Ask the Doctor (2017–…): Season 1, Episode 3 - Sleep - full transcript

Fresh air, good food.

What better ingredients for a happy life?

But what happens when your body starts
over-reacting

to what you're eating or inhaling

and your basic functions, like breathing,

start to shut down?

We're three medical professionals

seeking answers to a question that's been
making us itch.

What makes us allergic?

I ended up having four epipens

and that was one of the most scariest
things that I'd ever done.



Is there new hope for our most
common and deadly food allergy?

Sandro finds out.

What we're aiming for is a cure

that can allow children to live a life
as if they did not have peanut allergy.

I discover how you can be struck down
by thunderstorm asthma.

The doctor said to me,
"Please don't panic

but I'm calling an ambulance."

The experts tell us what you can do
if it hits your city.

With allergies on the rise,
can germs actually help?

To find out, Shalin gets down and dirty.

And we look at what an allergy is

and how you can best manage it.

Before I get started, we're going to need
to accept some pretty difficult truths.

So if you're eating right now,



I recommend you stop for the next couple
of minutes because it's time

to talk dirty.

Not that kind of dirty!

I mean these guys... germs, microbes.

You know, filth!

Take these four items that most of us use
every single day.

A computer keyboard, a TV remote,

a mobile phone
and a kitchen cutting board.

All items, you'll be horrified to know,

are commonly covered
in up to 10 times as much bacteria

as your toilet seat.

Now, to be clear, they're not necessarily
covered in the same kind of germs,

so I'm not suggesting you start
chopping tomatoes on your loo...

but the point is, our world is literally
swimming in germs.

Now, you might be wondering
what germs have to do with allergies.

Well, just as there are dangerous bacteria
that can make us sick,

research suggests that there are also
many beneficial microbes

that help train our immune system

to not over-react to things like pollen
and common house dust.

Now think of all the anti-microbial
products in your home

that promise to "keep your family safe"

by killing 99.9% of all common germs.

These products kill bacteria
indiscriminately,

both the good and the bad,

which leads to the question,

is our obsession with cleanliness driving
the massive increase in allergies

in developed countries like Australia?

Let's take a look at what
some of the research can tell us.

Starting with these grubby little guys...

dogs!

Research suggests that having pet dogs
around your kids

in the first year of life, while their
immune system is developing,

can be helpful in reducing
infant allergies.

Staying with this theme
is another bit of research

that compared city kids
who grew up in urban environments

to rural kids who grew up on farms.

The study looked at 10,000 adults

in 14 countries

and found that people who lived on farms

from birth to age five

are 54% less likely

to suffer from asthma
or hayfever as adults.

While it's unclear exactly what it is
about the farming lifestyle

that causes this,

some researchers believe a key reason
could be the bacteria found on farms.

There is evidence that suggests that the
bacteria found in soil and dust on farms

can actually help prevent the development
of allergic asthma in kids.

However, this doesn't make the battle
between clean and dirty clear-cut,

because good basic hygiene practices
remain crucial

for minimising contamination and infection
from harmful bacteria.

Man, that's like sandpaper!

But our industrialised inner-city lives
are clearly lacking something important

or have exposed us to something new.

This is supported by population-level
observational studies in Europe

that have led to new theories

that changes in lifestyle,
nutrition and envioronment

that come with rapid urbanisation

play a key role in the widespread
increase of allergies.

So I'm not suggesting
that urban dwellers pack up

and move away from all the good and useful
things that come with living in the city

but I would argue that we should all
let a little more dirt into our lives

and embrace the grubby great outdoors.

Seriously?

I was much more comfortable
filming in the lab.

With so many of us
suffering from allergies,

we asked you to tell us:

What's one of the worst things
a good Italian boy like me

could be allergic to?

You guessed it... food!

Australia has the highest number of
reported food allergies in the world.

Food allergies causing
potentially deadly anaphylaxis

have doubled here over the last decade

and the group most affected
is also the most vulnerable.

