Teresa Costello (Fianna Fail)
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I thank the Minister of State for coming to the House. I want to highlight an issue that was brought to my attention at a recent meeting of the health committee. In Ireland, over 160,000 people are affected by food allergies. By my own admission, until I sat in that meeting I never thought about the impact that a food allergy could have on people, how serious it can be and the difficulties they face. It is a serious public health concern. Allergies affect up to 6% of children and 1% to 2% of adults. They are chronic immune-mediated conditions, often linked with asthma and eczema. They are still often misunderstood and underestimated. For those living with food allergies, the risk of anaphylaxis is constant. For people who do not know, that is a rapid life-threatening reaction that requires immediate treatment with adrenaline. Families are very fearful of it.

Currently, there is no national policy framework or model of care for food allergies in Ireland. Patients can wait for up to a year to see a specialist and for two to three years for an oral food challenge. Access to allergy specialists is limited and care pathways are inconsistent. The delays are very harmful because without early intervention, children are more likely to develop additional allergies.

The impact goes far beyond healthcare. Parents often struggle to access childcare, with providers unwilling or unable to manage allergy risks. Many are forced to reduce working hours or to leave employment entirely. Children can be excluded from everyday activities, such as school trips or birthday parties, which leads to social isolation.

Some families are even travelling abroad to access treatment in places such as the UK, France and the United States. That is why I have raised this Commencement matter. Oral immunotherapy is a treatment that is already transforming allergy care internationally. It involves the gradual introduction of an allergen under medical supervision, with the aim of building tolerance. As I mentioned, people are travelling abroad. However, this is not covered by the treatment abroad scheme or the cross-border directive. It is not an experimental treatment. It is evidence-based and recommended by European clinical guidelines. It is widely used around the world. It can reduce the risk of severe reactions by up to 80% and it shifts care from passive avoidance to active treatment, giving patients protection rather than precaution. The benefits are life-changing. Children gain independence. Families gain confidence. Everyday activities, such as eating out or travelling, become a possibility again.

In Ireland, we have already seen its potential. A pilot programme at Cork University Hospital focused on young children with peanut and tree-nut allergies. It has shown that 91% of participants can tolerate small amounts of the allergen. However, access to this treatment is limited and it is not broadly funded by the HSE. There is no national roll-out plan.

I spoke to family members of people with allergies, some of whom talked about their experiences of travelling abroad, which was not something they really wanted to do. They said they would like the treatment to be available in Ireland. They are paying to go abroad. It is not covered by the schemes I mentioned. Even being on a plane, they are exposed to more allergens. We need a national model of care for food allergies. We need investment in specialist services and a clear, funded plan to expand access to oral immunotherapy across the country.

Mary Butler (Waterford, Fianna Fail)
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I thank Senator Costello for raising the really important issue around providing an update on the establishment of a cross-border scheme for oral immunotherapy treatment for food allergies. I am taking this Commencement matter on behalf of my colleague the Minister for Health, Deputy Carroll MacNeill, and I thank the Senator for the opportunity. I was struck by what she said: that she had never really thought about it. We do not really think about it unless we have a person in our family who might be impacted by some type of allergy.

More than one in four people in Europe suffer the effects of an allergy at some point in their lives and they are 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. I was struck by what the Senator said about having to travel abroad. I was coming back on a flight from Portugal recently, having been over there for St. Patrick's Day. The announcement on the flight was that there was a person on the flight with an adverse reaction to peanuts, that there would not be any sold that particular day, and to be careful. When I read the Commencement matter this morning, the two tied in completely. We have to become more aware of other people. You could be sitting beside a person, a complete stranger, and you might do something that would impact them. There could be unintended consequence through no fault of anyone.

GPs can help diagnose an allergy and, in the case of a mild allergy, can offer advice and treatment to help manage the condition. They may also refer to a paediatrician or onwards to an allergy specialist as needed for testing and treatment if the allergy is severe or the cause is not known. Children with allergies are seen at a number of regional paediatric services across the country. The allergy team at Children's Health Ireland, CHI, in Dublin runs specialist allergy clinics out of CHI at Crumlin and Temple Street, and also at Connolly Hospital and Tallaght University Hospital. The team deals with allergy prevention and diagnosis, along with treatment for allergic rhinitis and drug, venom and vaccine allergies. The team aims to improve 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 education resources.

Oral immunotherapy is a medical treatment that aims to desensitise the immune system to food allergies, meaning a person is less likely to have a reaction. It does this by gradually exposing a person to small amounts of food under careful supervision, slowly building up the amounts over weeks and months. There is also 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 adrenaline pen - or as we know them, an EpiPen - on their person. The State recognises the importance of pharmacies being prepared to administer these medicines safely and effectively. In 2024, pharmacists administered adrenaline in emergency situations on 365 occasions. The community pharmacy agreement in 2025 established an emergency medicine administration preparedness allowance to recognise that community pharmacists are authorised to administer emergency medicines, and that this service is provided on an ad hoc basis requiring pharmacists to be trained and ready to respond. An annual recurring allowance of €525 was made available to community pharmacy contractors, which commenced in January 2026, only two months ago.

The HSE operates the EU cross-border directive in Ireland, which plays an important role in facilitating Irish patients to access planned treatment abroad in another EU or EEA country. The EU cross-border directive provides rules for the reimbursement to patients of the costs of treatment abroad, where the patient would be entitled to such treatment in their home member state. It supplements the right that patients already have at EU level. The Senator is telling me the lived experience is not quite that, so I will come back in the next section.

Teresa Costello (Fianna Fail)
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I thank the Minister for State for her understanding on this matter. I was struck by the lived experience of people who said they were not being reimbursed. If it was something that was not available and they were going abroad-----

Mary Butler (Waterford, Fianna Fail)
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Yes, or that they were not entitled to it.

Teresa Costello (Fianna Fail)
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Then they were opening themselves to allergens. As the Minister of State said, she had that similar experience on the plane. I would be really grateful if she could bring something back to the Minister on that and maybe we could it flesh it out and be a bit of help to these people, advising them on a way of possibly getting reimbursement for this.

Mary Butler (Waterford, Fianna Fail)
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There is no cure for these conditions and those affected must continue to avoid the foods that make them ill. This is a daily challenge not only for them but for their families as well. To stay healthy, they must have accurate information on the foods they buy and eat. It is really important to mention the teachers, special needs assistants, SNAs, and school secretaries who play a huge role in regard to any child who might have an allergy. It is important that those selling or providing food in any scenario are aware of the impact of food hypersensitivity and the absolute requirement for accuracy in the accompanying information.

As I said, the food safety policy is a priority for the Department of Health and this is informed by scientific advice from the Food Safety Authority of Ireland and the European Food Safety Authority. The Food Safety Authority of Ireland has stated that there are several official controls in place in Ireland relating to allergens, as well as several regulations at EU level, setting out the responsibility of food business operators regarding allergen management and food information. This is a really important issue. I thank the Senator for raising it. It is the first time I have responded to a question such as this and I will bring it to the attention of the Minister.

Victor Boyhan (Independent)
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I thank the Minister of State, Deputy Butler, for her time this morning in dealing with the two Commencement matters.