Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

I am pleased to have the opportunity to rise and discuss an issue that affects so many Australians and an issue that I have raised in the parliament on numerous occasions. It is something that will not go away any time soon. The issue of anaphylaxis is growing rapidly in our community. The need for government action in relation to anaphylaxis has become even more apparent, given that the number of children suffering from severe food allergies has doubled in a generation. Many studies at the moment cannot pinpoint why, but an exponential number of people are now suffering from severe food allergies that can result in death. I have had the pleasure and the pain of meeting the Baptist family, who lost their son Alex at the age of four at kindergarten, and the Shannon family, who lost their only child, Sabrina, at the age of 13 in Canada. It makes you realise firsthand what this issue means. Having a 10-year-old who is anaphylactic and having had at least one terrifying scare, I know this is something very real that we need to deal with on a day-to-day basis.

But with increased awareness, better management systems and further research in food allergies, allergies do not need to be fatal. The growing group that are most exposed are teenagers, who think they know everything about life and do not need to take any precautions, and who certainly will not carry their epi-pen with them. This is a great debate when we go out on numerous occasions. My nephew who is 20 will not take his epi-pen with him. Even his girlfriend has got to the stage of saying, 'Well, we are not going out to dinner unless you take it with you.' We have had a couple of scares with him along the way too. But as an invincible 20-year-old he knows better than all of us.

An Australian study has estimated that a quarter of the population will have an adverse reaction to food, especially during infancy and early childhood. Food allergy affects approximately one in 10 children and two in 100 adults. Anaphylaxis is the most severe form of an allergic reaction, most commonly food associated, but as many people know there are other things such as bee stings. Many of these food allergies are potentially life-threatening, particularly with food such as peanuts, where even small traces may trigger severe symptoms and even causing death.

The number of hospital admissions for anaphylaxis has doubled in the last 15 years. Death and life-threatening episodes from food associated anaphylaxis are completely preventable. A simple medical procedure is all that is needed to treat it, prevent loss of life and provide the necessary time to transport the victim to hospital for further medical attention. Administering an epi-pen and giving a dose of adrenaline to individuals buys you time to get an ambulance. It does not relieve the symptoms or stop the anaphylactic episode. People need to be hospitalised and we need to get that message through to individuals, that using your epi-pen is not the end, it is the beginning of this process.

Apart from Victoria, where the Baptist family moved with the state government to ensure legislation, there are currently good policies across states and territories. But it is not legislated, and this is causing a grey area. I am a great believer in legislation where things are as important as life-threatening illnesses. I think childcare centres, kindergartens and primary and secondary schools need to have properly trained individuals and this is better managed in a properly legislated sense.

For the year 2010-11, there were 8,840 children in approved childcare in my seat alone. Given statistics, that is approximately 900 children with anaphylaxis in child care. When you send your small child off to childcare or kinder, you do not expect that they will not come home because they have come into contact with an allergen, as was the case with the poor Baptist family. Alex went to kinder one day—there has been a coronial inquiry and how this happened has never been quite resolved—and he came home dead. I do not want to have to see that situation ever again. My child's picture is all over the school. You can see him everywhere, and in the canteen there is a picture of him with the caption: 'Do not feed this child peanuts or eggs; please do not.' That is something he is quite used to; he is not worried about it. But as he moves on to secondary school, it becomes another issue entirely.

Since 2008, the Victorian government has had legislation that demands that each school has an anaphylactic management plan for each student, developed in consultation with the student's parents, carers and medical practitioner; prevention strategies for in-school and out-of-school settings; and a communication plan to raise staff, student, school and community awareness about severe allergies and the school's policy. Regulated training and updates for school staff in recognising and responding appropriately to an anaphylactic reaction, including complete administration of an EpiPen or Anapen and how to use the device appropriately, are very important.

As I said, I have been involved with this issue for many years and personally understand the precautions that must be taken when caring for a child with an anaphylaxis. With the increased number of children with anaphylaxis in each school across the nation, the risk of an allergic reaction is also increasing. It is not something where you can say, 'We won't have nuts at school.' The actual number of items to which there are allergic reactions these days is increasing. It might be strawberries, it might be honey, it might be lettuce—the number of items is enormous. The predominant one is still nuts and many schools have a policy of no nuts.

I want to talk about the SchoolNuts project, which is operating through funding from the Victorian Asthma Association and the Murdoch Children's Institute. I have had the pleasure of meeting with Katie Allen, who is the chair and the driving force of that study. The study is focusing on what has become a major public health concern, anaphylaxis, recognising the apparent increase in childhood food allergies. The research aims to investigate and determine the origins of true allergies in schoolchildren, engage with students to explore the knowledge of and attitudes towards food allergies in children and adolescents as well as provide education seminars to schools following the research. The research is essential in ascertaining modifiable risk factors and thereby helping to improve public health policy. The research aims state:

Since the 1980s, the world has experienced an epidemic of allergic disease. Asthma rose rapidly during the 1990s, followed by increasing eczema and allergic rhinitis, both of which continue to rise. Of great concern is new evidence that yet another allergic condition is on the rise, food allergy, with our own work showing that up to 10% of infants have food allergy proven using the golden standard method—oral food challenge.

