Internationally recognised allergist Professor Katie Allen shares insight into her life and research discoveries in the November edition of the Medical Observer, as published below.
1. I've been reading (or Top must-reads)
A Little Life by Hanya Yanagihara. It is a powerful story of human grit and friendship and really lays open the complex issues faced by adults who have suffered childhood abuse. It is beautifully written and the nuance of emotions as the protogonists struggle to make sense of events is very moving
The Knowledge Wars - Peter Doherty. Peter, an Australian who won a Nobel Prize in Medicine for his discovery of how T cells recognise their target antigen through MHC class restriction, writes a fascinating but easy to digest book for the non-researcher on the many issues that scientists grapple with when trying to deal with data. Peter passionately argues that we all need to roll up our sleeves and become informed about scientific debate. His argument that citizens can take meaningful action if they are better informed is really a call to arms that as medics and researchers we need to communicate evidence more simply so that others can use it appropriately.
2. I've been researching
Why food allergy is on the rise for the past 10 years. After overcoming initial scepticism about whether the phenomenon was real we are now testing in trials a number of different theories for why we think it is on the rise. We have labelled the factors that we think might contribute the 5 “Ds” – diet and dry skin (which relates to increased risk from infantile eczema and delayed introduction of solids), Vitamin D deficiency (indoor lifestyles, slip slop slap and lack of food chain fortification with Vitamin D may have altered the immune system early in life), and protective dogs and dribble (the hygiene hypothesis – which argues that we aren’t stimulating our immune system early in life with the right microbial triggers).
3. My team
I work with an incredibly dynamic group of clinicians and researchers including Allergists, Gastroenterologists, Epidemiologists, Epigeneticists, Geneticists, Dieticians and health economists. We collaborate extensively – both nationally and internationally- and now also work closely with government and policy makers. It is incredible to work at the intersection of such a diverse set of disciplines and it is very humbling to work with such a variety of talent and skill on what I believe is a problem that can be solved in our lifetime – the eradication of food allergy.
4. An anecdote
When we first started recruiting for our Healthnuts study in 2007 (a study of 5300 infants recruited from the population over four years) the waiting lists to see an allergist were in excess of 12 months. We heard over and over again of how parents were so relieved to be given free allergy testing as part of our study since they had planned to drive to the Royal Children’s Hospital to give their baby their first bite of a peanut butter sandwich in the car park. Ten years on and we have trained many more specialists to deal with the epidemic so it is easier to get an appointment but parents remain frightened to try peanut. Our new guidelines recommend infants should be given peanut butter in the first year of life to reduce the risk of peanut allergy even if they have a family history of allergy. As experts we are concerned that those that need to heed the message won’t.
5. I've heard
There are now a number of services being set up where babies will be given a supervised feed of peanut butter to ensure that they start eating it when they should. In America the level of fear is driving quite restrictive recommendations. I worry that we are medicalising infant feeding.
6. An interesting case
One of my patients (a two year old boy) with non-IgE mediated cow’s milk allergy and multiple food protein intolerance of infancy developed antibiotic-resistant C Difficile diarrhoea after multiple courses of antibiotics. He was also found to have a Specific Antibody Deficiency which is why he had had so many infections.
Despite recurrent courses of vancomycin we were unable to eradicate his C Diff and he was miserable with 5-10 episodes of diarrhoea per day. We undertook a faecal microbial transplant (placed in the caecum by colonoscopy) with immediate success in resolution of his diarrhoea and his C Diff has not recurred. His mother could not believe that his first bowel action was a formed stool – something he had not had his whole life. Interestingly his food allergies appeared to settle after this – which might have been coincidence since he was of the age when these things resolve – but we wonder whether by altering his bowel flora we also impacted his oral tolerance to food.
7. I'm worried about
The politicisation of evidence and the rise of pseudoscience driven by social media and the poor curation of new evidence as it informs our medical knowledge base. With the democratisation of information on the internet people are drowning in data and reach for explanations and treatments that might sound authoritative but are actually snakeoil.
8. I've been thinking
There should be an independent Health Care Think Tank to provide national guidance and advice to improve health care. The UK National Institute for Health and Care Excellence (NICE) provides an excellent example of how curation of knowledge can have a powerful impact on both clinical practice and public health policy. The independence of such a body from both government and industry would be key.
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