Australia is often called the allergy capital of the world . Allergic diseases - such as allergic asthma, hay fever, eczema and food allergies - affect almost one in five people . And this figure is expected to rise in the years to come.
Authors
- Desalegn Markos Shifti
Postdoctoral Research Fellow, Child Health Research Centre, Faculty of Medicine, The University of Queensland
- Jennifer Koplin
Group Leader, Childhood Allergy & Epidemiology, The University of Queensland
- Renarta Whitcombe
Public Health Officer, Central Queensland Hospital and Health Service, Indigenous Knowledge
An allergy happens when the body's immune system mistakenly reacts to certain foods or other substances as if they were dangerous.
But do allergies affect all Australians equally?
In a recent study , we looked at emergency department (ED) presentations related to asthma and other allergic diseases in central Queensland. The region has a population of 228,246 according to the most recent Census data, and 7.2% of residents identify as First Nations.
We found First Nations Australians were almost twice as likely to present to hospital with asthma or other allergy-related illnesses compared to other Australians.
What we did and found
We analysed 813,112 ED presentations from 12 public hospitals in central Queensland from 2018 to 2023. The hospitals were spread across regional and remote areas.
Of the conditions we looked at, asthma was the most likely to bring patients to the ED. This was followed by unspecified allergies, atopic dermatitis (or eczema) and anaphylaxis (a severe, potentially life-threatening allergic reaction). First Nations people were more likely than other Australians to present with each of these conditions.
Overall, we found First Nations people were almost twice as likely to visit an ED for asthma or allergic diseases compared to other Australians. It should be noted that asthma is not always caused by allergies, and in this study we looked at all presentations for asthma, regardless of the cause.
Our study also found ED visits for allergic diseases among First Nations people increased over time. They were around 1.5 times more common in 2023 compared to 2018.
Further, we found a notable peak in asthma-related visits to the ED among First Nations people in 2019. This increase may have been partly due to Australia's Black Summer bushfires during 2019-20.
Other research has shown ED visits and hospitalisations for asthma and chronic obstructive pulmonary disease increased during the Black Summer bushfires. Exposure to bushfire smoke significantly increases the risk of breathing problems and other health issues.
The increase in asthma-related ED visits could also be linked to the severe flu season in 2019 , as flu is known to trigger asthma attacks.
Are these findings surprising?
National data shows asthma is one of the most commonly reported chronic illnesses for First Nations Australians. More than 16% of First Nations Australians reported they had asthma in 2022-23 compared to 10.8% of the general Australian population.
So it's not entirely surprising that hospital presentations for asthma were higher among First Nations people.
However, we were surprised to find First Nations people visited the ED more often for other allergic diseases. Allergies have not necessarily been recognised as an important concern among First Nations people, particularly in remote areas.
That said, international studies have reported a higher burden of allergic and atopic diseases (eczema, hay fever and asthma) among the Indigenous peoples of Canada.
How about food allergies?
Interestingly, we didn't find any food allergy cases in our data. But some of the "unspecified" allergies could be linked to food allergies, as could some of the cases of anaphylaxis.
Australian researchers have found differences in the prevalence of food allergies among different groups, but they lacked specific data on First Nations populations. We know little about how common food allergies are in First Nations Australians.
In a recent national survey , 12% of First Nations people self-reported an allergy to a food, drug, or other substance (compared to 14% in the overall population ). But some cases might go unrecognised or unreported, and these data were not broken down into different types of allergies.
Some limitations
This is the first comprehensive study, to our knowledge, that looks at asthma and allergic disease-related ED visits among both First Nations people and other Australians in an under-researched part of Australia.
However, we only looked at asthma and allergic diseases treated in the ED, which doesn't encompass all cases. For example, some people might visit other health services such as GPs when they're having a less severe allergic episode.
Ultimately, we need more research to better understand how common allergies and allergic diseases are among First Nations Australians.
Why do these gaps exist?
We don't know exactly why there are disparities in ED presentations for allergic diseases between First Nations people and other Australians.
One possibility is that asthma and allergic diseases might be more severe in First Nations people, leading to more hospital visits, even if they're not more common.
Another reason could be limited access to specialists, especially in rural and remote First Nations communities. Long wait lists to see allergy doctors and their limited availability in some areas could lead to delays in care and make it harder to get the right treatment. This can worsen asthma and allergic disease symptoms, causing patients to seek ED care instead.
We want to learn more about how allergies affect First Nations people, especially in regional and remote areas, and whether people have unmet needs. In initial conversations with First Nations Australians living with a food allergy, we've heard allergies might not be well understood in rural areas. This could be because they're rare or because traditional lifestyles offer some protection.
We're interested in finding out more, especially whether allergies are a concern for First Nations people, and, if so, how we can support communities to develop targeted and culturally respectful strategies to address them.
Desalegn Markos Shifti is supported by the National Health and Medical Research Council (NHMRC)-funded Centre for Food and Allergy Research (CFAR) Postdoctoral Funding.
Jennifer Koplin receives funding from the National Health and Medical Research Council of Australia. She is a member of the Executive Committee for the National Allergy Centre of Excellence (NACE), which is supported by funding from the Australian government.
Renarta Whitcombe does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