If you have ever had to do one with your child, it is fairly scary. The project outline continues:

The emergence of this new allergy epidemic poses significant and unanswered questions relevant to ensuring a healthy start of life for future generations of children.

This is particularly so for the most unstudied age group of children, adolescents, the age group that is most likely to be lost to follow up in the medical system but most worryingly at high risk of food deaths from food-related anaphylaxis.

The study is looking at this group of adolescents by going into schools and recruiting students to understand food allergies and then test students. It has discovered that a lot of them have an allergic reaction to food that has gone undiagnosed. The SchoolNuts program is up and running. It is seeking assistance to get more funding to produce a DVD answering those questions about why foods make people ill, not just making them break into a rash but potentially leading to death. Talking about all those things is very important and this is a groundbreaking study. One of the other unanswered questions is why anaphylaxis, food reactions, asthma and eczema are exponentially on the rise in Australia. We have a greater concentration of them than any other country. Whilst I welcome the action of many childcare providers, kindergartens and schools who have voluntarily introduced policies related to food allergy management, there is currently no consistent national approach to improving awareness and understanding about how to treat a severe allergic reaction in a child. This must change, especially given the increased number of children with anaphylaxis and the potential for sudden death if not treated correctly.

The government must through consistent legislation through the COAG program, with the cooperation of the states, ensure that all preschools, primary schools and secondary schools are set up to deliver life-saving information and care to students. As I say, it is not just about having a photo up around the school that says, 'Don't feed this child peanuts.' It is about how to ensure that an EpiPen is administered and that an ambulance is called.

As I said before, I have been in contact with the Baptist family, who are courageous, brave parents who have lost their son and are still caring for two other children. The parents of children like Alex, who was four when he died, and people like the Shannon family, who created 'Sabrina's law' in Canada, are the driving force behind seeing that no more children die in vain. We should honour their memory by passing laws that will ensure all children are protected whilst at child care and at school.

I have spoken about the increased prevalence of anaphylaxis in our community and among young Australians in particular. The key is ensuring greater awareness, planning, engagement and research. (Time expired)

Karen Andrews (McPherson, Liberal Party) Share this | Link to this | Hansard source

I start by thanking the Deputy Speaker for this motion on food allergies in general and anaphylaxis in particular. I believe that this is a very serious issue. It affects many Australians and action needs to be taken to better inform the community in general and parents in particular about food allergies and also food intolerances.

Tonight I would like to draw attention in particular to food allergies and intolerances. For most Australians, food is a part of our everyday lives that is generally a pleasant experience. Not only do we have the pleasure of preparing the food but we also see it as a social experience. We go out to dinner, we have friends over for dinner and we meet at restaurants and cafes. It is really part of our lives. However, for some people food can and does cause distressing reactions and even death through a severe allergic reaction—anaphylaxis.

A food allergy is an immune reaction to food protein. To manage the allergy and the reaction it is necessary to determine the food that is the cause of the allergy and eliminate all traces of that food. It is mainly babies, toddlers and young children who are affected by food allergies, but this is not always the case as allergies to peanuts and shellfish often last into adulthood or even present during adulthood. But in these cases it is often that the food was not tried when the person was younger. A common example of this is an allergy to crustaceans. A toddler is unlikely to taste a crustacean and hence the allergy is not picked up until adulthood when the older person tries a crustacean for the first time.

The most common food allergies in children are from peanuts, eggs, milk, other nuts, seafood, sesame, soy and wheat. The most common reaction is eczema, which can be particularly distressing for very young children as scratching inevitably makes the eczema much worse and it is virtually impossible to do anything to give instant relief. Also, the eczema can remain long after the food has been consumed, often making it difficult to determine precisely which food is causing the reaction.

The reaction to a food allergy varies considerably depending on how sensitive the individual is to the allergen and how much of the food is eaten. There are also other factors such as whether the food is raw or cooked. Eggs are a very good example of this, with some individuals who show an allergic reaction to raw or soft-cooked eggs, such as soft meringue, able to eat eggs when they are well cooked—for example, in a cake. This is not the case for everyone, but it is the advice that has been given to me by an allergist. As I understand it, cooking or heating the food changes the protein structure and hence the cooked food may not produce an allergic reaction in susceptible individuals. But I stress that that is not always the case. As I have already said, eczema is the most common food allergy reaction but there are others, including hives and redness around the face, swelling and, if the food is swallowed, there can be vomiting and diarrhoea. The most severe reaction, anaphylaxis, can proceed very rapidly with swelling of the throat and breathing difficulties, and it can be life threatening if not treated immediately with an injection of adrenaline.

