- Louise McQuater, 41, from Cluckmannanshire, has chocolate allergy
- Eating cocoa sweet treat can trigger asthma and even attacks
19:07 EST, 31 March 2014
|
19:07 EST, 31 March 2014
Louise McQuater from Tullibody, Clackmannanshire, has chocolate allergy which triggers asthma
When
you tuck into those chocolate eggs this Easter, spare a thought for
Louise McQuater. For even one tiny bite of chocolate could trigger her
asthma and lead to a potentially life-threatening attack.
Most people
think asthma is brought on by dust or pet fur, but there are many
triggers for the characteristic coughing, wheezing, tightness in the
chest and shortness of breath.
However, many of the 5.4 million
Britons with asthma – and even some GPs – aren’t aware of these, and
failing to identify and then avoid their more unusual triggers could put
them at risk.
Indeed, Louise, 41, never thought chocolate was making
her asthma worse until December 2012, when her asthma consultant
suggested she looked at her diet after a number of attacks.
‘I ate
chocolate every day so thought it might be a trigger and started cutting
down,’ says Louise, a school learning assistant who lives with her
three children in Tullibody, Clackmannanshire.
‘My asthma seemed to
improve, although I still didn’t really believe chocolate was a trigger
because I’d never heard of that before.’
But a terrifying experience a few months later made her realise it was.
She’d
given in to temptation and bought her favourite chocolate bar, a
Galaxy. After the first bite, she started coughing but finished it all
because her craving was so bad.
Her coughing worsened and she was
struggling to breathe – even a reliever inhaler, which relaxes the
lung’s airways that can become inflamed in an asthma patient, didn’t
help. She went to an out-of-hours emergency doctor, who put her on a
nebuliser, which gives high doses of reliever medicine through a mask or
mouthpiece, easing her symptoms.
‘I was astounded chocolate caused
that reaction,’ she says. ‘Looking back, it’s possible it played a part
in other attacks I’d had.’
Since then, Louise, whose severe asthma is also triggered by dust mites, hay fever and mould, has avoided chocolate.
Patients
who don’t know all their triggers can risk asthma symptoms or attacks,
says Deborah Waddell, clinical lead nurse at Asthma UK.
‘Everyone’s
triggers are different and can be difficult to identify. It can take
people years to understand their asthma. Sometimes this can be because
their triggers are more unusual, such as chocolate, wine or fizzy
drinks,’ she explains.
‘Potential triggers are all around us. Health
professionals need to be open-minded when patients report what they
think makes their asthma worse.’
People whose asthma is triggered by chocolate may not be having a true allergic response
Patients’ airways become inflamed
in response to irritant triggers such as exercise, stress or cold
weather, or allergic triggers such as pollen or dust mites.
Irritants
make vulnerable airways inflamed and narrow. This leads to contractions
of the muscle of the bronchi (the main airway of the lungs), causing
breathlessness and other symptoms. With allergic ones, the immune system
goes into overdrive and sees the harmless substance, which can be
inhaled or ingested, as dangerous.
An antibody, immunoglobulin E
(IgE), looks for the allergen and signals to the immune system to
produce powerful chemicals including histamine, which cause inflammation
and swelling in airways.
Goblet cells, which produce mucus, are also
set off. This results in thick, sticky mucus in the airways – one of
the biggest problems during an attack is making huge amounts of mucus
you can’t clear, explains Ms Waddell.
Allergic asthma is often seen
in people with a family history of atopy (predisposition to produce high
amounts of IgE), including hay fever, eczema and food allergy, she
adds.
53 per cent
The proportion of people with asthma who’ve had an attack in the past year
Triggers can be identified through skin-prick tests, where a
tiny amount of the suspected allergen is injected into the skin. A red,
itchy bump larger than 3mm appearing after ten minutes confirms allergic
sensitisation to that substance, says Dr Ramesh Kurukulaaratchy, a
consultant respiratory physician at Southampton General Hospital.
Blood
tests are also used, when blood is mixed with allergens and checked for
IgE. But these only look for specific allergens and can give misleading
results.
For suspected food allergy triggers, patients can take
challenge tests, ingesting small amounts of the substance under medical
observation. ‘But access to allergy services is extremely limited across
the UK,’ says Dr Kurukulaaratchy. Some people find they have more
triggers over time, while others may show a lessening of triggers.
However,
Dr Kurukulaaratchy believes people whose asthma is triggered by certain
foods such as chocolate are not having a true allergic response
involving the immune system, but have been irritated by chemicals they
contain known to aggravate some people’s asthma.
‘Chocolate is rich in organic compounds called amines that can provoke allergic-type reactions in some people,’ he explains.
There
are natural and artificial chemicals in other foods and drinks that
could be triggers – for example, alcohol has naturally-occurring amines
and salicylates, and preservatives like sulphate, which are not commonly
regarded as triggers, but can lead to symptoms.
There are natural and artificial chemicals in other foods and drinks that could be triggers
Mother-of-one
Christina Nicol discovered at 18 that vodka was a trigger for her, and
needed her reliever when it left her unable to breathe. ‘Other types of
alcohol don’t trigger my asthma but when I’ve tried vodka since, the
same thing happened, so I avoid it,’ says the hotel receptionist, now
38, from East Kilbride, South Lanarkshire.
Dr Kurukulaaratchy says
salicylates (the active ingredient in aspirin) can be found in herbs,
spices and mint – so even toothpastes and mouthwashes may lead to
symptoms.
Samantha Rawlings, 30, had an attack after using her
mother’s toothpaste instead of her own.
‘Within an hour of using it I
was in hospital,’ says the pub manager from Bristol. ‘The consultant
said it was likely to be a chemical in the toothpaste.’
Unfortunately,
there aren’t validated tests for substances that provoke chemical
sensitivities, so recognising patterns is vital, says Dr
Kurukulaaratchy.
Being aware of triggers can also help because there
are additional treatments for allergic asthma. One treatment, approved
for UK use last year, is Xolair, an injection which tackles IgE. ‘New
treatments are being developed, so patients should receive more tailored
treatment,’ says Dr Kurukulaaratchy.
Drugs known as leukotriene
antagonists, such as Singulair tablets, which block a chemical reaction
that can cause inflammation in airways, can also be effective for
allergic asthma, adds Dr Nazim Nathani, a consultant respiratory
physician at BMI The Priory and City Hospital in Birmingham.
‘As
well as trying to avoid triggers, it’s crucial to take your preventer
inhaler (containing steroids) daily to build up protection – this should
reduce the effect of triggers,’ says Deborah Waddell.
People with
asthma should think carefully about what may be triggering symptoms,
adds Louise.
‘They may need to think outside the box.’
asthma.org.uk
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