One in ten children in Australia today

will develop a food allergy.

We've all seen the signs
in schools and public spaces

telling us certain food types
are not allowed.

But what does it mean to live with
a food allergy on a day-to-day basis?

To understand what it's like,

I'm catching up with
James, 14, and Harry, 10.

The boys are allergic to lots of foods
the rest of us take for granted.

Like eggs, some nuts, milk,

sesame and fish

and even kiwifruit, for good measure,

making the weekly shop
particularly tricky for mum Wendy.

So, when did you first find out that
the boys were allergic to these foods?

Um, when James was four months old,

he had bad excema

and there's a link between excema
and food allergies

and so the doctor thought he should
have some skin-prick tests done

and we found out that he was
allergic to foods.

So to me, it was a really steep
learning curve,

'cause I went from knowing nothing

and thinking that people with
food allergies were all a bit odd

and maybe it was a bit make-believe
and not really a thing.

And then, when I've seen my child
have a severe reaction

and end up in hospital,

it makes you realise that it is a thing
and it's very real

and it is something I had to learn about
pretty quickly.

James had his first
life-threatening anaphylactic reaction

at age six,

to milk.

I had no clue what to do
because I was so young.

I ended up having four epipens in my thigh

and that was one of the most scariest
things that I'd ever done.

I think allergies makes me feel more aware
about what we're eating

but it does get very annoying.

Birthday parties are generally the worst.

I always have to bring my own food
when others eat cake and all that

and it's... not fun.

With the list of things
the kids are allergic to,

if you go away somewhere,
what do you do then?

Holidays are pretty challenging,

'cause we then have the problem
of the plane,

'cause you've gotta take your own
food on the plane.

And then, if there's a restaurant
at the hotel,

speak to them about whether the kids
can or can't be catered for

and sometimes they'll say yes

and then, when you turn up,
they change their mind.

So it makes it very challenging.

And what are your hopes
in terms of future treatments?

Well, a cure!

We've always gotta live in hope.

I mean, for 14 years, we've lived with it

and I'm sure the scientists
will get there.

The researchers will find the cure.

While the search for a cure
is ongoing,

so is the suffering of our favourite
living human medical dummy.

Alright...
hands up if you have an allergy.

Don't worry, Gary... you're not alone.

In fact, millions of people
around the world

have at least one allergy.

Allergic reactions occur when our immune
system over-reacts

to something that's generally harmless
to most people,

like plant pollen, dust, insect bites,

mould, our pets,

or a variety of food types.

Gary, you're covered in hives!

What was in that bag?

Ah! You're allergic to peanuts!

How convenient for us!

Whatever the allergy

and whether eaten,
inhaled, touched or injected,

the substance that triggers a reaction

is called an allergen.

While peanuts are just harmless food
to most people,

when Gary eats them, his immune system
incorrectly targets them as dangerous

and releases antibodies and chemicals
to defend itself.

One of the primary chemicals used to
mistakenly fight against allergens

is histamine.

Histamine can cause sneezing,

wheezing,

a runny nose, weepy eyes,

diarrhoea,

headache, nausea,

abdominal pain, an itchy rash

and lower a person's blood pressure.

The worst possible reaction,
known as anaphylaxis,

is life-threatening.

For those with non-life-threatening
allergies,

there is relief in the form of medications
called antihistamines,

which can quell symptoms in some cases.

There you go, Gary!
Your rash is all cleared up.

Now just remember
to stay away from peanuts!

Did you know that certain proteins in food

are similar to the parts of pollen
that trigger allergies?

That's why, if you're allergic to grasses,

you're more likely to get an itchy,
tingly feeling in the mouth and throat

after eating these foods...

cucumbers, melons, oranges

and tomatoes.

Nope. I'm good!

So, what can you do if you
think you have a food allergy?

To find out, I'm catching up
with an expert

to learn about skin-prick tests.