Those who are known to have a severe, life-threatening allergic reaction generally carry an EpiPen. I certainly take on board what the Deputy Speaker said about teenagers and young adults and their view of an EpiPen. Unfortunately, they do often believe that they are invincible and that they do not need to carry their EpiPen. I would hate for there to be a tragedy because of that, but unfortunately that has been the case in the past. There is always that initial reaction when it is first determined that there is a potential for anaphylaxis or when it actually occurs. In most instances there is unlikely to be an EpiPen handy for that very first attack. Often it will happen at home with a parent or a carer, or at a childcare centre where the carers are responsible for the care of that child.

I recently visited a before-school care centre in my electorate of McPherson on the Gold Coast. One of the staff there told me about a child who had recently experienced their first allergic reaction to a food at before-school care. Fortunately, a staff member identified what was happening. They saw the symptoms and realised what was going on, and an ambulance was called and it arrived very quickly. In the interim, the staff member stayed on the phone and spoke to the emergency operator and followed all the instructions until the paramedics arrived. The child was taken to hospital and treatment continued. In that case, the allergen was ginger. It was certainly not something that would have been easily detected in any food that the child was bringing into the centre, but that was the advice that came back.

As I said earlier, food allergies do affect a significant number of people in Australia. An Access Economics report published in 2007 found that 4.1 million Australians have an allergy of some type, and the cost to productivity is $5.6 billion. Two per cent of Australians are thought to have some form of food allergy that will trigger anaphylaxis. Based on Australia's current population, that means that about 500,000 people suffer from a food allergy. So it is a significant number. It is particularly concerning that over the last 12 years there has been a doubling of admissions to Australian hospitals, with a fivefold increase of young children under the age of five.

I note that this motion refers to the work of the Murdoch Childrens Research Institute and Asthma Victoria in the SchoolNuts study. I commend them for their work and encourage them to continue with their research. I also congratulate and commend the Royal Prince Alfred Hospital Allergy Unit for the work that they have done over a number of years—not only with food allergies but with food intolerances, which is the next issue I would like to speak about tonight. Many people consider food allergies and food intolerances to be the same thing, but they are not. They are very different. Whilst a food allergy is an immune reaction to a protein, a food intolerance—which is also known as non-allergic food hypersensitivity, is not an immune reaction. The chemicals involved in food intolerances can be naturally occurring or artificial. They are quite varied and they occur in many different foods. The issue often becomes determining which chemicals are causing the reaction and eliminating those entire food groups.

The Royal Prince Alfred Hospital developed the elimination diet in the late 1970s, and this diet has now been used very widely throughout Australia and in some overseas countries, including New Zealand and the United States, to assist with the identification of foods that cause reactions. The three natural substances that are most likely to cause reactions in sensitive individuals are salicylates, amines and glutamates. They are common to many foods—for example, apples, tomatoes, peas and avocadoes, just to name a few. So the intolerances that come from these various chemicals are very widespread.

Research has shown that individuals who are sensitive to naturally-occurring food chemicals usually react to colours, flavours and preservatives. So, with our modern diet, sensitive individuals can react to goods that less sensitive individuals consume on a daily basis with no effect. Essentially, our highly processed diet creates a range of reactions for an increasing number of people. Those reactions from food intolerances, whilst not normally life threatening, can be very debilitating and include a range of symptoms, such as eczema, stomach pains, leg pain, flu-like symptoms, headaches and sinus problems.

The elimination diet requires the elimination of food chemicals, both natural and artificial, and food additives for such time as the symptoms have disappeared for a certain period of time and then each food group is reintroduced to test for a reaction. Following these diets is a huge commitment from the individual and also from the families of those individuals, because it has an absolutely huge impact on their life. But it is a necessary step in determining the food intolerances. I believe that it is time for schools to renew their policies in relation to food being brought into school and also sold in tuckshops, and consideration most certainly must be given to children with food allergies. (Time expired)

Laura Smyth (La Trobe, Australian Labor Party) Share this | Link to this | Hansard source

I am very, very pleased indeed to be able to support the motion that is before us this evening, both in terms of the significance of this as a public health issue and also in terms of family allergies and friends' allergies. Certainly that has been a consistent theme through the discussion of this motion this evening. We know that anaphylaxis is the most severe form of allergic reaction and it is potentially life threatening; although, the incidents of fatalities in Australia as a result of anaphylaxis are happily still relatively rare. However, the incidents of anaphylaxis is obviously on the increase, so the risk of potentially life-threatening consequences from it is inevitably also on the increase.

