UK researchers say peanut allergy could plummet by 77% if peanut products were added to all babies’ diets at four to six months of age. Peanut allergy has seen a three-fold increase in recent decades. It now affects around one in 50 children in the UK. However, there is increasing evidence that eating peanut products from an early age during infancy can reduce the risk of allergy and help reverse this trend. Now, a new study has gone even further to assess the best time to introduce the allergen into babies’ diets, identifying a clear ‘window of opportunity’ between four and six months of age depending on the child’s health. The new analysis was led by Professor Graham Roberts from the National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre and University of Southampton, and Professor Gideon Lack at King’s College London, with expertise from the Immune Tolerance Network (ITN) and National Institute of Allergy and Infectious Diseases (NIAID) in the USA. The study, titled “Defining the window of opportunity and target populations to prevent peanut allergy” has recently been published in the Journal of Allergy and Clinical Immunology. Reducing risk Most peanut allergies have already developed by the time a child turns one year of age. It is more common in children with severe eczema and egg allergy. Children of non-white ethnicity are also more likely to be affected. The new study used data drawn from the Enquiring About Tolerance (EAT) and Learning Early About Peanut Allergy (LEAP) randomised-controlled trials - both studies led by Professor Lack - plus the Peanut Allergy Sensitization observational study. These include children who are at high and others who are at low risk of developing peanut allergy. The modelled approach showed it was best to introduce peanut products to babies at four to six months of age. For babies with eczema, four months is recommended. This should be in the form of smooth peanut butter or other peanut snacks suitable for babies – not whole or broken peanuts. The baby should also be developmentally ready to start solids. Researchers advise mothers to breastfeed at least the first six months of their child’s life as well as introducing peanuts to their diet from four to six months. Window of opportunity Overall, the data found that introducing peanut products into all babies’ diets by six months could reduce peanut allergy across the population by up to 77%. Waiting to introduce the peanut products until 12 months of age would lead to only a 33% reduction. Professor Graham Roberts, from the National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre and University of Southampton said: “Over several decades, the deliberate avoidance of peanut has understandably led to parental fear of early introduction. “This latest evidence shows that applying simple, low-cost, safe interventions to the whole population could be an effective preventive public health strategy that would deliver vast benefits for future generations.” Professor Gideon Lack, from King’s College London and Guy’s and St Thomas’ NHS Foundation Trust said: “The benefits of introducing peanut products into babies’ diets decreases as they get older. This reflects the experience in Israel, a culture in which peanut products are commonly introduced early into the infant diet and peanut allergy is rare. “There is a narrow window of opportunity to prevent an allergy from developing. Introducing peanut products at four to six months of age could substantially reduce the number of children developing peanut allergy.” Targeting the whole population The research also showed that the greatest benefit can be achieved if the whole population is targeted. This is because most allergies occur in the many babies without any known risk factors. Targeting just babies with severe eczema would only reduce peanut allergy in the population by less than 5%. The findings provide evidence for recommendations in recent North American and European allergy guidelines. These recommendations suggest the early introduction of peanut products for all infants, based on an extrapolation of previously published data from the LEAP and EAT studies conducted at King’s College London. Advancing allergy trials Research into the prevention of peanut allergy in children has been driven by years of investment by the NIHR, ITN, NIAID, and partners around the globe. The LEAP study was led by Professor Gideon Lack and Professor George Du Toit from King’s College London and the NIHR Guy’s and St Thomas’ Biomedical Research Centre (BRC). The trial examined the early introduction of peanut products and enrolled 640 babies considered at high risk of developing peanut allergy from the Evelina London Children’s Hospital. It was supported by grants from the US National Institute of Allergy and Infectious Diseases of the National Institutes of Health and by Food Allergy Research and Education, the Medical Research Council (MRC) and Asthma UK Centre. The UK Food Standards Agency (FSA) provided additional support. The EAT Study investigated the early introduction of six allergenic foods: milk, peanut, sesame, fish, egg and wheat. It was supported by the NIHR through the Guy’s and St Thomas’ BRC and an NIHR Clinician Scientist Award with grants from the FSA and MRC.

