Yes. These can be purchased over the counter for about $120 each. It is more cost effective to buy them using a prescription. All people who need an adrenaline auto injector device are now able to have a prescription for 2 devices at any time, to be subsidised by the PBS (Pharmaceutical Benefits Scheme, which is part of Medicare). If using a prescription, you would be able to buy 2 of the devices for the price of a normal prescription. ASCIA recommendations on the prescription of Anapen and Epipen adrenaline auto injector devices can be found at http://www.allergy.org.au/images/stories/anaphylaxis/
ascia_guidelines_for_adrenaline_autoinjector_prescription.pdf. There is also a good section on the ASCIA website, detailing the various resources available to aid in understanding and treating severe allergic reactions, which can be found at http://www.allergy.org.au/content/view/10/3/

Eczema is very common in babies. If it occurs before the age of 6 months, it is often associated with food allergy. If it starts after the age of 6 months it can be due to food allergy but is also likely to be due to food chemical intolerance. My usual advice is that if the child is breast fed, the mother should stop eating nuts and egg, and minimize the amount of milk and other dairy products she consumes. In many cases, soy products are a good substitute in the mother's diet. If the mother does not take soy, she needs calcium supplementation in her diet. Two Caltrate tablets a day should be sufficient. The mother should also decrease the amount of tomato and citrus she is taking, and cut back on dried fruit, stone fruit, melons and berries. These can all worsen eczema in a breast fed baby. The mother will need to eat something else to replace these foods, and increasing the amount of meat, and bland carbohydrates, such as rice and potato, would be one way to do this. It would be appropriate to consult a Dietitian if the mother wants to change her diet in this way. If the baby is bottle fed, consider changing from a milk-based formula to a soy-based formula. It is worth noting here that if a baby is less than 6 months old, and reacts to milk based formula, that baby will likely also react to soy, so changing formula should be done with the help of a Paediatrician. If the child is taking solids, the amount of tomato, citrus, dried fruit, stone fruit, melons and berries should be decreased. Other foods will need to be substituted, such as bland cereals and meat. Again, seeing a Dietitian would be wise. In all children with eczema, I recommend decreasing the child's contact with house dust mite, by decreasing the contact with carpet, and the use of good quality dust mite covers for bedding on all beds the child gets into. I recommend avoidance of soap, and frequent use of good quality skin moisturizer. Steroid creams and ointments are very safe and useful treatments for eczema. They have been used for many decades and do not cause any serious side effects when used appropriately. Cream should be used twice a day until the rash has completely settled. The amount of cream to use is 2cm of cream to cover the area of 2 adult palms. It is better to continue treatment until the rash is gone, rather than stopping early and having the rash come back over and over; less cream overall is used by treating adequately the first time rather than half treating many times. The use of a sedating antihistamine is often useful as this allows the child to sleep well and not scratch, and lets the skin heal and regain its normal barrier function. Sedating antihistamines should be used for short periods only, and if the child is less than 2 years old, medical advice should be sought before using these medications.

No. The size of the skin prick test is recorded so the doctor can have complete records of any testing undertaken. Many studies have looked at this issue, and all have shown that there is absolutely no link between the size of the skin reaction and the severity of the reaction a person would have if they eat that food. Roughly speaking, the bigger the skin prick test result, the bigger the reaction that would happen. It is not possible to compare the severity of an allergy between one food and another on the basis of the size of the skin prick test. Nuts are much stronger at provoking allergic reactions than other foods and comparing the size of a nut skin reaction to that of egg, for example, cannot show which allergy is worse.

Skin prick testing can safely be done at any age, but is more reliable when performed after age 6 months. Even at that time, there can be false negative results, meaning that there could be a real allergy, but the skin prick showed no reaction. Generally, all skin prick tests for foods should be reliable by age 12 months.

No. A positive skin prick test only means that the body has formed IgE antibodies against that substance. It does not necessarily mean that this will trigger an allergic reaction. Diagnosis of allergy means that the person should have had a reaction to exposure to that food or other substance, and has a positive skin prick test, or positive blood test (capRAST test) for that substance.