Geoff Ford is a paediatric doctor

who has specialised in allergies
for the last 25 years.

He's also...

a fan of the blues.

Dr Geoff has invited me along for a test

with 11-year-old Dexter.

He's checked every three years to see
if he's outgrowing his allergies or not.

So, we're going to have
another look at peanut

but we might have a look at a few of those
other things you're allergic to as well.

- Yes.
- Grass pollen.

- Mmm
- Maybe your old friend, the cat.

Ooh.

...Not the cat!
...No!

Anything but the cat!

OK. So, we need to write
a few numbers down.

The skin-prick test involves dropping
a dab of allergen extract onto your arm...

So, we've got house dustmites.

...and then pricking that layer of skin.

So, did that hurt?
- Um, no.

It's just, like, a little prick.

If you are allergic, your skin will react
with a small, red hive, or bump,

within about 15 minutes.

OK.

So, now we've come to the measuring stage,
now that the 15 minutes is up.

So we measure the widest diameter
in each direction.

Look at that one!

Yeah, we can see some reactions happening.

Um, notably, the peanut
hasn't gotten better at all.

The good news is, children can outgrow
their allergies

by the time they're 18.

Why this is the case is unknown

but at least for my buddy Dexter,

there's still time.

But what if there was a way
of developing a tolerance?

Recent work at the Murdoch
Children's Research Institute

has been gaining worldwide attention...
and for good reason.

Professor Mimi Tang is Group Leader
of Allergy and Immune Disorders

at the institute.

She also likes...

going to the movies.

So, Mimi, what motivates
this important research?

As a doctor, I was seeing
more and more children

coming in with food allergy problems

and at the moment, it's frustrating...

we can only say to them,
"Well, just avoid your food antigen."

And that isn't very helpful, really.

And what's the objective of the research?

Well, I'm really hoping
that we can identify a cure

for children with food allergy,

working with peanut allergy
as the first step.

Peanuts are the most common cause
of death due to food allergy in Australia.

Finding a cure for peanut allergy could
save countless lives worldwide.

So, what did you do
in your original study?

So, what we did was we combined
a probiotic bacteria

together with peanut,

so when the immune system saw the peanut
antigen together with the probiotic,

it would then be encouraged
to develop a tolerance to the peanut,

rather than respond
with an allergic reaction.

Sounds sciency, right?

Let me break it down for you.

Probiotics are good bacteria that
everyone's immune system likes.

Peanuts... mmm, not so much.

If you take these good bacteria
together with the problematic peanut,

over time, the hope is your immune system

will stop seeing peanuts as the enemy
that warrants an allergic reaction

but as a friend that it can tolerate.

62 children with peanut allergy

participated in Mimi's trial.

At the end of the trial,

more than 80% of children who received
our active probiotic peanut treatment

were able to go home eating peanut,

as compared to only 4% of children
in the placebo group.

Impressive results, right?

But it's not as simple

as eating probiotic-packed yoghurt
and some peanuts.

So please don't try this at home!

Oh, Gary!

There is still a lot more clinical testing
that needs to be done.

So we've embarked on
a new clinical trial.

We've been running now for about a year

and we expect that this trial will
continue over the next four years

with results around five years from now.

And is what we're ultimately aiming for
a cure?

Or will this be part of a cure?

What we're aiming for is a cure.

We want to be able to develop a treatment

that can allow children to incorporate
peanut back into their diets

and live a life
as if they did not have peanut allergy.

And it's not just peanut
allergy sufferers

that stand to benefit from
this life-changing treatment.

If you're like James and Harry,
living with other food allergies,

there's hope for you too.

Mimi and her team believe

by pairing the probiotic
with other problem foods,

like milk, egg or shellfish,

they could cure these food allergies
as well.

Although an effective treatment
for this widespread problem

is a long way off,

Mimi's work with peanut allergy

is leading the way for other food groups

and providing hope for those
who have suffered for so long.

