When death could be only a mouthful of food away . . .

Parents of children with a food allergy have to find a balance between over-anxiety and complacency

Mon, Jan 13, 2014, 18:15

The death in Dublin last month of a teenager with a peanut allergy, minutes after suffering a fatal reaction when she mistakenly ate satay sauce, was chilling news – particularly for parents of the estimated 20,000 children in Ireland with the same allergy.

Emma Sloan (14) collapsed on the street in the city centre on December 18th after going into anaphylactic shock as a result of consuming peanut sauce in a Chinese restaurant. She did not have with her a pen that is used to inject adrenaline into the thigh to counteract an allergic reaction.

Altogether, up to one in 20 children is affected at some time by a food allergy and, at the outset, it is impossible to say which of them could have life-threatening reactions.

It is the “sword of Damocles” over these people’s heads, says Prof Jonathan Hourihane, consultant paediatric allergist at Cork University Hospital (CUH). All food allergies are potentially serious and all need equivalent medical assessment.

“Half of people who die from anaphylaxis have never had a severe reaction before,” he explains. “We haven’t any way of predicting future severity.”

However, he says it’s a myth that each reaction will be worse than the last one and it is important for people to know that.

Hourihane is chairman of the Irish Food Allergy Network (IFAN) which, in the wake of Sloan’s death, said the health service was not recognising allergic disease as a priority, despite documented increases in such conditions – food allergy, asthma, eczema and hay fever – over recent decades and public demand for services.

A consultant paediatric allergist who was appointed at Our Lady’s Children’s Hospital in Crumlin, Dublin, just last November, already has a waiting list of a year, he says.

Anaphylactic incident study
IFAN is being funded by the Children’s Research Centre in Crumlin to conduct the first national study of anaphylactic incidents and Hourihane expects about 600 cases in an 18-month study of children.

A short list of foods account for about 90 per cent of food allergies: milk, egg, peanut, tree nuts, fish, shellfish, soy and wheat. Most milk and egg allergies are gone by the age of 10 but nut allergies are usually for life.

Naturally families of small children with one allergy will err on the side of caution with other foods on that list but it may be unnecessary. However, unless their child is tested, they won’t know that.

IFAN, which is a multi-professional collaboration, produced guidelines for healthcare staff around the country last year, to promote better diagnosis and management of food allergies.

Each local hospital has somebody who deals with patients with diabetes or asthma or epilepsy and an equivalent level of care and competency is needed for people with food allergies, Hourihane argues.

Paediatric cases need to be kept under review to see if the allergies have resolved or are persisting. At around age 10 a “food challenge” can be done in a hospital setting to determine this – feeding the child a small amount of the substance they have reacted to in the past.

Where the allergy persists, youngsters move into a different phase of management, says Hourihane, as they need to be taught to look after themselves and not be “stupid adolescents”.

“Teenagers are the highest risk group. They don’t tell friends; they eat things that they know they shouldn’t; they may be taking drugs or alcohol; and they are kissing strangers and hanging around with people who have no vested interest [unlike parents] in their survival.”

Janet Murphy’s 15-year-old daughter, who has a peanut allergy, carries adrenaline pens wherever she goes – she has two at home in Santry, Dublin, two at school and two in her schoolbag.

“She is very sensible – thank God,” Murphy says. If she is in a restaurant with friends, she would not eat anything unless it is a place her mother has checked out.

“She would have a lot of anxiety around food,” says Murphy. “Unfortunately, the restaurants here are so bad with allergy control – we would love to go out more.”

Safe places
Murphy regards McDonald’s and Burger King as safe places for her daughter to eat – indeed Hourihane describes McDonald’s as the “safest place in the world” to eat because its food production is so rigorously controlled. The Murphys chose another American chain, TGI Fridays, for their daughter’s Confirmation – but only after her mother had gone out and interviewed the chef of the Swords outlet.

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