No. Skin prick testing is more accurate than blood testing. Both can be useful in the management of a person; I generally would use blood testing in a person who was not able to have skin prick testing (perhaps due to severe skin rash at the time I would want to do the skin testing in the office, or if the person lived a great distance from specialist medical care. I usually reserve blood testing for situations where I feel the person is likely to be outgrowing his allergy, and I am considering supervised oral challenging with that food. The results of blood testing do not correlate with the kind of reaction a person would have if they ate that food; researchers have analysed the results of large numbers of oral challenges compared to blood and skin prick test results, and have drawn up charts showing the likelihood of a reaction of some sort, compared to blood test results, but were totally unable to predict the severity of a reaction.

I generally do not perform oral challenges to confirm a diagnosis of allergy, as most children have already reacted to the food before coming for an appointment.

No. There is evidence that children who are breast-fed can become allergic to foods that the mother eats, as small amounts of many foods are found in breast milk. This does not mean that mothers should or should not breast feed their babies; rather, if they are to do so, and there is a family history of asthma, eczema or hay fever/sinus disease, the mother should consider modifying her diet to minimise nuts, shellfish eggs and chocolate in her own diet. Research performed at the Allergy Unit at Royal Prince Alfred Hospital in Sydney has shown an 80% decrease in the rate of allergy and asthma in children to age 5, when the mother adopts this approach.

Investigation and treatment of allergic disorders is best done with scientifically proven methods such as Skin Prick Testing and cap RAST testing, both of which detect the presence of IgE antibodies specific to certain foods or other allergens. Food intolerance can only be investigated and treated with dietary exclusions and challenges. A full explanation of this can be found at http://www.allergy.org.au/content/view/322/271/

There is no single answer for this. In any individual there are many factors, which contribute to the development of allergy, including a genetic predisposition (family history), and exposure to the substance in question. Many theories are being put forward including "the hygiene hypothesis", which says that people are not getting sick with infectious illnesses so frequently and therefore are immune systems attack food instead of germs. I think the western diet we eat has a part to play, as we are eating a wider variety of foods in comparison to only 2 or 3 decades ago, and we are eating more processed foods. Some researchers have looked at the issue of processed foods and have made a link between this and increased rates of allergy in remote populations in New Guinea villages.

Eczema is not in itself caused by food but can be made worse by it. If a child has eczema, there is a much higher chance than average that the child will have allergy to egg, and possibly to peanut, so I generally suggest the child with eczema should be investigated for these allergies. Children where the eczema is easily controlled with occasional use of topical steroid creams do not need this testing. Before testing is done, avoiding nuts in particular is wise. If there has been a reaction to a food then that food should be avoided until testing is done and discussion of the results is completed. I suggest that if a mother is breast-feeding, the mother avoids eating egg and nuts (especially no chocolate), and if this does not improve the situation, she should also decrease her consumption of citrus and tomato products. The child himself should eat a bland diet, without egg and nuts, and the parents need to talk to a properly qualified Allergist and Dietitian for further advice.

I suggest that if a medicine is not strictly necessary, it is better not to take it. If the child does need medication, for example pain relief or antibiotics, then the child can be given the appropriate dose using an adult capsule (broken open) or tablet (crushed up). If this is done then the parent can mix the medication with soft food and give it to the child. It is best not to mix it in the baby's milk/ formula or juice, as the complete dose may not be taken or the fluid in which it is placed may inactivate the medication. If the parents are keen then medications can often be made up into syrups without colour, flavour or preservative. A Compounding Pharmacist does this. You will need to talk to your local Pharmacy about where to access your closest Compounding Pharmacy.