Peanut allergies
are incredibly common

and that got us thinking:

As a doctor who spends plenty of time
in the emergency department,

I've seen the frightening effects
of asthma.

In the spring of 2016, the city of
Melbourne experienced a freak storm

that turned into a devastating
health emergency.

It triggered a huge increse
in the cases of asthma

and also caused several fatal attacks.

So how did this occur

and what can we do if this happens again?

A night of bizarre weather in Melbourne

rapidly escalated into a disaster,

leaving two people dead.

A phenomenon known as thunderstorm asthma
has been blamed.

As the storm
rolled across the city,

people gasped for air

in what was the world's most devastating
outbreak of thunderstorm asthma.

Almost 10,000
rushed to Victorian hospitals,

struggling to breathe.

As we go to air, four people have died

and three remain in a critical condition.

Calls to 000 increased by over 500%,

compared to an average day.

By nightfall, the city's emergency
services were pushed to breaking point.

So thunderstorm asthma's sudden occurence

put a huge strain on the city's
medical services

and this hospital was one of the first
to feel the brunt.

On the front line of this epidemic

was the Director of Intensive Care
at Western Health,

Dr Craig French.

He's a leading epxert
on thunderstorm asthma.

So, what was the evening of the storm like
for you here in the ICU?

You know, we had well over 300 patients
presenting with asthma

across Western Health
in that 24-hour period alone.

We might normally see 10 or 15.

In Victoria, nine patients died of
complications related to their asthma.

How do you think your staff
felt, both during and after the event?

I guess during the event,

you focus on doing what you have to do,

'cause you've got the patient
there in front of you

and they're your absolute priority.

It was only after the event

that we realised the enormity
of what had actually happened.

With nine dead,

November 21, 2016
was a day no-one saw coming.

Yet it was months in the making.

Victoria's second-wettest September
on record

had sprouted fields of lush green grass
and pollen.

But by November, the rain had dried up,

temperatures began to soar

and grass pollen filled the air.

That day, as the storm clouds gathered
and the winds picked up,

vast amounts of pollen
swept into an unsuspecting city.

It was the perfect... deadly... storm.

So, explain... how does thunderstorm
asthma in particular actually work?

It requires a number of factors
occurring simultaneously.

When it's very humid, pollens can expand

and when they expand, they can explode

and they release lots and lots
of tiny little particles.

Now, normally, pollens can't get into the
lung... they're too big.

But these little particles
can be breathed in

and they go all the way down
into the deepest part of the lung

and when they get there, they do damage.

They set off a major allergic reaction,

causing severe asthma.

It's like an anaphylaxis in a way...
it can come on that quickly

and be that life-threatening

and patients can go from being
relatively normal

to being unable to breathe

in a matter of minutes.

So one of the scariest things
about thunderstorm asthma

is that it can strike people
that have never had asthma before.

And that is exactly what
happened to this Melbourne family

when their six-year-old son, William,
fell critically ill.

When William's dad, Lachie,
was called to pick up his son at school,

he thought he had a bout of gastro.

But when mum Natalie got home,

she knew immediately something more
serious was wrong with her little boy.

So, what made you decide to see the doctor
in the end?

Well, Will was very, very listless

and then all of a sudden
went into the bathroom

and was sort of, you know,
heaving into the toilet

and came out and said, "Mum, I just...

I feel like I can't breathe.
Can you take me to the doctor's?"

OK. So what happened from that point?

The doctor assessed him very,
very quickly and then said to me,

"Please don't panic...
but I'm calling an ambulance."

And at that point...

I was digging deep not to panic.

So for you, you basically went
from thinking your son had gastro,

which is quite normal,

to realising that
he just couldn't breathe.

It was a big shock to know that,
out of nowhere,

for a child that has no illnesses or has
never had any asthmatic-related symptoms,

to suddenly be having a major,
you know, asthma attack.

Like many affected that day,

William suffers from hayfever

but he's never experienced asthma before.

