, tree nuts, milk, eggs, sesame seeds, fish and shellfish, soy, lupin and wheat.
The Australia New Zealand Food Standards Code that must be declared on food labels whenever they are present.
All foods sold in both countries must comply with the relevant standards set out by Food Standards Australia New Zealand (FSANZ), which are then enforced by state, territory and New Zealand regulators.
Said believes Australia’s laws are strict when it comes to labelling of the most common allergens, but questioned whether enough surveillance is taking place.
“For the most part, we wait for people to have reactions before we find a product is not properly labelled,” she said. “However, I am pleased there is more government testing happening, and we are having recalls due to spot checks on particular products.”
According to FSANZ, undeclared allergens are the most common reason for food recalls year-on-year.
From 1 January 2022 to 18 August 2023, there were 141 recalls in Australia, with 43 per cent of these being due to the presence of undeclared allergens.
Since 2018, the average annual occurrence of recalls resulting from this reason has hovered around 44 per cent.
The number of food recalls from 2013 to 2022 due to undeclared allergens (by allergen). Source: SBS News
Of the 346 recalls between 2013 and 2022, the most common undeclared allergens were milk (30 per cent), multiple allergens (18 per cent) and peanut (15 per cent).
In 2021, the Code was amended to introduce new requirements for labelling allergens in food.
“The changes are intended to make allergen information on food labels clearer and more consistent by requiring allergen declarations in a specific format and location on food labels using specific, simple, plain English terms,” a FSANZ spokesperson said.
Businesses have until 25 February 2024 to comply with the changes, after which a two-year stock-in-trade period will apply.
The number of food recalls from 2013 to 2022 due to undeclared allergens (by food type). Source: SBS News
They are voluntarily made by food suppliers and not regulated by the Code.
Said believes these statements, known as precautionary allergen labelling (PAL), are a concern.
“A company can choose to - or not to - put a statement on, and a consumer has no way of telling whether a thorough risk assessment has been made,” she said.
“This is a huge issue that we’ve voiced to the government and to the food industry.”
“FSANZ currently has no plans to introduce requirements for precautionary allergen labelling into the Code,” the FSANZ spokesperson said, adding the Allergen Bureau has developed guidelines on the use of PAL.
The bureau is the peak industry body representing food industry allergen management.
What about imported food products?
Researchers have also voiced concern over the mislabelling of food products that are imported into Australia.
Several years ago, James Cook University professor Andreas Lopata led a study which tested 50 packaged items from six Asian grocery stores in Melbourne. Just under half of the products analysed (46 per cent) , with 18 per cent containing multiple undeclared allergens. These included egg, gluten, milk and peanut - some in very high concentrations.
“They were mislabelled, meaning they did not have any information about the presence of allergens which were confirmed using diagnostic tests,” he said.
“These shops and these products often don’t have English labelling on them … which does not conform with our regulations.”
At the time, Lopata said the study attracted interest from authorities in charge of regulating imported food into Australia. He hopes the study increased awareness and led to tighter protocols.
The Department of Agriculture, Fisheries and Forestry is responsible for administering the act which requires imported food to be safe and compliant with Australia’s food standards.
To ensure compliance, it operates a “risk-based border inspection scheme”.
“Under this scheme food classified as ‘risk’ is initially referred for inspection at the rate of 100 per cent,” a department spokesperson said. “Other foods are randomly referred for inspection.”
They said all food undergoes a label check, which includes checking the label is in English, and that any allergen declarations comply with the Code.
Once the food is in Australia, state and territory food regulators also monitor the compliance of imported food at the point of sale.
The spokesperson said the department is aware of Lopata's study, and that the relevant state food regulator took follow-up action with the businesses that sold the food.
“However, as the samples had been purchased in 2017, many of the businesses were either no longer trading or the foods were no longer being imported,” they said.
They said while it is not practical nor feasible to test all imported foods for undeclared allergens, the department seeks to minimise risk through actions such as monitoring international alerts, recalls and incidents, and responding to non-compliance in Australia identified by state and territory regulators.
The number of food recalls from 2013 to 2022 in Australia. Source: SBS News
“If you have a product in your pantry that has been recalled, don’t consume it. You can take it back to the place of purchase and usually you will get a refund,” said Lydia Buchtmann, communications director for the Food Safety Information Council.
She urged any consumers who come across food items that are incorrectly labelled to keep a sample, along with the package.
“You can report it to your local council,” she said.
And, if you think you’re becoming ill after consuming a product, always seek medical advice - particularly those who are pregnant, elderly or immunocompromised.
If you are having an allergic reaction, A&AA recommends following advice on your ASCIA Action Plan. If in doubt, use an EpiPen or Anapen to administer adrenaline. If you do not have an action plan, EpiPen or Anapen, call triple zero for an ambulance.