Yes. The only reason for the GP not to vaccinate an egg allergic child is if there has been a severe allergic reaction (anaphylaxis) to egg, requiring the use of Adrenaline. The use of the MMR vaccine and Influenza vaccines has been shown to be very safe for egg allergic children. If the GP in unsure about vaccination, there are Adverse Events Vaccination Clinics at the major Children's Hospitals and the GP should consult these units for advice.

It is possible to eat out at restaurants, providing you carefully explain to the staff about the allergy and choose carefully from the menu. I usually advise that you go to a restaurant with which you are familiar and where you feel you can communicate well with the staff. If in doubt, leave the restaurant without ordering. I also suggest that when the food arrives at the table, the allergic person touches the food to the outside of the lips and then waits for a few minutes (you may need to have a distraction for the hungry child, such as colouring in or something else to eat); if there is no tingling or swelling of the lips in a couple of minutes after touching the food to the lips, then it is likely to be safe to eat that food.

A person cannot be allergic to something they have never been exposed to. This means that a person will not be allergic to foods they have never eaten (but in the case of babies, they are exposed to foods through breast milk, and before birth, across the placenta). There is evidence that children who are breast-fed can become allergic to foods that the mother eats, as small amounts of many foods are found in breast milk. This does not mean that mothers should or should not breast feed their babies; rather, if they are to do so, and there is a family history of asthma, eczema or hay fever/sinus disease, the mother should consider modifying her diet to minimise nuts, shellfish, eggs and chocolate in her own diet. Research performed at the Allergy Unit at Royal Prince Alfred Hospital in Sydney has shown an 80% decrease in the rate of allergy and asthma in children to age 5, when the mother adopts this approach.

If an allergic child refuses to eat something, he or she should never be forced to eat that food. One of the first symptoms of an allergic reaction is a tingling or itchy feeling in the mouth, which is so unpleasant the child usually spits the food out and starts to rub at the mouth. Making a child eat something they are unhappy to eat may be forcing them to have a bigger allergic reaction. I recommend that if a child refuses to eat something, the child should be watched carefully for the next hour or so as they could go on to have an allergic reaction. The caregiver should make the medications on the Allergy Action Plan available to use if the child does go on to have a reaction.

This question does not necessarily have a clear answer, which would apply to everyone. The foods most likely to cause a severe allergic reaction are nuts. Largely speaking, children with asthma are at slightly higher risk of having a severe allergic reaction, requiring the use of an Epipen, in comparison to children without asthma. Other factors to take into consideration are whether the child has had a previous severe allergic reaction, if the child is allergic to many foods as well as nuts, and if the nut allergic child is also allergic to dust mite. There is a blood test that has recently become available in Australia, which allows a prediction of the likelihood of having a severe allergic reaction to peanut (not other foods or other nuts). It has been used in research in other countries and more work will need to be done in Australia to see how accurately the test can predict such severe reactions.

It is very common for babies to be unsettled. There are many different reasons that a baby could be irritable. Some babies have reflux, meaning they have heartburn type discomfort, and some babies have difficulties settling into routine, or are over stimulated. I suspect food may be an issue if the baby has a rash on the face or on the bottom after eating certain "acidy" foods (either the breast feeding mother or baby eating these). These foods include tomato, citrus, berries, stone fruit, melons and dried fruit. Other hints are if the baby has difficulty sleeping, has vomiting, or has diarrhoea or constipation. If there is a combination of these symptoms, then I suggest the mother cuts back on the amount of these foods she eats, or that she feeds to the non breast-fed baby. These foods do not need to be completely avoided. Avoiding dairy and soy in the mother's diet can also be very helpful, particularly if the baby has blood staining in loose stools. If the mother changes her diet, it is important for her to consult a Dietitian experienced in the management of food intolerance, to ensure the best possible nutrition for both the mother and the breast fed baby.

Histamine is used as the positive control for the test. This means that you can only trust the results of the test if the Histamine result is positive. If it were negative, I would suspect the person may have taken antihistamine medications, and all the negative skin prick tests may be false negatives (meaning the whole skin prick test would be unreliable on that occasion). Histamine is used as a "pilot light" for the test. If the "pilot light does not work, the rest of the test will not work.