Thunderstorm asthma didn't only
affect kids like William.

Thousands of people, of all ages,
were caught off-guard that day.

But this wasn't the first time Melbourne
has experienced this phenomenon.

Ambulance crews have treated
more than 300 people

suffering from what doctors are
calling 'thunderstorm asthma'.

2010 was the last time
Melbourne was struck by this epidemic

and it's been hit twice before...
in 1987 and '89.

So the thunderstorm that caused
respiratory problems

in so many people in Melbourne

was a rare but not unheard-of event.

What I want to know is,
what made this thunderstorm so deadly

and are there any things that we can do to
be better prepared for this in the future?

To get some answers, I'm catching up
with a pollen expert.

Associate Professor Ed Newbigin

is from the School of Biosciences
at Melbourne University.

He also...

quite likes hiking.

So, obviously not every thunderstorm
causes thunderstorm asthma.

- No!
- So...

- Thankfully for that!
- It'd be terrible if it did!

So, what are the bits that put that
together? Sort of, what happens?

There must be something
about these thunderstorms

but it's very hard to identify
common themes,

so there's a factor-X, if we like,
that we still don't understand,

that distinguishes some thunderstorms
as causing thunderstorm asthma

and a lot of them don't cause
thunderstorm asthma.

Mmm.

So, while we know what happens to the body
during thunderstorm asthma,

understanding what this 'factor-x' is

will enable us to forecast
when the next one might hit.

The other thing that's essential for
forecasting thunderstorm asthma

is knowing how much grass pollen
is in the air.

That's where this pollen-counting machine,
the Burkard Spore Trap, comes in.

- Hear that?

Oh, my gosh! I haven't heard that sound
in ages!

- Yeah.
- That's beautiful!

- Clockwork.
- So, how does the pollen get in there?

- Got a... this little entrance there.
- Ah!

And there's a very simple motor
down there.

- So it's sucking the air in.
- And then it's...

- That's great.
- This is just moving past the entrance

and we get a trace of pollen,
kind of down there.

- And we just take out the slide.
- As time goes by.

And stain it, take it back to the lab
and count it.

- Wow.
- It's a real counting process.

Aside from forecasting,

the other thing
that's crucial to understand

is who is most at risk when one of these
deadly thunderstorms hits.

As we've discovered,

thunderstorm asthma
not only impacts asthmatics

but hayfever sufferers as well.

About a third of people who experienced
thunderstorm asthma on that night

had never experienced asthma previously

and that's a really frightening thing.

So, the next time one of these
thunderstorms rolls through,

what can people do

to try to prevent it being
quite as terrible as it was last time?

Well, if they're an asthmatic,
having an asthma plan,

trying to control their hayfever

and much the same way as people put
suncream and wear hats and so on

to protect themselves against
UV radiation,

people have just gotta take the same
sort of steps at that time of year,

during when the grasses are flowering,

to minimise the risk that they might face

from their allergies generally and
particularly thunderstorm asthma.

So what steps can you take now
to be better prepared?

Number one on your list,

if you have hayfever or asthma,

is to see your doctor

to make sure you're being properly treated
before spring arrives.

And if a high pollen count
and a thunderstorm are forecast,

try to stay indoors.

The Victorian government has also
now budgeted $15.6 million

for better treatment, education
and research

into the thunderstorm asthma phenomenon.

Allergies might not be fun to live with

but as we've learnt,

there's a lot we can do to help
to improve the lives of allergy sufferers.

Getting grubby seems to be
a good first step.

A little dirt under our nails

can help our immune systems
become more tolerant to allergens.

There's good news
for kids with food allergies...

they may outgrow them
by the time they're 18.

Failing that, a world-first medical trial

is on track to developing a cure.

So it's not all doom and gloom
for allergy sufferers...

and that's good news.

Because as they say,

life is sweeter
when you can stop and smell the roses.

Hope you're feeling better
after the peanuts, Gary!