Peanut allergy affects up to 1 in 50 children in the UK. However evidence increasingly suggests that eating peanut products from an early age can reduce the risk of allergy. New analysis by researchers from Southampton and London has identified a ‘window of opportunity’ to introduce smooth peanut products. If all babies were introduced to peanuts this early in life, they say overall allergy rates could plummet by more than three quarters. Why would this reduce the risk of allergy? And can parents apply these principles to other foods? We spoke to lead author Professor Graham Roberts from the NIHR Southampton Biomedical Research Centre to find out more. What is peanut allergy? Peanut allergy occurs when the body mistakes peanut as something dangerous and reacts to it. The reaction can involve the whole body - your lips may swell up, you may get an itchy rash and you may start having problems with your breathing. When does this research suggest babies should first be introduced to peanut products? Our research suggests that all babies should be introduced to peanut between four and six months of age. Some babies are at higher risk of developing a peanut allergy, such as those with severe eczema or an egg allergy. They should be introduced to peanut at four months of age if they are developmentally ready for solids. Do you know why introducing peanut products at an early age reduces the risk of allergy? A baby’s immune system needs to learn how to differentiate between food and dangerous bugs that need to be kept out of the body. The way the body does this is through the form it sees things in. If it sees peanut in reasonably large amounts in the gut, it will come to see this as a safe food and will not develop an allergy to peanut. How would you recommend parents introduce peanut products to their children? Parents are recommended to start offering their babies small amounts of vegetables, fruit and starchy foods (e.g. baby rice) as a puree initially. Once they are eating some of these, peanut products (e.g. peanut butter) can be introduced. Are there potential risks of introducing peanut products in early life? The first risk of giving peanuts to pre-school children is choking. To avoid this, parents should use peanut products like smooth peanut butter or Bamba. Pre-school children should not be given whole or chopped nuts. Parents may also worry about the risk of allergic reaction. However, our research clearly shows that babies introduced to peanut between four and six months of life are much less likely to have a reaction to peanut than babies introduced after six months of age. What should parents do if their child has an adverse reaction to their first taste of peanut? In our experience, babies usually only have minor reactions to peanut. This might be some swelling or an itchy rash. These tend to get better quickly; some antihistamine may make the child more comfortable. A more serious reactions would involve breathing problems but this is extremely rare in babies. If there are breathing problems with an allergic reaction, a 999 ambulance should be immediately called. What were the clinical trials that you have used in this analysis? The analysis used two big, randomised control trials: 1. Learning Early About Peanut Allergy (LEAP) The landmark study involved 640 children from the United Kingdom between 4 and 11 months of age who were identified as high risk for peanut allergy. It found that early introduction to peanut in high-risk babies protected against the development of peanut allergy. 2. Enquiring About Tolerance (EAT) This study involved 1,303 exclusively breast-fed children from England and Wales. It found that introducing babies to six foods (milk, peanut, sesame, fish, egg, wheat) between four and six months of age could reduce the risk of allergies developing. Can the results of this study be trusted? This study is an analysis of data that’s already been collected. We looked at results from two UK studies that were both very well carried out. They cover the entire population, including infants that are both high risk and low risk of peanut allergy. They also cover the entire population in terms of ethnicity, so we think they can be trusted. We have been very careful with our assumptions and believe that they are conservative. How do these findings compare to current guidance given to parents about peanut allergy? Current guidance suggests that peanut should be introduced from around six months of age. The last government report on introducing food into babies’ diets was published in 2018. Since then, a number of studies have been published that suggest earlier introduction of peanuts and other foods can help prevent allergies from developing. These studies also show that introducing foods early does not conflict with mothers continuing to breast feed their infants until 6 months or more. Do these findings mean that current guidance on the introduction of peanut will be changed? We think that the government should review the current guidance on when to introduce peanuts into babies’ diet. In our view, peanuts should be introduced earlier if infants are developmental ready for solids. Can parents apply these principles to other foods? Data from trials in other countries suggests that early introduction of other solids can reduce the risk of food allergy to these foods. However, we need more data about the best way for parents to introduce other foods into infants’ diet in the UK before we would suggest changing the recommendations for other foods in the UK.