Anaphylaxis obviously requires emergency attention and early medical treatment and can affect a range of different body systems—for instance, the skin and respiratory systems. We also know that anaphylaxis takes place within a relatively short period of time after exposure to the relevant trigger—within 20 minutes or two hours. So for parents with young children who are at school or who are in unfamiliar environments and exposed to different foodstuffs or to different allergens, it is an ongoing source of concern.

Indeed, it also a worry for people who are contemplating having children or those who are currently pregnant, because family history of allergic reaction clearly has a significant impact upon the propensity for your offspring to have an anaphylactic response or to have an allergic reaction of any kind. If a person or their partner has an allergy, the chance of the child of that relationship developing an allergy is around 30 per cent, which is an extraordinary figure, and it goes up to between 40 per cent and 60 per cent in the event that both parents have a history of allergic reactions.

The significance of the motion this evening cannot be overstated. Indeed, allergies, particularly food allergies, have become a significant public health concern in many developed countries. In particular, Australia and New Zealand have amongst the highest prevalence of allergic reaction disorders in the developed world. So we are living in a region where this is increasingly becoming of significance—and to a population of young people who are increasingly exposed to the prospect of allergic reaction.

Earlier this evening we heard speakers in this debate talk about the Access Economics report of 2007, which—we understand from discussions earlier—estimated that around 4.1 million Australians had at least one allergic disease. That is an incredible figure in a population of our size. Around 78 per cent of those with allergies were aged between 15 and 64, so even though we are increasingly concerned about the incidence of allergies amongst very young children, it is the case that the bulk of those people who are exposed to allergic reaction are between 15 and 64 years.

The report that I mentioned earlier considered the impacts of an ageing Australian population and, based on current trends, it is estimated that there will be a 70 per cent increase in the number of Australians with allergy from 4.1 million in 2007 to 7.68 million by 2050—that is more than one in four Australians who are likely to be exposed. So the consequences for quality of life for those who are exposed to allergic reaction and, particularly given the motion before us, the extreme effects of allergic reaction, namely anaphylaxis, are significant. They inevitably have consequences for the quality of life for individuals and their families, particularly in cases where small children are concerned. Family holidays, going to school and the very independence of individuals and families are affected significantly by anaphylaxis and allergies.

The consequences from a public health perspective for our economy are significant. The consequences in terms of health costs and the economic costs associated with productivity are clearly very significant, so it is timely that this resolution come before us tonight. I encourage others to take note of the resolution and, particularly for some of our piecemeal responses at a state and territory level, for those in a position to influence policy development to consider this resolution and the deliberations of the House. (Time expired)

Greg Hunt (Flinders, Liberal Party, Shadow Minister for Climate Action, Environment and Heritage) Share this | Link to this | Hansard source

I thank the member for Chisholm for this motion. I think it is a very important motion. Almost every member of this House will have had experience either on a personal basis or with family members, friends or constituents that have suffered from serious issues of allergy and therefore the risk of anaphylaxis.

It is an emerging and evolving problem in our society. Others are better qualified to define the cause, but the incidence is clear. We will all have our theories, and no doubt the exposure to different chemicals, different products and different elements of modern life contributes to this issue.

I want to proceed briefly in three phases: firstly, with a personal reflection; secondly, with a notion about the broader societal risk; and, thirdly, in terms of the solution. Let me deal with the personal reflection: my wife's goddaughter, Grace Diamond, is a beautiful girl in the upper levels of primary school on the Mornington Peninsula. She is extraordinarily artistic and bright but was born with a major allergy which, as she became a little older and travelled through her toddler years, was discovered to be a peanut allergy but at the extreme end. Whenever the family comes to our house there is a purging, as it were, of all items associated with nuts and, in particular, peanuts. The school, to its eternal credit, has adopted a no-nuts policy. We have this engagement with the family of this beautiful, young, highly intelligent girl but it is a broader issue to be aware of the threat that the family has to carry with them. Pens, which can be used for the immediate injection to deal with anaphylaxis, if it arises, put a different layer of responsibility on the problem. So it is not just an inconvenience for the parents; it is a great, lasting and abiding threat. This is part of a broader risk.

We know that around 20 per cent of cases of peanut allergy, for example, resolve but around 20 per cent of cases can become worse with time. About 60 per cent are stable. From the UK and the USA, we see that there has been a doubling of this one area of peanut allergy over five years. It is now estimated to affect one in 50 young infants, and we are seeing broader allergies with general nuts. The real issue here is that a minor problem can evolve into anaphylaxis. So there are two things we need to do going forward: one is education and two is a set of standards for our schools which are universally understood and which are at the appropriate level of protection. I thank the member for raising this issue. It has resonance in our family and resonance in our community. I think it is time for a national approach upon which we can all agree.

Kirsten Livermore (Capricornia, Australian Labor Party) Share this | Link to this | Hansard source

Order! The time allotted for this debate has expired. The debate is adjourned and the resumption of the debate will be made an order of the day for the next sitting.