Evanne Ní Chuilinn (Fine Gael)
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I thank the Minister of State for being here to take this matter. Given that she is not based in the Department to which it relates, I really appreciate her being here.

I want to raise awareness of what I and others believe is an undeclared public health issue that needs to be made the subject of a legal and policy framework as a matter of urgency. Every day in Ireland, tens of thousands of people of all ages manage the risks of living with food allergies. The constant threat of accidental exposure shapes their choices about what they eat, where they go and even who they interact with intimately or socially. As people can imagine, children in particular are at huge risk of accidental exposure often simply because these allergies first present at a young age and also because children are usually at the mercy of what is being served to them by an adult, be that in school, on a play date or at a party.

In Ireland, the standard of care provided following a diagnosis of food allergy is generally limited to the strict avoidance of the allergens and a prescription for an auto-injector or an EpiPen to treat a serious reaction.

Before I address a better way forward, let me first point out the gaps in that particular model of care. Children often present with multiple allergies and so could find themselves having to avoid a long list of foods for the rest of their lives. Can the Minister of State imagine trying from now on to avoid, simultaneously, milk, eggs, nuts, kiwi fruit, sesame and raw vegetables? It would be virtually impossible to live a normal life. Now imagine being at school, playing sports, going to college or even dating someone who loves to eat ice cream. It is not sustainable and not fair, yet that is the case for thousands of children and teenagers in Ireland today.

Of course, parents bear the brunt of this frustration, worry and financial pressure. On Tuesday, I met one such parent. Her name is Ruth. She explained how her child minder quit following a near fatal incident involving one of her three children. All three of Ruth's daughters have severe food allergies and so not only did she and her husband give up working intermittently for five years to care for their girls, but they actually prepared food for every child, 20 children, in their daughters' crèche for five years just to make sure their daughters could attend a preschool programme.

Let me move on to the school-going age. There is no overarching policy for emergency medicine to support teachers in schools. The burden of responsibility is put on parents to train teachers and SNAs in the use of their child's EpiPen and also in recognising the onset of a reaction. That is an enormous burden on teachers who are not offered formal training. There is also a policy of no emergency kits in schools. If in a school there are ten children at risk of anaphylaxis due to food allergy, there are probably about 20 EpiPens knocking around the school. All 20 pens are on prescription, all have use-by dates and all have to be replaced at various intervals. The waste alone should by now have triggered a policy and a cross-departmental approach to that policy between the Department of Health and the Department of education. Not only that, but 88% of schools do not have a spare emergency medicine for undiagnosed pupils in their school. Imagine the irony of having 20 or 30 EpiPen in a school and finding that a previously undiagnosed child needs medicine. There is no policy in existence to administer an EpiPen in that instance, leaving the child involved in real danger.

We all remember Emma Sloan from Drimnagh in Dublin who died on O'Connell Street eight years ago after eating a meal containing nuts at a restaurant. She recognised the reaction she had, went to a pharmacy in the city centre but was denied an EpiPen and died. Publicly available emergency medicine kits at schools and public places makes sense. A similar programme has saved 11 lives in the UK since its introduction 18 months ago.

On a more positive note, I have met with a number of advocacy groups, parents and healthcare professionals recently. Even though the risk, danger and worry are what really stand out when we hear their stories, it is important to point out that a life full of limits does not have to be the only way forward. There is a life-changing treatment available. In fact, Ireland is at the forefront in delivering research and development in this area. Oral immunotherapy treatment involves the gradual introduction of increasing doses of an allergenic food to help build tolerance and reduce the severity of allergic reactions, including anaphylaxis. It is not a new treatment. Due to the data on both its safety and effectiveness, it is widely used across the world to treat allergies. Aside from one programme for under-fives in Cork, this treatment is not available in Ireland.

Parents are further adding to their financial strain by travelling to France and other countries to access care over a number of years at great personal cost. Of course, the vast majority of people cannot afford to do that. The treatments can run into tens of thousands of euro because a child needs to go every six months and that is for just one allergen. A child who has more than one allergen needs to go over and back for years and years. Costs include flights and accommodation because they need to stay for about a week each time.

Professor Jonathan Hourihane is a consultant paediatric allergist. He spoke at a briefing here in Leinster House which I hosted on Tuesday alongside a number of parents whose children have allergies. After the parents delivered third testimonials call, he stood up and said, "It is embarrassing to hear my own patients say the care they receive is lousy despite being global leaders in research in allergen and immunology treatment." As well as publicly available EpiPen kits, longer term progress must be advanced in terms of treatments like OIT so that children are not robbed of the joy of childhood and families can live a normal life safe from the ever-present danger of a life-threatening incident.

Will the Minister of State provide an indication for the timeframe to roll out OIT and where the Department stands? I know this matter is not within the Minister of State's remit, but I would be grateful if she could pass on the concerns of tens of thousands of people in Ireland living with these conditions and provide an update on where we are with OIT in Ireland.

Malcolm Noonan (Green Party)
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The presentation on Tuesday, which I attended, very powerful. I congratulate the Senator on organising it.

Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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I also congratulate the Senator. I am sorry that I was not in a position to attend on Tuesday. This is an issue I am not very familiar with.The Senator has certainly presented a very strong case today. We all have issues to raise but the Senator has also provided solutions. We think of that girl on O'Connell Street, who knew what had happened to her and knew her symptoms, but, because of policy, the pharmacist was afraid to administer the EpiPen. It is awful.