Southampton researchers have created a potentially life-saving test that can quickly find out which antibiotics will and won’t work for treating a bacterial infection. The pioneering new technique was developed by Prof Hywel Morgan at the University of Southampton and National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre, with colleague Dr Daniel Spencer. The diagnostic test has been spun out after a decade of research and raised £2M in a recent investment round. It is now undergoing laboratory studies, funded by a £1M grant awarded by the NIHR i4i programme. These will run at University Hospital Southampton and Porton Down, led by the UK Health Security Agency (UKHSA). The test gives results in a matter of hours rather than days. It could help stem the rise in hard-to-treat bacterial infections. It would allow patients’ infections to be treated before they become serious. Antibiotic testing The current gold standard to find out if an antibiotic can be used to treat a bacterial infection is the disc diffusion test. A sample containing the bacteria is taken from the patient and grown in a laboratory, in a dish with a small disc infused with the antibiotic. The larger the bacteria-free space around the disc, the more effectively the antibiotic kills the bacteria. Bacteria growing right next to the disc may be resistant to the antibiotic. This technique takes two to three days to deliver results. During this time, the patient may be prescribed an antibiotic that doesn’t work, and their infection could be getting worse. Alternatively, they may be given a broad-spectrum antibiotic, which often have bad side effects. There is an urgent need for a faster method, allowing patients to get the right treatment sooner. Pioneering new technique The researchers have therefore designed a new method, known as iFAST. This enables the rapid identification of antibiotic resistance within a few hours. Just as a balloon filled with water will leak or burst when pierced, antibiotics damage the outer cell wall of bacteria to kill them. If the bacteria are resistant to the antibiotic, this will not happen. The iFAST device measures these changes to assess how effective the antibiotic will be as a treatment. To do the test, the sample is briefly grown in the presence of antibiotics before being loaded onto a microfluidic chip. The bacteria flow, one by one, through a channel thinner than a human hair, passing between two tiny electrodes. The device uses this to measure the electrical properties of 5,000 individual bacteria in 30 seconds. This can be used to see if there is any damage to the bacteria. The approach provides accurate data, whilst reducing the time to result by a factor of 10. This would allow doctors to rapidly prescribe an effective treatment. Saving lives and improving care With a serious bacterial infection, such as MRSA, or in cases of sepsis, it is essential to act quickly to prevent it from getting worse. This new test, by speeding up treatment, could therefore save lives. Prof Hywel Morgan, Professor of Bioelectronics at the University of Southampton, said: “Informed prescribing is the goal, so you can actually give the correct antibiotic for the correct bacteria, and ensure the bacteria are not resistant to that antibiotic. What it means for patients is that they get the right antibiotics earlier. “There’s demand for faster ways of determining whether the bacteria are or are not resistant to the antibiotic you prescribe. This test takes it down from a few days to a few hours.” Preventing bacterial resistance Antimicrobial resistance (AMR) caused over one million deaths in 2019. This is more than malaria and AIDs combined. This a global challenge that is getting worse. Antibiotic resistance occurs when bacteria change so that an antibiotic, or sometimes multiple antibiotics, no longer kill them. These antibiotic resistant bacteria, such as MRSA, cause infections that are much harder to treat. AMR has many causes, including over-use of antibiotics. Rapid diagnosis and treatment of bacterial infections with the right antibiotic cuts unnecessary antibiotic use. This would help prevent antibiotic resistant bacteria spreading and increasing these hard-to-treat infections. ‘Fast-paced and exciting journey’ This iFAST investment round was led by QantX. The company received co-investment from UKI2S, KHP Ventures, Kadmos Capital, and a group of angel investors. Dr Toby King, iFAST CEO, said: “We are delighted to welcome our new shareholders and to be able to begin the commercialisation of this game-changing technology, fighting one of the WHO’s top 10 global challenges. “We look forward to working together on what will be a fast-paced and exciting journey, with research systems expected to be available for evaluation next year.” David Woolley, Head of Technology Transfer and Impact Programmes at the University of Southampton, said: “iFAST Diagnostics is the latest example of University research, supported by the vibrant enterprise eco-system in place at Southampton, advancing strongly through the translational pathway to deliver real world impact. “We’re delighted to have achieved this for the first time, in strategic partnership with the UK Health Security Agency and also having received significant NIHR funding support. “Playing a key role in helping bring in a strong business leader in Toby King to work alongside world-leading scientists and engineers has been exciting in the last year, and I look forward to seeing iFAST continue to flourish and make a key difference in healthcare in the future.”

