Maria Corrigan (Fianna Fail)
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I thank the Cathaoirleach for allowing me to raise this very important issue, to ask the Minister for an update on initiatives being undertaken to raise awareness, provide education and deliver supports re the incidence and impact of anaphylaxis.

We do not have accurate data in Ireland as to the exact incidence of it. We know, however, that admissions to hospitals due to allergic reactions has risen by more than 700% in Britain from the late 1990s, partly due to increased medical awareness. However, it was mostly due to an increase in the actual incidence of reactions, according to Professor Jonathan Hourihane. Again, this is a pattern that has been repeated internationally. Internationally hospital admissions for food allergies among children have risen by 500% in the past 20 years. There is anecdotal evidence to the effect that they have risen similarly in Ireland, but we do not have data. One of the reasons we do not is due to the absence of postgraduate allergist training for medical doctors in this field. In fact there are very few.

There are 300 children on a waiting list at the moment. It will take several years, at the present rate, even to assess them. If a child is put on a waiting list today for assessment, it will be at least a year before he or she will be called, and yet we know that extreme reactions to allergies such as anaphylaxis in addition to being life threatening also have direct implications for a person's ongoing health quality and wellbeing. In the case of a child it has an impact on how he or she is doing at school, and yet we know that if we increase awareness and education while also increasing investment on the preventative side, there will be an immediate result in terms of improved health, better quality of life and improved school performance. Most significantly from an economic perspective it would dramatically decrease health costs.

One of the areas about which Professor Hourihane is particularly vocal is the enormous need to identify what supports can be provided in schools. We know that in every school, apart from the very smallest, one will find children with allergies and reactions. I am asking the Minister whether there will be a link between the HSE and the Department of Education and Children, through the schools, to try to ensure a greater level of awareness and support so an early interventionist and preventative approach may be taken, particularly for children who have these allergies, when we will see the knock-on benefits.

Áine Brady (Kildare North, Fianna Fail)
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I am taking the Adjournment on behalf of my colleague, Deputy Mary Harney, the Minister for Health and Children and I thank Senator Maria Corrigan for raising this issue. This is an important matter, not least for those who might be affected and their families as it can have very serious consequences. Anaphylaxis is an acute, allergic type response which can involve multiple body systems - cardiovascular, respiratory, skin as well as mucosal - and may rapidly progress to a severe, life-threatening reaction. It may occur following exposure to allergens from a variety of sources including food, insect bites or stings, as well as medicines and vaccines.

The life-threatening nature of severe allergy makes it a serious condition. Symptoms include itching, tingling around the mouth and back of the throat, a sudden drop in blood pressure and difficulty in breathing. In severe cases anaphylaxis can result in death. Most attacks can be reversed with an injection of adrenaline. The key is avoidance, along with a combination of proper diagnosis, attention to food labelling and the availability of emergency medication such as Anapen.

Any medicine may trigger an anaphylactic shock. In relation to vaccines, the immunisation guidelines issued to all GPs include details for treatment of anaphylaxis following a vaccine dose. Anaphylaxis is very rare in relation to immunisation, 0.42 per million doses. The Irish Medicines Board, IMB, continues to advise health care professionals to be prepared to treat allergic reactions, including rare cases of anaphylaxis, when administering any vaccine.

The IMB has a robust and well established national reporting system to monitor adverse reactions to medication. Reports of suspected adverse reactions are encouraged and received from health care professionals and patients. Pharmaceutical companies are obliged to report any suspected serious adverse reaction occurring in Ireland to the Irish Medicines Board.

A food allergy can be defined as an immune response to food that the body incorrectly recognises as harmful. Antibodies are produced and this leads to a histamine release. This can cause allergic symptoms including asthma, rhinitis, conjunctivitis and anaphylaxis. Although anyone can have an allergic reaction to anything at any time, for those who have a diagnosed allergy, the life long treatment is avoidance of that food which causes allergy. Therefore, individuals need to know what is in their food and whether there is a potential risk associated with it. Reading food labels to determine whether or not an allergen is present is crucial in managing an allergy and avoidance of anaphylaxis.

There is legislation in place to protect those with allergies. Annex IIIa of European Directive 2000/13/EC on labelling, advertising and presentation of foodstuffs requires manufacturers to declare the presence of known allergens in their food products. There are currently 14 categories of ingredients according to EU legislation, namely, cereals containing gluten, crustaceans, eggs, fish, soybeans, milk, celery and celeriac, mustard, sesame seeds, sulphur dioxide and sulphites, peanuts, tree nuts, molluscs and lupins. The Food Safety Authority of Ireland has responsibility for overall labelling and allergen labelling legislation.

The food control services in Ireland are aware of the potentially severe effects on certain groups of the population of foods which contain allergens, foods which may become cross-contaminated with allergens during preparation or foods containing allergens which are not properly labelled. According to the FSAI, it is estimated that approximately 5% of children and, on average, 3% of adults in Ireland have food allergies.

Environmental health officers in the HSE have been provided with training on the management of allergens in the catering and manufacturing sectors, which should assist in preventing cross-contamination and ensuring labels bear the appropriate information. The HSE has also undertaken a considerable amount of training for nurses, especially those involved in vaccination programmes, which makes this expertise more widely available in the system. In the past year, a significant number of pharmacists have also participated in vaccination skills training as part of their continuing professional development. Management of anaphylaxis is a core part of this training. I am glad this subject was raised and that I have had the opportunity to provide information on the matter.

Maria Corrigan (Fianna Fail)
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I thank the Minister of State for her response. I am not being awkward. There was a considerable amount in the response that was informative and encouraging, including the information on the training given to auxiliary staff, the recognition of the consequences of anaphylaxis and the necessity of avoidance and early intervention. All of that can only come into play if allergies are diagnosed. We do not know the incidence of allergies in Ireland, yet there is nothing in the report that indicates any plan to try to capture data to establish this. Directly linked to this is the question of how to assess and diagnose patients. The key issue is that we do not have the medical training. We have not continued with postgraduate training programmes. The rest of the report is super, but the issues of the incidence and the need for diagnosis must be dealt with. We must also address the fact that there is only one public service consultant in this area and the need for postgraduate training.