This is not an ideal situation but I suggest that the child who brings the peanut butter to school is taken to a safe area to eat by himself, and then the child has his hands and face washed before he is allowed to rejoin the rest of the children. I do not like the allergic children to have to sit by themselves to eat as the allergic child should not be made to feel different or excluded.

Not necessarily. The child who is predisposed to allergy will become allergic to the thing they are exposed to most, and won't become allergic to something to which they have never been exposed.

This is different in each person, but most children will have some kind of reaction within a few minutes of eating the food to which they are allergic. As soon as you see any sign of a severe allergic reaction (within a couple of minutes) it is important to give the Adrenaline. The longer you wait, the less effective the Adrenaline, and the child will feel sicker for longer. I like =n it to trying to stop a train before it gathers too much speed; if you wait for too long the train is too fast and is harder to stop.

The tendency to develop allergy is genetic in some cases, and can be inherited in families where there is a history of hay fever, "sinus", asthma, eczema or food allergy.

Most children with food allergies travel very safely on airplanes. I advise that families travel early in the morning, as planes are cleaned overnight and therefore the planes are likely to be cleaner for early morning flights. I suggest discussing the child's allergy with the airline company, to see what the staff will be able to do to accommodate the child's needs. It may be necessary to take sufficient food and drink for the air travel period, to ensure the child only has safe food and drink. I suggest that children are not allowed to walk around the plane alone as they could pick up food or rubbish from the floor of the plane, or could be offered food by other passengers. I also suggest that the child is given a dose of antihistamine for each of the 3 days leading up to and including the day of any plane trip, to make sure that any reaction which may occur, is less severe. Parents should make sure they take all of the medications they might need to treat an allergic reaction, in the hand luggage so it can be easily accessed during any travel on a plane. You will also need to take all appropriate covering letters from your doctor, to make sure you can take the medications through customs and security onto the plane.

No. Using a wet cloth, or a baby nappy wipe, is sufficient to clean surfaces before they surfaces are touched by the allergic child.

Oral food challenges are done with medical supervision. The aim is to see if a person has a reaction to eating a particular food. In my practice, I use food challenges to establish that a person no longer reacts to a particular food ("has outgrown the allergy"). If there is some doubt about the diagnosis of food allergy in the first place, it is sometimes appropriate to do a food challenge, but only under medical supervision. In most cases it is obvious whether a child has true allergy or not, from the history supplied by the parents. Blood testing can be helpful in deciding whether a food challenge will be appropriate in showing the absence of allergy.

Behaviour problems are occasionally caused by food intolerance. In the majority of people, changing the diet will not be effective. If you want to change the diet, many people start by avoiding all additives (colours, flavours, and preservatives) in foods the child eats. If you want to make other changes to the diet, it is best that you consult a Dietitian experienced in the use of an elimination diet as these can be very restrictive and can lead to poor nutrition. These restrictive diets should not be continued long term, and should always be followed by food challenges to see what exactly affects the child in which way, and will allow a fuller (more complete or nutritious) diet in most children.

You should make sure you have removed the grey safety cap from the end of the Epipen, and make sure the black end of the Epipen is applied firmly to the child's upper outer thigh, and then pressed firmly into the thigh until a loud click is heard. The Epipen should then be held in place for 10 seconds to allow all of the adrenaline to be injected into the child. For the Anapen, make sure you have removed the grey safety cap and the black plug from the needle end of the device (it will be clearly marked "needle end"). Place the needle end against the child's upper outer thigh and press the red button (you will hear a click) then hold it in place for 10 seconds to allow all of the Adrenaline to be injected. Make sure you call an ambulance to take the child to hospital immediately after using the Epipen or Anapen.