Professor Tom Wilkinson, Respiratory and Allergy theme lead at our NIHR Southampton Biomedical Research Centre, has been recognised as one of the most prominent health researchers in the UK. Prof Wilkinson has been appointed an NIHR Senior Investigator. The prestigious honour from the National Institute for Health and Care Research (NIHR) underlines his status as an outstanding research leader. He is one of only around 200 members of the NIHR College of Senior Investigators. The College includes six other senior researchers from Southampton. Prof Wilkinson is Professor of Respiratory Medicine and Associate Dean for Enterprise at the University of Southampton, and Honorary Consultant at University Hospital Southampton. Leading respiratory and allergy research Respiratory diseases affect 10 million people in the UK, kill 1-in-5, and cost the NHS more than eight billion pounds a year. The UK prevalence of allergy is high and rising; a quarter of our population now has a respiratory allergy. Prof Wilkinson leads our NIHR Southampton BRC’s Respiratory and Allergy theme. Our researchers in this theme aim to improve clinical outcomes from allergies and respiratory diseases. They take discoveries from the lab, and use them to create new diagnostic tests, preventative therapies and treatments to increase the resilience of patients, communities and the NHS. His work focusses on developing new approaches for preventing COPD exacerbations and reducing the burden of respiratory infections. He has authored more than 150 papers and 500 abstracts presented at national and international meetings. He is chief investigator and clinical director for the National UNIVERSAL Respiratory Viral Research Programme, and clinical lead for the Royal College of Physicians national COPD audit programme. Prof Wilkinson said: “I’m incredibly honoured to be recognised in this way by the NIHR. For me this award recognises the amazing work going on in Southampton to improve respiratory health, and the advances we are making for our patients. “It’s so important that respiratory health is recognised by the NIHR as a key priority, and I will work with other Senior Investigators to ensure that is the case.” Double success Prof Wilkinson is one of two Southampton researchers selected in the 16th NIHR Senior Investigators Competition, along with Professor Jackie Bridges at the University of Southampton. Their terms will last until March 2027. Senior Investigators are among the most prominent and prestigious researchers funded by the NIHR. They are outstanding leaders of patient and people-based research within the NIHR research community. Senior Investigators receive an award of £20,000 per year of appointment to fund activities that support their research. NIHR Senior Investigator responsibility brings an enhanced role in providing thought leadership and support in developing the UK’s research capacity. There are 11 current and emeritus NIHR Senior Investigators based in Southampton. They include professors Mike Grocott, Saul Faust, Keith Godfrey, Paul Little, Rob Read and Maria Stokes from NIHR Southampton BRC.

A new innovation hub led by Southampton researchers aims to transform the nutritional quality of food and drink sold in the UK. The Diet and Health Innovation Hub is one of six across the country in an investment of almost £15 million. They are funded by the UK’s Biotechnology and Biological Sciences Research Council (BBSRC) in partnership with the Medical Research Council (MRC), Innovate UK and DEFRA. The new hub is directed by several researchers from the NIHR Southampton Biomedical Research Centre. Driving collaboration The Southampton-led hub will bring together leading researchers, industry experts and other stakeholders to develop more healthy eating options. It is a collaboration with the Universities of Cambridge, Leeds and Reading and Quadram Institute Biosciences in Norwich. The hub will focus on the role of good nutrition in: promoting early-life development supporting body and brain function and resilience from adolescence into adulthood contributing to healthy ageing in later life ‘Fantastic opportunity’ Professors Philip Calder, Jon Swann, Keith Godfrey and Dr Caroline Childs are all involved in leading the new hub. Prof Calder said: “Obesity is a major challenge in our society, but so is undernutrition and many people have nutrient gaps in their diet. These can be addressed by helping people to make healthier dietary choices including providing better quality food and beverages that are affordable and available. “This award is a fantastic opportunity for us to work with our partner institutions and with industry to find solutions that help people to improve their health through what they eat and drink. We also want to make sure that we foster the next generation of researchers, so parts of our award will be used specifically to support early-career researchers.” Public health challenge Poor diet has a huge impact on public health. There remains a major challenge in producing and encouraging the uptake of healthier, more nutritious food products in the UK. Mark Spencer, Minister of State for Food, Farming and Fisheries, said: “I am delighted that scientists and experts can now come together in these new innovation hubs to convene the latest science around obesity and healthy eating. “Together they can work to close the knowledge gaps between current dietary trends and obesity, whilst improving our understanding of the relationship between food and health. Supporting this research is part of our commitment in the food strategy to boost healthier, more sustainable and accessible diets.”

