Barramundi is reportedly Australia’s most popular fish for restaurant eating. People love it because it’s buttery and benign – that is, not too fishy. This week it was revealed that a father-to-be collapsed at a restaurant after eating barramundi, and died five days later in hospital.
Some reports suggested this was an “unknown” allergy. In fact, the man, Alexander Hall, told his wife that night, by way of dinner conversation, that a previous meal of barramundi some years before had caused his lips to tingle – an indication that he was allergic to the fish.
Some people might have read the “unknown allergy” line to mean that barramundi, also known as Asian sea bass, isn’t the kind of food that would cause anybody an anaphylactic shock … or even a case of hives.
In fact, at betterhealth.vic.gov, it’s at the top of a list of fish that can cause an allergic reaction – followed by cod, flake, salmon, snapper,
trout, tuna and whiting. Better Health advises that one in 100 people have some kind of seafood allergy.
According to the Australasian Society of Clinical Immunology and Allergy (ASCIA), food allergies occur in around 10 per cent of infants, 4-8 per cent of children, and about two per cent of adults in Australia and New Zealand. The most common triggers are egg, cow’s milk, peanut, tree nuts, sesame, soy, fish, shellfish, and wheat.
The ASCIA says that hospital admissions for severe allergic reactions (anaphylaxis) have doubled over the last decade in Australia, USA and UK. In Australia, admissions for anaphylaxis due to food allergy in children from birth to four years are even higher, having increased five-fold over the same period.
A great resource for food allergy information and support is Allergy & Anaphylaxis Australia.
The broader point we’re making here: you can be allergic to just about anything, including water (submersed in it, not drinking), sunlight and exercise (very rare, but can cause anaphylaxis).
‘First World problem’
Professor Jo Douglass is the James Stewart Professor of Medicine and the Director of Research at the Royal Melbourne Hospital, Melbourne Medical School. She is a physician with a clinical practice and was head of the Department of Immunology and Allergy at the Royal Melbourne Hospital from 2012 to 2020.
She said that the increase in food allergies and in people presenting at hospitals with severe allergic reactions is “probably a First World problem, because it’s not seen in the Third World or in low income nations – which probably says that it’s a lifestyle issue.”
“We don’t quite know the reasons that drive it, although all over allergic diseases have been increasing – both food allergies and respiratory allergies,” she said.
Gaining traction is the idea that an altered gut microbiome plays a pivotal role in the development of food allergies. A June 2019 study identified a species of bacteria in the human infant gut that protects against allergies – which suggests a pathway to suppressing allergies.
But this is just one piece of a complex puzzle.
Still holding sway is what’s known as the hygiene hypothesis. This once suggested that allergies were a product of precious parenting, kitchen disinfectants and limiting children’s exposure to germs.
In fact, the hypothesis suggests that food allergies are, in part, the consequence of the relatively successful containment of bacterial diseases that are still killing children overseas.
“Negative-gram infections seem to be protective of developing allergies,” said Professor Douglass. “Although one wouldn’t wish to necessarily have them all… hepatitis A and tuberculosis have been been shown to be protective.”
Less malign infections are also protective. “Children who go into day care and get a lot infections are somewhat protected compared to children kept at home,” she said.
Another protective factor, said Professor Douglass, is early exposure to foods.
Where peanuts in are one the main causes of allergy in Australia, “if you look at Israeli children, they don’t have the same level of peanut allergy because they get fed boiled peanut rusks from six months of age,” she said.
The recommendation now is to introduce nuts early in a child’s life. It won’t safeguard every child, “but it’s proving to be protective for a large number of people.”
So what about fish? According to the ASCIA, fish allergies are more common in teenagers and adults than young children.
“In my experience, people who eat fish frequently don’t go on to develop allergies as adults,” said Professor Douglass.
Regarding Alexander Hall, the Ballarat man who died after eating barramundi, the professor said there were three things to keep in mind. Firstly, a fatal reaction to food is “very rare”.
If you experience tingling on your lips when eating a particular food, as Mr Hall had years before, see a doctor in short order.
Noting Cassandra Hall’s distress that an Epipen couldn’t be sourced at the scene to help her husband, Professor Douglass advised that an Epipen “doesn’t always work”. Knowing what you’re allergic to is your only guaranteed protection.