Allergies in Australia

 

Last reviewed April 2011

Allergic disease in Australia

Allergies have emerged as a major public health problem in developed countries during the twentieth century. Australia and New Zealand have among the highest prevalence of allergic disorders in the developed world.  An  ASCIA-Access Economics Report estimated that in 2007:

  1. •4.1 million Australians (19.6% of the population) had at least one allergic disease;

  2. •The highest prevalence of allergies is in the working age population, with 78% of people with allergies aged 15 to 64 years;

  3. •There are 7.2 million cases of allergy (i.e. an average of 1.74 simultaneous allergies per person).

  4. •The Australian population is ageing.  If current trends continue, there will be a 70% increase in the number of Australians with allergy, from 4.1 million in 2007 to 7.68 million by 2050 (26.1% of the population or more than one in four Australians) compared to 5.62 million (19.1%) by mid-century due to demographic ageing alone and compared to one in five Australians today.

  5. •In Australia there is a lack of appreciation of the impact of allergic disorders on quality of life, and even less of the economic impact to society and individuals who suffer allergic disease.  Raising awareness of the economic and health impacts is an important factor in facilitating the early recognition and control of allergic disease.


Allergy Fast Facts (Australia and New Zealand)


Allergic rhinitis (hay fever) currently affects

•1/10 children aged 6-7 years

•1/6 children aged 13-14 years

•2/5 adults


Asthma currently affects

•1/5 children

•1/10 adults


Eczema currently affects

•1/6 children aged 6-7 years

•1/10 children aged 13-14 years

•1/14 adults


Stinging insect allergy 

•Australian population surveys have shown that up to 2.8% have had episodes after a bee sting consistent with systemic allergic reactions (not just local swelling)

  1. •Wasp sting allergy is currently less common, but

  2. •In Tasmania, 1% of the population has experienced a severe systemic reaction to a sting from the “jack jumper ant” (JJA, Myrmecia pilosula).

  3. •Bee sting anaphylaxis is estimated to result in approximately 2 deaths/year in Australia, with wasp stings causing an estimated 1 death/year.

  4. •In southern Tasmania, where suspicious deaths have been carefully investigated, four deaths from JJA sting anaphylaxis were identified over a 10-year period. One other study and anecdotal evidence suggests a similar situation in parts of rural Victoria and South Australia.


Food Allergy   

  1. •A questionnaire-based study of 4173 South Australian school children aged 3-18 years published in 2000 showed that 55 (1.3%) and 18 (0.4%) were assessed as having food allergy and food induced anaphylaxis, respectively.

  2. •In adults aged 20-45 years, approximately 1.3% were estimated to suffered from food allergy, most commonly to peanut, followed by shrimp (prawn), cow's milk and egg.

  3. •A Canberra based study published in 2009 estimated that the minimum proportion of children with food allergy by age 6 years to be 2.5% of children, and than 1.15% would develop peanut allergy by the same age, both considered to be very conservative estimates.

  4. •In the most accurate estimate of food allergy in Australia performed thus far and published early 2011, the HealthNuts study based in Melbourne, Victoria, demonstrated food challenge proven incidence of food allergy at age 12 months to be much higher than previously suspected;  food allergy overall (10%); peanut allergy (3%); raw egg (8.8%) and sesame seed (0.8%). Of those with egg allergy, 80% could eat egg baked into cake. Cows milk allergy was estimated at 2.7%, but this was based on history rather than challenge proven.


Anaphylaxis

  1. •The major causes of anaphylaxis are food (most commonly dairy products, hens egg, peanut and tree nuts in children, and seafood and peanut/tree nuts in adults), insect stings and medication.

  2. •The minimum estimated rate of new cases of anaphylaxis in Australia has been estimated at one new case per 5000 people per year.

  3. •Of those who experience an episode of anaphylaxis, recurrent allergic reactions occur on average once every 2 years, further serious allergic reactions once every 10 years.

  4. •Of those who experience an episode of anaphylaxis, 1/10 will develop more serious symptoms after initial milder presentations, 1/100 will develop new allergic triggers with follow-up and approximately 1/100 may develop transient psychiatric morbidity after an episode.

  5. •Hospital admissions for anaphylaxis in Australia in 2005 were 80.3 admissions per million people per year. These rates are approximately double that reported in the UK, have doubled between 1993-2005, and increased 5-fold over the same period in children aged 0-4 years.


Deaths from anaphylaxis

Deaths from anaphylaxis are relatively rare in Australia. In an examination of coroner’s reports of deaths attributed to anaphylaxis occurring 1995-2007, 112 deaths were recorded over a 9 year period. Causes were food, 7 (6%); drugs, 22 (20%); probable drugs, 42 (38%); insect stings, 20 (18%); undetermined, 15 (13%); and other, 6 (5%). All food-induced anaphylaxis fatalities occurred between 8 and 35 years of age, despite the majority of food-induced anaphylaxis admissions occurring in children less than 5 years of age


Drug allergy

•Approximately 1/10 people with asthma are allergic to aspirin, compared to the general population where around 1/100 are estimated to be allergic.