Professor Saul Faust has received his OBE for COVID-19 vaccine research. He was presented the honour by the Prince of Wales last week in a ceremony at Buckingham Palace. Prof Faust is a Consultant Paediatrician at University Hospital Southampton and Professor of Paediatric Immunology and Infectious Diseases at the University of Southampton. He played a prominent role in research that informed the national COVID-19 vaccination programme. World-leading research Southampton delivered the highest number of COVID-19 studies across all acute NHS trusts during the pandemic. One of the biggest studies, COV-BOOST, looked at the safety, immune responses and side-effects of seven vaccines when used as a third booster jab and made international headlines. The trial was led by Prof Faust. Their findings played a major role in shaping the UK COVID booster programme. Prof Faust has been involved in wider studies including a needle-free vaccine for COVID-19 variants. Most recently, COV-BOOST found that a fourth dose of UK-approved vaccines give a strong immunity boost. Supporting the vaccine rollout Professor Faust received his honour alongside former University of Southampton Chief Operating Officer, Richard Middleton. He was awarded an OBE for services to the Commonwealth and Higher Education. Prof Faust is Director of the NIHR Southampton Clinical Research Facility (CRF). He is also Clinical Director of the NIHR Clinical Research Network (CRN) Wessex and a co-lead for Microbiology, Immunology and Infection in the NIHR Southampton Biomedical Research Centre. “I am very proud to be recognised for my work to support the UK’s pandemic response,” comments Prof Faust. “It is a tribute to the fantastic research teams in Southampton and across our region who worked tirelessly throughout the pandemic and the generous public who take part in our vaccine trials. I could not have done it without their support. “Working together, we made enormous progress in determining the safety and effectiveness of vaccines, which are now saving lives around the world.”

Southampton researchers are part of a new, global collaboration for better bone health and ageing. The agreement is led by the World Health Organization (WHO) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Osteoporosis weakens bones, making them fragile and more likely to break. It affects more than three million people in the UK. The five-year agreement was signed at the WHO Headquarters in Geneva last month. Professors Cyrus Cooper and Nicholas Harvey from the University of Southampton and NIHR Southampton Biomedical Research Centre attended the ceremony. Improving bone health The new agreement aims to prevent fragility fractures among older people. A fragility fracture is a broken bone caused by a fall from a standing height or less. They often affect the bones of the back, hip or wrist. The agreement includes the development of a public health strategy. It also sets out plans to improve the coverage of health services for fractures. The collaboration will: develop global estimates on fracture and osteoporosis; review evidence-based interventions to prevent fractures; create an economic model for an investment case in fracture prevention and care; provide guidance to countries on strengthening national health information systems by integrating osteoporosis and fractures in routine data monitoring; and provide guidance to countries on using data to design evidence-informed policies and programmes to reduce the risk of fractures in older people. Working together WHO will establish a Bone Health Expert Working Group to move their plans forward. They will receive support from the International Osteoporosis Foundation (IOF) and the WHO Collaborating Centre for Epidemiology of Musculoskeletal Health and Ageing at the University of Liège. Prof Harvey is the MRC Lifecourse Epidemiology Centre (LEC) Director Designate, IOF Committee of Scientific Advisers Chair and ESCEO Scientific Board Member. He said: “It is an enormous privilege to contribute to this international collaboration. It could help close the massive treatment gap in the prevention of osteoporotic fractures.” Prof Cooper, MRC LEC Director, IOF President and ESCEO Vice-President, said: “There is huge value in this international collaboration between disease focused societies and the WHO. “It represents an unprecedented opportunity to tackle the health burden secondary to osteoporosis. This is a leading cause of ill health, and indeed mortality, in older age.” Image: Professors Cyrus Cooper and Nicholas Harvey, and Dr Nicholas Fuggle with Dr Philippe Halbout, IOF Chief Executive Officer, at WHO Headquarters.

