CEO of Allergy New Zealand
Mark Dixon is the CEO of Allergy New Zealand.
Allergic diseases have become increasingly common and more complex over the last two decades, and Allergy New Zealand estimates up to a third of the New Zealand population is now affected.
Regarded as an important public health issue in Australia and other developed countries, allergic diseases contribute to increased demand for medical services, significant economic cost of care, and reduced quality of life for people with allergies, and their carers.
It’s unclear what causes allergies but there are limited options for treatment and no cure. Managing an allergy effectively involves avoiding the things you react to, which is not straightforward as they (the allergens) are often widespread in our environment. Avoidance can involve major changes in lifestyle, and therefore much of the burden falls on patients themselves, not on the health system.
Those at risk of anaphylaxis, a potentially life-threatening allergic reaction, are particularly affected.
When a person experiences anaphylaxis, a large amount of histamine and other chemical mediators are released into the body, causing an inflammatory response.
This can lead to a sudden drop in blood pressure and blocked airways, making it difficult to breath. The symptoms can go from bad to worse very quickly, and if anaphylaxis isn’t recognised and treated immediately, it can result in serious complications and can be fatal.
Intramuscular adrenaline (epinephrine) continues to be the first-line treatment for anaphylaxis, and is funded through healthcare systems in many countries including Australia, the United Kingdom, Canada and Europe. However, international surveys find its use remains suboptimal in some countries, with the lack of affordability of adrenaline auto-injectors for patients being a major issue – as is the case in New Zealand.
Food allergy is one of the major contributors to hospital admissions for anaphylaxis.
One in ten New Zealand children under the age of two are likely to have a food allergy and, while some will outgrow them, around 5% have food allergies that persist into adulthood. The main foods which cause food allergies are common in the everyday diet of New Zealanders – and therefore are very difficult to avoid.
Generally, those with food allergies have a choice of how to manage their condition – avoid any interaction that involves food (which is most interactions), or carry an adrenaline auto-injector in much the same way we all click on our seatbelts in the car. However, in spite of 24 years of advocacy on this issue, Pharmac has consistently turned down applications for funding this. It seems that quality of life does not count. It ignores those with depression and anxiety, and the lost income through carers not able to enrol children in early childhood services and/or through inability to work safely in many places.
Significantly, it also ignores its commitment to improving health outcomes and reduce inequalities experienced by Māori and Pacific peoples, and to achieving health equity for Maori.
Data shows the highest rates of food allergies and of hospital admissions for food-triggered anaphylaxis in New Zealand are in Asian and Pacific people.
Maori and Pacific people are significantly disadvantaged by allergic diseases and associated risk of anaphylaxis. They are more likely to have asthma – which increases their risk of anaphylaxis to a food, or bee or wasp sting, and are more likely to have difficulty accessing health care and safe food.
Allergy New Zealand remains committed to working with Pharmac to overcome their assessment challenges that have blocked funding for this emergency medicine, despite PTAC approval more than 15 years ago.