I will be taking this matter on behalf of the Minister for Health, Deputy Carroll MacNeill. I thank Senator Ní Chuilinn for the opportunity to address the House on this important issue. More than one in four people in Europe suffer the effects of an allergy at some point in their lives, and it is particularly common in children. It is important to note that most allergic reactions are mild and can be kept under control. Severe reactions can occur, but these are rare. GPs can help to diagnose an allergy, and in the case of a mild allergy, they can offer advice and treatment to help to manage the condition. They may also refer to an allergy specialist for testing and treatment if the allergy is severe or the cause is not known.

The allergy team at CHI runs clinics out of CHI at Crumlin and Temple Street, as well as CHI at Connolly and Tallaght. The team deals with allergy prevention and diagnosis, along with treatment for allergy rhinitis, and drug, venom and vaccine allergies. The team aims to improve the quality of life for children with allergies and their carers to minimise the risk of allergy, promote food allergy prevention and provide Irish healthcare professionals with allergy educational resources. CHI has advised that there is currently no timeline for the rollout of oral immunotherapy services for the treatment of children living with allergies in Ireland.

That is not what the Senator wants to hear but, to be fair to her, she has started the campaign. I have no doubt that I and the Minister for Health will be here in front of her on many other occasions. This is how things get done: by starting a campaign to ensure there is a planned roll-out of treatment and care for young people.

In October 2015, the then Minister for Health signed the Medicinal Products (Prescription and Control of Supply) (Amendment) (No. 2) Regulations 2015 into effect. The regulations increase access to specified prescription-only medicines in an emergency, including adrenaline. This allows for the administration of adrenaline for known or suspected anaphylaxis to be administered by trained members of the public in emergency situations, without the need for a prescription. Of note, there is provision for organisations such as schools and workplaces to store these medications for administration by a trained person. The Pharmaceutical Society of Ireland provides guidance on the implementation of this amendment for pharmacists, and the Pre-Hospital Emergency Care Council has established a course for the education and training of persons to safely and competently administer adrenaline in an emergency.

There is a responsibility to ensure that medications are stored and administered safely and appropriately. Those with a known risk of anaphylaxis should carefully follow their doctor’s guidance regarding carrying an EpiPen on the person. However, we know it is not always the case that people carry an EpiPen. As the Senator has rightly and eloquently outlined, emergencies do happen. These situations can occur because people do not know the allergies they have.

In 2024, pharmacists administered adrenaline in emergency situations on 365 occasions. Community pharmacies are among the most accessible and trusted healthcare providers in Ireland. The State recognises the importance of pharmacies being prepared to administer these medicines safely and effectively. This is reflected in the community pharmacy agreement 2025, which establishes an emergency medicine administration preparedness allowance that recognises that community pharmacists are authorised to administer emergency medicines. It is deeply sad that this did not happen in the case on O’Connell Street outlined by the Senator. This service is provided on an ad hoc basis, requiring pharmacists to be trained and ready to respond. The Minister for Health has agreed that an annual recurring allowance of €525 will be made available to community pharmacy contractors, commencing in 2026.

I am out of time. The Senator has a copy of the answer, which is comprehensive. As I said, it does not give the answer that the Senator wants. Nonetheless, I commend her on starting the campaign for the rollout of EpiPens. I will reflect her views, thoughts and suggestions to the Minister for Health following this debate.

Malcolm Noonan (Green Party)
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I know the Minister of State was just handed the response, so she did really well. I note that this is the second time this has happened on my watch with a Department of Health matter. I call the Senator to respond.

Evanne Ní Chuilinn (Fine Gael)
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I have the rest of the written response, which I will go through later. I want to reflect on some of what the Minister of State has said. It is really disappointing that there is no plan to roll out OIT in Ireland. The average cost per year for an allergy sufferer is €1,600; this has been worked out and many people have done research on it. The OIT cost would be €4,000 per year, but it would be finite and would only have to be done for a couple of years. The cost per year would disappear or be significantly reduced, so it makes sense to roll this out.

In relation to training people to use EpiPens, Professor Hourihane, who is one of the four allergists in Ireland, said it would take 20 minutes, so that is the kind of training that would be needed. Another group I met with said this could be done on Zoom with teachers on their Croke Park hours. It is the kind of common-sense stuff that can be done.

There are four allergists in Ireland for a population of 5.3 million. Finland, with a similar population of 5.6 million, has 100 allergists. We are just not prioritising this, although allergies are on the increase. We need to be a lot more proactive in how we deal with this and roll it out.

There is a very good team at CHI but it is very difficult to get access to food challenges, as I know from speaking to parents. When someone is diagnosed with an allergy by a GP, they are referred to that team. The person will then have to do a food challenge, where they are exposed to, say, a bit of a nut in order to see how they get on. It is very hard to get access to those, and people may actually need five or six different challenges, depending on what their allergies are. More joined-up thinking is definitely needed.

The Minister of State is right that it is the start of a campaign. I am disappointed to hear that OIT is not on the agenda. However, we could have more movement on the policy for publicly available EpiPens, from what I am hearing.

Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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As I said, I will certainly reflect the Senator's thoughts and views to the Minister for Health. I will support her in any way I can. It is a common-sense approach to policy to protect the most vulnerable. As the Senator said, we have just four allergists for a population of our size. Unfortunately, this is on the increase. We know many people who are intolerant of various food products and ingredients, which can have fatal consequences, as the Senator outlined. I appreciate that the Senator is starting a campaign. I congratulate her on her audiovisual room presentation today. It had a powerful impact on everybody across the House who attended. As I said, I will reflect her views and thoughts to the Minister for Health after this debate.

Malcolm Noonan (Green Party)
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It is important, when a Minister of State is on duty for Commencement matters, that the response is given to the Minister in a timely manner.