Southampton researchers have recommended a method to help diagnose preschool children with Primary Ciliary Dyskinesia (PCD). PCD is a rare, inherited condition that leads to chronic lung, ear and sinus infections. Children with the condition have a problem with mucus build-up. This leads to inflammation in the airways, and infections in the lungs, nose, sinuses and ears. Difficulties diagnosing young children Most people with PCD have symptoms from birth or early childhood, but some children may not be diagnosed until much later. Currently, a commonly used diagnostic test for PCD is measuring the nitric oxide (nNO) in the nose. This is done using a chemiluminescent analyser, holding a sampling tube at the nostril. The patient must hold their breath or breathe out through their mouth against a resistance. But controlled breathing in these ways is not always possible for young children. Chemiluminescence analysers are also extremely expensive, not portable, and unavailable in most countries. New recommendations Prof Jane Lucas at the NIHR Southampton Biomedical Research Centre led an international task force. This aimed to find better methods for diagnosing PCD in young children. They reviewed existing studies and literature to find more effective and accessible methods. The task force concluded that adequate measurements could be achieved by measuring nasal nitric oxide whilst a preschool child breathes normally. They therefore recommend this as the standard way to diagnose PCD in children under the age of five. They published their findings in the European Respiratory Journal. They also suggested electrochemical devices have a role in healthcare systems with limited resources. These are more portable, so may be useful in countries where patients live long distances from a specialist centre. However, chemiluminescence analysers are more reliable. The task force also recommends that future research is needed to ensure the technical standard is kept up to date. Professor Lucas, Professor of Paediatric Respiratory Medicine at the University of Southampton, said: “We know that the earlier we can diagnose a condition, the better the chances are of implementing the best treatment plan for the patient. But current guidelines and technical standards focus on nNO measurements in older, cooperative children using technology that is not widely available. “Preschoolers often need different methods to be employed when measuring nNO, methods that are less invasive and adaptable. Without guidelines for younger children, and electrochemical analysers there is huge variability in how people take the measurements and interpret them. “This paper is the first step towards standardising sampling, analysis, and reporting of nNO measured as part of the diagnostic testing for PCD in all age groups including preschool-age children. We hope this will promote earlier diagnosis of PCD, and a standardised approach to interpreting and reporting results.” Support from charities and parents The findings have received support from charities and parents. A spokesperson from Primary Ciliary Dyskinesia (PCD) Support UK said: “We support the recommendations outlined by the European Respiratory Society Task Force. The use of nNO in preschool children will help to facilitate an earlier diagnosis for many with PCD. "PCD is a multi-system disorder, requiring multi-disciplinary care. This includes respiratory management, Ear, Nose and Throat (ENT), cardiology, dietetics and fertility input. Earlier diagnosis will ensure PCD patients get timely access to appropriate care. This is vital for preventing irreversible airway damage and poor quality of life.” One parent said: “As a parent of a child with PCD, it is now clear to me why early diagnosis is so important. Diagnosis was only confirmed because I advocated for my son and insisted on further testing. My child had all of the classic symptoms of PCD but unfortunately, he had six operations for glue ear and the insertion of grommets (not recommended in PCD) before he was referred for PCD testing. “Access to testing and an early diagnosis would have prevented these unsuccessful and unnecessary procedures. Earlier intervention may have prevented his bronchiectasis from developing at such a young age.”

Young people in deprived areas are drinking more energy drinks while the total falls in wealthier communities, according to new research. The results paint a picture of widening inequality between the richest and poorest families in the UK. It also signals growing health concerns for teenagers from disadvantaged backgrounds. Researchers from the University of Southampton and City, University of London examined energy drink habits in young people. They then assessed links with deprivation and dietary inequalities. They found that every extra £1,000 in annual household income was associated with being 2% less likely to consume energy drinks. Researchers say the study highlights the need for a ban on the sale of energy drinks to young people under 18 years of age. Their findings are published in Public Health Nutrition. Eight years of data Energy drinks contain large amounts of caffeine and sugar. Current UK sales are estimated at 680 million litres per year, with young people the biggest consumer group. This study was led by researchers from the National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre, Medical Research Council (MRC) Lifecourse Epidemiology Centre, NIHR Applied Research Collaboration Wessex and Centre for Food Policy, City, University of London. It used data on 2,587 participants from the National Diet and Nutrition Survey (NDNS), collected between 2008 and 2016. They ranged from 11 to 18 years of age. Each participant completed a food diary with details of what they ate and drank on four consecutive days. The researchers also interviewed parents, teachers and adolescents in Hampshire through the NIHR-funded Engaging Adolescents in Changing Behaviour (EACH-B) programme. Increasing inequalities Analysis of the NDNS data showed that young people from deprived areas and lower income households are more likely to drink energy drinks than those from affluent areas and households. This difference increased between 2008 and 2016. During this period, energy drink consumption by young people decreased across the UK. However, it continued to rise in deprived areas. The researchers also found that children and teenagers who drink lots of energy drinks are more likely to eat unhealthily. Some of the teachers interviewed for this study expressed alarm at how this was affecting students’ school attendance and ability to learn. Professor Mary Barker is the Principal Investigator of the EACH-B programme and a Professor of Psychology and Behavioural Science at the University of Southampton. She said: “This inequality in energy drink intake is concerning, particularly as it increased during the eight-year period. “Evidence shows that energy drinks are harmful to both the physical and mental wellbeing of young people. “However, many adolescents do not understand why they are unhealthy and are unaware of the harm they are doing to their body.” Time for change In 2019, the UK Government announced that they would ban the sale of energy drinks to under 16s to help reduce childhood obesity. This ban is yet to be put in place. Some major retailers have imposed voluntary bans on the sale of energy drinks to under 16s. Many schools have also introduced voluntary bans on their premises. However, data from this latest research suggests many young people think these voluntary bans do not work. Professor Christina Vogel, Professor of Food Policy at City, University of London and University of Southampton, and lead author of the paper, said: “The findings from this important study provide support for a ban on the sale of energy drinks to young people. Such a ban could help reduce inequalities in energy drink intake and improve the health of children and young people. “However, our research indicates that the ban should also be raised to 18 years. This would support 16–18-year-olds from disadvantaged backgrounds who consume the most energy drinks to reduce their consumption.”