•Measles Mumps and Rubella vaccine allergy in children is very rare: 1.06 per 100,000 doses Allergic reactions to general anaesthetics is uncommon, occurring between 1/10,000 – 1/20,000 anaesthetics

•Allergic reactions to x-ray contrast injections rarely results in death: 8 deaths/13 million doses

•In general practice surveys, an estimated 1/10 general practice patients had experienced an adverse drug reaction in the previous 6 months, of which 1/10 was judged by their doctor to be allergic in origin.


References

•Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP,Weiland SK, Williams H;ISAAC Phase Three Study Group.Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional  surveys. Lancet. 2006; 368: 733-43.

•Marks R. The public health approach to the burden of common skin diseases in the community. J Dermatol. 2001; 28: 602-5.

•Kilkenny M, Stathakis V, Jolley D, Marks R.  Maryborough skin health survey: prevalence and sources of advice for skin conditions. Australas J Dermatol. 1998; 39: 233-7.

•Plunkett A, Merlin K, Gill D, Zuo Y, Jolley D, Marks R. The frequency of common nonmalignant skin conditions in adults in central Victoria, Australia. Int J Dermatol. 1999; 38: 901-8.

•Douglas R, Weiner J, Abrahamson M, O'Hehir R. Prevalence of severe ant venom allergy in southeastern Australia. J Allergy Clin Immunol. 1998; 101: 129-31.

•Brown SGA, Franks RW, Baldo BA, Heddle RJ. Prevalence, severity, and natural history of jack jumper ant venom allergy in Tasmania. J Allergy Clin Immunol. 2003; 111: 187-92.

•Brown SGA, Wu QX, Kelsall GR, Heddle RJ, Baldo BA. Fatal anaphylaxis following jack jumper ant sting in southern Tasmania. Med J Aust. 2001; 175: 644-7.

•Stuckey M, Cobain T, Sears M, et al. Bee venom hypersensitivity in Busselton [letter]. Lancet 1982; 2: 41

•Roberts-Thomson PJ, Harvey P, Sperber S, Kupa A, Heddle RJ. Bee sting anaphylaxis in an urban population of South Australia. Asian Pac J Allergy Immunol 1985;3(2):161-4.

•Harvey P, Sperber S, Kette F, et al. Bee-sting mortality in Australia. Med J Aust 1984; 140: 209-211.

•McGain F, Harrison J, Winkel KD. Wasp sting mortality in Australia. Med J Aust. 2000; 173: 198-200.

•Boros CA, Kay D, Gold MS. Parent reported allergy and anaphylaxis in 4173 South Australian children. J Paediatr Child Health 2000; 36: 36-40.

•Woods RK, Stoney RM, Raven J, Walters EH, Abramson M, Thien FC. Reported adverse food reactions overestimate true food allergy in the community. Eur J Clin Nutr 2002;56(1):31-6.

•Mullins RJ. Anaphylaxis: risk factors for recurrence. Clin Exp Allergy 2003; 33: 1033-40

•Mullins RJ. Time trends for food allergy 1995-2006 in the ACT: increased incidence or increased anxiety? Internal Medicine J 2006; 36 (Suppl. 6): A208, P29.

•Gupta R, Sheikh A, Strachan DP, Anderson HR. Time trends in allergic disorders in the UK. Thorax 2007 ; 62: 91-6.

•Vally H, Taylor ML, Thompson PJ. The prevalence of aspirin intolerant asthma (AIA) in Australian asthmatic patients. Thorax 2002;57(7):569-74.

•Cashman JD, McCredie J, Henry DA. Intravenous contrast media: use and associated mortality. Med J Aust 1991;155(9):618-23.

•D'Souza RM, Campbell-Lloyd S, Isaacs D, Gold M, Burgess M, Turnbull F, et al. Adverse events following immunisation associated with the 1998 Australian Measles Control Campaign. Commun Dis Intell 2000;24(2):27-33.

•Fisher MM, Baldo BA. The incidence and clinical features of anaphylactic reactions during anesthesia in Australia. Ann Fr Anesth Reanim 1993;12(2):97-104.

•Miller GC, Britth HC, Valenti L. Adverse drug events in general practice patients in Australia. Med J Aust 2006 3; 184: 321-4.

•Liew WK, Williamson E, Tang ML. Anaphylaxis fatalities and admissions in Australia. J Allergy Clin Immunol. 2009 Feb;123(2):434-42.

•Mullins RJ. Paediatric food allergy trends in a community-based specialist allergy practice, 1995-2006. Med J Aust 2007; 186: 618-621. http://www.mja.com.au/public/issues/186_12_180607/mul11320_fm.html

•Mullins RJ, Dear K, Tang ML. Characteristics of childhood peanut allergy in the Australian Capital Territory 1995-2007. J Allergy Clin Immunol 2009; 123: 689-93.

*Osborne NJ, Koplin JJ, Martin PE, Gurrin LC, Lowe AJ, Matheson MC, Ponsonby AL, Wake M, Tang ML, Dharmage SC, Allen KJ; HealthNuts Investigators. Prevalence  of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol. 2011 Mar;127(3):668-76.e1-2.

*Osborne NJ, Koplin JJ, Martin PE, Gurrin LC, Thiele L, Tang ML, Ponsonby AL, Dharmage SC, Allen KJ; HealthNuts Study Investigators. The HealthNuts population-based study of paediatric food allergy: validity, safety and acceptability. Clin Exp Allergy. 2010 Oct;40(10):1516-22.