A child can be given paracetamol (the same active ingredient as Panadol syrup) by dissolving a white Paracetamol tablet in water, then giving the appropriate dose to the child, by mouth. If you crush a single 500mg paracetamol tablet and mix it in 10ml of cooled boiled water, you can give a dose of 2ml per 10kg body weight, every 4 hours as needed. On average, this means that a 12 month old person would have 2ml every 4 hours. A 2 year old weighing 15kg would have a dose of 3ml every 4 hours as needed. A 4 year old, weighing 20kg, would have 4ml every 4 hours as needed. The appropriate dose for your child can be calculated according to weight. You can also get a Compounding Pharmacist to make up unflavoured colour free Paracetamol suspension.

The special formulas made without milk or soy taste very different from normal baby formula. They look "thinner" than normal formula and smell very different. It can take several weeks for some children to take the formulas so the parents need to be very persistent in giving them to the baby. It is best if they are given cool (too warm makes the taste stronger) and best if they are mixed with 2 teaspoons of heaped icing sugar in each bottle. This will not be needed forever. As soon as the child accepts the formula, the parent should slowly start to wean the child off the sugar. I liken it to a teenager starting to drink coffee. As coffee is bitter, the teenager will probably want sugar in the coffee for a while but as his taste "matures" the sugar can gradually be removed. It can be useful to mix small amounts of the new formula into the child's usual formula and gradually change the balance, increasing the new formula and decreasing the old formula over a few weeks. This will not be appropriate if the child is actually allergic to the old formula (hives or swelling when exposed to the old formula).

Desensitisation is given in two different ways. There is a chance of side effects with both methods of giving the therapy. Injectable immunotherapy carries a higher rate of reactions in comparison to the sublingual ("under the tongue") method. The most common reaction to the injections is an itchy lump at the site of the injection. There are some people who have more severe reactions, including a feeling of faintness and some shortness of breath or wheeze. For people who take their treatment by the sublingual method, the most common reaction is some itch under the tongue and perhaps some nausea. It is very unlikely that a person would have a severe allergic reaction to taking their immunotherapy under the tongue. In both methods of immunotherapy, I recommend taking a dose of antihistamine about 30 minutes before the treatment; I also ask that the patient does not exercise for 2 hours after each injection, and I get them to stay under my observation for at least 30 minutes after each injection.

If there is peanut butter brought to school, there is a small chance that small amounts of peanut butter will be spread around the school on surfaces. If the allergic child touches some peanut butter, it is likely the reaction would be a skin rash. More severe reactions usually only happen in certain children, if the peanut butter is actually eaten. Smelling peanut butter is not likely to cause a reaction.

Eczema is a skin condition, which causes itch, and rash, and is often associated with allergy to dust mite or to foods. In small babies, it often affects the face and the neck. As children get older, the skin in the fold of the elbows and knees is likely to also be affected.

Children who are allergic to one nut are not necessarily allergic to other nuts. In general I recommend that young children less than 3 years old avoid eating all nuts, even if they allergic to only one nut, as there is a chance of developing allergy to other nuts. There is also a cross reactivity between many nuts, meaning that the body sees the nut proteins as looking similar to each other and in some cases people react to foods they were not known to have been allergic to. It is also not good enough to pick the "bad nuts" out of mixed nuts, or to pick them off cake or other foods. There are still some traces of that "bad nut" left on the food even if the "bad nut" has been removed.

Adrenaline always helps to control a severe allergic reaction. In some cases more than one dose is needed. The main thing to remember is that there is less chance of the Adrenaline working well enough if there is delay in giving it. If there is even one symptom of a severe allergic reaction (you need to look at your written Allergy Action Plan) you should give the Adrenaline without delay. IF IN DOUBT, USE THE EPIPEN OR ANAPEN. THERE IS MORE HARM IN NOT GIVING IT THAN IN GIVING THE ADRENALINE EVEN IF IT IS NOT NEEDED.

Some people are prone to developing allergy. He reason for this is pt fully understood, but it is likely to be due to several different factors in any one person. There is a genetic component in many people (a family history of asthma, eczema, hay fever, "sinus" or food allergy) and if these people are exposed to certain foods or other substances, the body recognizes these substances as "foreign invaders" and sets up a reaction against them, to "fight them off". These reactions then start to damage the body itself. It is not possible to be allergic to something the body has never been exposed to.