Professor Sir Stephen Holgate has called for urgent action to tackle a global rise in allergy cases. It comes amid warnings that 70 percent of people in the UK could have food allergies by 2060. Tackling the allergy epidemic Prof Holgate is MRC Clinical Professor of Immunopharmacology at the University of Southampton and a researcher at the NIHR Southampton Biomedical Research Centre. He spoke about the urgent need to tackle the problem in a keynote speech at the BSACI Global Allergy Symposium. He explained how environmental factors are fuelling a worldwide allergy epidemic. These include the loss of biodiversity, pollution, changes in diet and urbanisation. An urgent, worldwide programme of clinical trials, he said, is essential to turn the tide. He said these should focus on developing immunity in babies and young children. “Prevention is best achieved in the womb and in early life, because a developing child is very receptive to having its immune response shaped,” comments Prof Holgate. “We are talking about training an immune response similar to our learnings from the COVID-19 vaccination programme.” His speech pointed to the development of mass programmes to halt and reverse the rise in allergies. These could potentially use bacterial extracts similar to those encountered in livestock farm dust, or minimally-processed cow’s milk as treatments. Both treatments have shown promise in pilot studies. Inspired by a royal event Prof Holgate's talk was based on the findings of a recent landmark workshop. The workshop, at Dumfries House in Scotland, was hosted by the then-Prince of Wales in September 2022. The two-day event was called Understanding the Environmental Causes of Allergic Disease to Identify Effective Interventions. Sixteen world-leading allergy experts from the UK, US, Finland, Germany and Hong Kong attended. Professor Holgate led the workshop. It was organised by The Natasha Allergy Research Foundation, set up by the parents of Natasha Ednan-Laperouse. Natasha died aged 15 in 2016 from anaphylaxis, the most severe form of allergic reaction. Losing contact with animals At the symposium, Prof Holgate said studies carried out across the world show a loss of biodiversity is driving the rise in allergies. Biodiversity is the all the different kinds of life in one area, the variety of animals, plants, fungi, and even microorganisms like bacteria that make up our natural world. This includes studies in Africa, China, the United States, Germany and South East Asia. Other studies show livestock farming and other aspects of a rural environment protect against the development of allergy. He cited a study of 1,300 German children, published last summer. Those brought up on traditional farms were protected against allergy reactions. In another example from the US, two immigrant communities with common ancestry - the Hutterites and Amish - adopted different lifestyles. The Amish stuck to traditional family farming on single farms, working manually in cattle sheds. The Hutterites adopted the American communal farming lifestyle, using mechanical farming. “If we look at prevalence of asthma and allergy, you will see a huge difference. The Amish are hugely protected, the Hutterites are not,” says Professor Holgate. Similar results have been reported across the globe, where communities have chosen different and more traditional lifestyles. Professor Holgate adds: “Where humans come into close contact with animals, the farm environment can protect against the development of allergy. High exposure to environmental microbes leads to protection against the early development of allergic disease. In contrast, decreased biodiversity is a major driver in diminishing the protective immune reactions.” Stopping the 'relentless rise' in allergies One in three people in the UK now has an allergy, and the numbers continue to rise. These conditions range food and drug allergies to asthma and eczema. Between two to three million people in the UK are living with food allergies. Hospital admissions for anaphylaxis caused by food allergies have tripled over the last 20 years, according to recent research in the British Medical Journal. Prof Holgate warns that on the current trajectory, 70 per cent of the UK population could have food allergies by 2060. He is calling for global action. He says: “The support of King Charles and Natasha’s Foundation in bringing together allergy scientists has enabled us to come up with a plea, to help us stop the relentless rise of allergies across our populations. “What are needed now are large global clinical trials to determine whether modifying the lung and gut microbiome in early life through trained immunity can protect against the development of allergy.” Nadim Ednan-Laperouse OBE, co-founder of The Natasha Allergy Research Foundation, said: “It is quite clear that loss of biodiversity and the environment are key factors affecting the huge rise in the numbers of people with allergies. There is no time to lose in confronting the allergy and environment crisis. It is crucial that new landmark studies in this field are fully funded now. We, at Natasha's Foundation, intend to play our full role in delivering on the urgent actions required.” BSACI Chief Executive Fiona Rayner said: “Our understanding of the environmental factors that cause allergies and the effective interventions is a huge breakthrough. We therefore call upon our global colleagues to undertake clinical trials to protect and prevent the further development of allergies.”

