The Irish healthcare system is not yet set up to cope with the changing allergy environment, reports Sylvia Thompson.
Children with severe allergies to foods such as peanuts have a poorer quality of life than children with diabetes, according to Prof Jonathan Hourihane, the incoming professor of Paediatrics and Child Health at University College Cork.
It's a surprising comparison but Prof Hourihane sincerely believes that daily insulin injections are less troublesome for a child than the threat of eating something that could be fatal.
"Children with diabetes have to learn how to inject themselves with insulin, but for children with a severe food allergy, there is a tragedy waiting to happen," he explains.
Prof Hourihane has returned to Ireland from Southhampton University in England to head up Ireland's first major clinic and research centre into childhood allergies.
He is keenly aware of the dearth of specialised services in this area and the anxiety caused to an estimated 20,000 children with food allergies and their families from the lack of or poor information about their allergies.
"Allergies have been on the fringe of the medical establishment because of a vacuum in medical knowledge about allergies and during that time [ the treatment] of allergies has been exploited by people with unproven, pseudo-medical knowledge," he says.
Paula Mee, dietician and mother of a nine-year-old boy with a peanut allergy, believes that lack of access to expertise has caused families huge stress. "I've seen some mothers driving themselves crazy with worry when one of their children is allergic to something like peanuts. This nervousness and anxiety is then transferred to the child who doesn't like being around food and won't stay over with their friends. That's very sad. Children shouldn't have that worry." Her son, Cian, adds: "I have to be careful about what I eat and sometimes when I am with other children's minders, I tell them that they can't give me nuts."
Cian carries an adrenaline pen (see panel) with him and another remains in his school should he inadvertently eat peanuts or almonds, to which he is also allergic.
Mee continues: "Very few GPs have an interest in allergies and some of them can be dismissive about such problems. I'd like to see a general practitioners' allergy interest group set up to put in place skin prick tests and blood tests for severe allergies in GP clinics. I've had to bring Cian abroad to check whether he was still allergic to nuts as some children grow out of their allergies." In Britain, there is a major drive to have those with allergies cared for by GPs.
Some 20-30 per cent of children who are allergic to nuts outgrow their allergy around the age of eight. Between 80 and 90 per cent of children with allergies to milk and eggs outgrow their allergies at a similar age. Many families choose not to allow any nuts in the house at all when one family member is allergic. However, taking such measures is virtually impossible when a child is allergic to milk or eggs. Repeat testing for allergic reaction to the allergenic food is deemed necessary to check whether a child remains allergic or not.
Prof Hourihane continues: "More than 90 per cent of severe allergic reactions are caused by eight foods - peanuts, tree nuts, milk, eggs, fish, shellfish, wheat and soya. Children who come to us with allergies that are not on that list, we doubt the diagnosis immediately. Broad elimination diets are not required. I spend as much time putting foods back into people's diets as I do taking them out.
"The problem is that food allergies are becoming more prevalent and more severe. Ten or 15 years ago, preschool children showed allergic reactions to milk and eggs which they mainly outgrew. Now, children are developing longer term allergic reactions to certain foods. This is linked to the general rise in atopic diseases which include eczema, asthma, hay fever and allergies."
Reasons for the rise in atopic diseases include super-clean homes in which the immune systems of babies and young children remain underdeveloped because they are not given enough exposure to germs. Some research studies also suggest that first born children are more likely to have allergies because they are protected more from germs by their parents than subsequent children. Children reared on farms also show lower rates of atopic diseases due to their early exposure to animals. Similarly, children brought up with pets from an early age have been found to be less likely to suffer from allergies.
Apart from his clinicial work at Cork University Hospital, Prof Hourihane and research psychologist Audrey Dunngalvin will carry out the first prevalence study of childhood allergies in Ireland. They will also look at how such children cope at home and at school. Further research will investigate the effectiveness of the new broad treatments for atopic diseases and more specific immunotherapy approaches which target specific allergies. They have been granted €380,000 from the European Union as part of a pan-European project into food allergies.
Parents of children aged eight and under who think their child may have a food allergy and who are interested in taking part in research into childhood allergies at University College Cork can make contact with research psychologist Audrey Dunngalvin on tel: 021-4662782. E-mail: audreydunngalvin@eircom.net
Food Allergy in Children, a symposium for paediatricians, paediatric dieticians, dermatologists, specialist nurses and GPs with an interest in allergy goes ahead on Friday, September 23rd, in the Herbert Park Hotel, Ballsbridge, Dublin 4. Tel: 1800 341 111 for more details.