Antihistamines are medications, which stop the effect of histamine in the body. Histamine is a "poison" which certain blood cells make. It is released when these blood cells are provoked by exposure to something to which the person is allergic. Antihistamines help to control symptoms of allergic reactions. Some have better effects on itch (mostly the sedating antihistamines) and some are non sedating and better for people who need to continue to work or go to school despite having the medication.

There is a use by date on the side of each of these devices. Make sure you know when the device expires and get a new prescription before that date. Each of the companies that provide these devices has a "loyalty club" for you to join ("Epiclub" or "Analert") which will register your auto injector for you and will send you a reminder letter when the expiry date is getting close.

ASCIA recommends that a child should change to having an adult size Epipen or Anapen, when their body weight is 20kg or more, as the Junior Epipen dose would be too small for those weighing more than 20kg. Persons weighing more than 50kg will need to use the Anapen 500mcg unit.

An Epipen and an Anapen are the two different brands of Adrenaline auto injector devices, currently available in Australia. They both deliver a preset single dose of Adrenaline; they are used for the treatment of severe allergic reactions, prior to the patient being taken to hospital. Each auto injector unit can only be used once and then needs to be discarded. In some cases a person needs to be treated with more than one dose of Epipen or Anapen.

An Epipen and an Anapen are the two different brands of Adrenaline auto injector devices, currently available in Australia. They both deliver a preset single dose of Adrenaline; they are used for the treatment of severe allergic reactions, prior to the patient being taken to hospital. Each auto injector unit can only be used once and then needs to be discarded. In some cases a person needs to be treated with more than one dose of Epipen or Anapen.

Asthma is a common respiratory illness, involving inflammation and tightening of the small lung passages. Often people with asthma have cough and wheeze with exercise or with colds and flu like illnesses, but children can have asthma without wheeze. I become suspicious that a person may have asthma if they have cough in the middle of the night for a few weeks at a time, or if they cough with exercise, particularly in the late afternoon if it is cold. Some children will limit the amount of exercise they do so they do not have symptoms, so looking at their ability to keep up with the other children at school when they exercise can often give a hint the child may have asthma.

This question is difficult to answer as every child and every family is different. It very much depends on the history of the person in question; if they have required more than one Epipen /Anapen to be used to treat any one allergic reaction, then the child should have at least that many Epipens/Anapens available to treat future reactions. There has been a suggestion that children with difficult to treat asthma should carry more than one Epipen/Anapen, as there is a risk of around 20% that the child will need to have treatment with 2 or more adrenaline injections in any one allergic reaction. Nonetheless, the Federal Government Pharmaceutical Benefits Scheme allows for the subsidised purchase of only 2 adrenaline auto injectors to be held by a family at any one time for any one child (one for home and one for school). If the parent wants to purchase more then the family will need to buy the extra auto injector devices privately form the Pharmacy, at full cost.

There is a chance the person will need more than one injection of Adrenaline, or other treatments for any particular severe allergic reaction. For that reason a person should be observed carefully in hospital for at least 4 hours after any reaction to ensure they are not becoming sick again, or needing any extra treatment. Staying in the waiting room of the doctor's office does not give the proper amount of direct observation, and does not allow for the person to lie down and rest. More equipment and staff are available at a hospital to treat a person with a severe allergic reaction, than at the average GP's office. I recommend that if a person goes to a GP to have treatment of a severe allergic reaction, the GP should call an ambulance to transport the patient to hospital as soon as practical after the appropriate emergency treatment has been administered.

A person with asthma has a 20% chance of needing a second dose of Adrenaline to treat any sever allergic reaction. I recommend that these children stay in hospital for a full 12 hours observation to ensure there is no need to treat them again with Adrenaline, for a rebound or "late phase" reaction.