A new study will develop an app to support young people with Autism Spectrum Disorders (ASD) to manage their own mental health. Around seven in 10 autistic people experience a mental health condition, according to the Mental Health Foundation. A €4.3 million grant from the European Commission's Horizon Europe programme and UK Research and Innovation (UKRI) will fund a new study. This will assess how factors in a young person’s environment affect their mental health. These factors include diet, sleep pattern, physical activity, and exposure to stress and anxiety. The study also aims to identify ways they can manage these. Developing an app to help The team will develop app known as an automated Personal Digital Nurse (PDN). This will support the individual to manage their own health. The app will also be integrated with care services, including SENCO at school and community clinics. This will allow them to access personalised, flexible services when they need it. More than 400 teenagers, aged between 11 and 14 years old, will take part for nine months in the UK, Republic of Ireland and Romania. Researchers from many different specialisms The study is known as ETHEREAL. It will bring together researchers from many different specialisms. These include medicine, computer science, psychology, biology and business. They will work with research teams and autism charities across the three countries. Prof Jonathan Swann is Professor of Biomolecular Medicine and a researcher at the NIHR Southampton Biomedical Research Centre (BRC). He will work to understand the genetic and biochemical mechanisms underlying ASDs. He aims to identify biomarkers that can predict the start and progression of mental health outcomes. His team will work with Prof Karen Lillycrop, Professor of Epigenetics and a researcher at the BRC. Her team will study the participant’s epigenetics - how a person’s environment affects their how their genes work, for example by switching them ‘on’ or ‘off’. They aim to identify epigenetic ‘signatures’ associated with ASDs and mental health status. Prof Lillycrop, said: ‘The grant will allow us, for the first time, to characterise epigenetic changes over time with mental health status and determine the drivers of such changes.” Prof Swann said: “This exciting multidisciplinary project will combine multi-omics, mathematics, and engineering expertise from across the University. It aims to understand complex gene-environment interactions, and how they contribute to autism spectrum disorders and mental health outcomes. “Our goal is to incorporate this knowledge into a mobile app. This will allow individuals living with autism to self-control the factors having a negative impact on their mental health.”

Southampton researchers have been recognised for studying the use of machine learning for inflammatory bowel disease (IBD). IBD is the name of a group conditions that cause the gut to become inflamed. The most common types of IBD are ulcerative colitis and Crohn’s disease. It affects more than half a million people in the UK. Recent research led in Southampton reviewed computer methods to help combat the disease. Results suggested progress can be made toward personalised medicine for IBD. Findings published in Inflammatory Bowel Diseases have now been named a winning paper in the journal’s annual awards. Treating complex conditions Artificial Intelligence (AI) and machine learning are increasingly being applied to complex conditions. The winning paper surveyed the use of these methods for IBD between 2001 and 2021. It found that the most common uses include diagnosis, assessing disease activity and identifying patients more likely to develop complications. The paper went further to identify how machine learning models could translate into the clinic. Sarah Ennis, Professor of Genomics at the University of Southampton, led the study. She is driving further research in this area through the NIHR Southampton Biomedical Research Centre’s Data, Health and Society theme. Prof Ennis said: “We are delighted that our work in collaboration with colleagues at Pfizer has been recognised in this way. “As always, our driving goal is to impact change for patients with IBD. “We are hopeful that machine learning applications hold promise to discover cryptic signals from complex data, such as genomics, to advance this goal in the near future.” Award-winning research The IBD Journal Awards recognised excellent research published in 2022. The shortlist consisted of ten top-performing articles: five for basic science and five for clinical research. The Associate Editors selected a winner from each category. Prof Ennis and her team won the award for basic science. The winners were announced at the 2023 Crohn's & Colitis Congress held in Denver last month.