Ms Anna Burke (Chisholm, Australian Labor Party) Share this | Link to this | Hansard source

I move:

That this House:

(1)

notes that it is estimated that anaphylaxis effects up to 380 000 Australians who experience a food allergy, 5-8 per cent of whom are children;

(2)

recognises that tragically, three Australian students died between March 2002 and April 2003 during school hours as a result of an anaphylactic reaction;

(3)

acknowledges that a simple medical treatment is all that is needed to treat an anaphylactic reaction, prevent loss of life and provide the necessary time to transport the victim to hospital for further medical treatment; and

(4)

asks that the Government introduces legislation, devised in a COAG capacity, to ensure all preschools, primary and secondary schools:

(a)

have necessary policies and procedures to provide effective response to a student who experiences an anaphylactic reaction;

(b)

include policies that reduce the exposure to causative agents in the classroom environment;

(c)

ensure staff members are appropriately trained to support life in the event of an anaphylactic reaction; and

(d)

develop an individual action plan for each student that has an anaphylactic allergy that comprises treatment plans from the student’s physician.

I have spoken previously in the House about the tragic death of Alex Baptist—he was only four; he went to kindy and never came home—due to anaphylactic shock, and the continuing grief suffered by his parents. I have had the privilege of speaking to them: Nigel and Martha. Sadly, three other children have also died from anaphylactic shock since 2002. As in Alex’s case, these tragic cases also occurred during school hours.

Deaths from anaphylactic shock can be averted if the correct measures and safeguards are put in place. Amongst other things, these preventative actions would involve the training of all teachers in reducing exposure to anaphylaxis-inducing agents at school and in the correct manner to administer an EpiPen, the only effective treatment, which buys valuable time until the child suffering the attack can be seen by a medical professional. The Canadian government has introduced such a law—it is known as Sabrina’s law. The Victorian government has recently announced that if re-elected it would also introduce similar legislation. I applaud that move. I cannot see why we in the federal sphere cannot do likewise and ensure that, via COAG, legislation consistent across all states is introduced to train all teachers and childcare workers in the analysis of anaphylaxis and the correct use of an EpiPen. The lives of our children literally depend upon it.

A recent Australian study has estimated that a quarter of the population will have a reaction to food, especially during infancy and early childhood. The number of children suffering from food allergies has doubled in a generation. Currently 10 per cent of children and two per cent of adults have some form of food allergy. Many of these food allergies are potentially life threatening. This is particularly the case with peanuts as even small traces may trigger symptoms and cause death. Recent international studies show peanut allergy has doubled over a five-year period, with approximately one per cent of children being allergic to peanuts. No comprehensive statistics are kept of deaths due to allergic reactions. However, one study has found that over 90 per cent of fatal or near-fatal anaphylactic shocks from food are caused by peanuts and tree nuts.

It is estimated that three to five per cent of preschool children are allergic to one or more of the common food allergens, with 0.6 per cent of Australian preschoolers and schoolchildren having suffered at least one episode of anaphylaxis. The adrenaline auto-injector treatment known as an EpiPen is currently used by one in every 544 Australian children under the age of 10. This is an extraordinary amount. Despite the lack of statistics, it is believed that up to 10 Australians die each year from anaphylaxis. Thousands more require urgent medical attention. Research conducted overseas suggests that roasting peanuts enhances allergic reaction. Preliminary investigations have been made in finding an effective vaccine. Despite the increased prevalence and the increased burden this serious condition presents for parents, teachers and our health system, there have been few studies into food allergies in Australia.

A Beazley Labor government will deliver $5 million for research into understanding the causes of serious food allergies, with a specific focus on peanut allergies, in the hope that we can find a cure. The research, with funding to be administered by the National Health and Medical Research Council, will aim to build a better understanding of the unexplained, dramatic increase in the incidence of food allergies in Australian children and to search for the answers we need to protect them. A Beazley Labor government will also work with the states and territories to ensure that uniform national guidelines for preschools and schools are implemented. These are laws that the Labor government in Victoria have announced they will introduce if re-elected.

The Labor government in Victoria will ensure that up to 70,000 teachers and childcare workers will be trained under the proposal, which will cost at least $2.1 million over five years. We know that lives are being lost because of the lack of early identification. The training program is equipping childcare workers and teachers with the resources required to take action immediately with an adrenalin injection, which can save lives. The training will include ways to minimise risk, recognise the signs and symptoms of an allergic reaction, and perform emergency treatment with an EpiPen, which gives an instant adrenaline interaction. Schools would also be required by law to have an anaphylactic policy. The AMA says that Victoria is now leading the world in introducing mandatory allergy training. This should be done so that no more small lives are lost.

As the mother of a four-year-old with anaphylaxis, this turns your mind to the dangers of such a thing. When you send your small child off to child care you do not expect that they will come into contact with an allergen and never come home. Nigel and Martha Baptist ask us to remember their dear boy. He may be gone, but hopefully he is not forgotten. Indeed, the introduction of these laws by the Bracks government will mean that he is not forgotten. I move the motion today in memory of Alex and hope that we never again see a small child die through an allergy which could have been prevented if someone had been appropriately trained at that school.

David Hawker (Speaker) Share this | Link to this | Hansard source

Is the motion seconded?

Ann Corcoran (Isaacs, Australian Labor Party, Shadow Parliamentary Secretary for Immigration) Share this | Link to this | Hansard source

I second the motion and reserve my right to speak.

John Anderson (Gwydir, National Party) Share this | Link to this | Hansard source

I join with the honourable member who has moved this motion in expressing real sympathy to the parents and family of this lost child. It is not an easy experience for any family, particularly when, as I understand is the case, anaphylaxis can be dealt with. I understand the sentiments behind the motion before the House. There is no doubt that anaphylaxis is a severe and potentially life-threatening form of allergic reaction. It usually comes on very suddenly and unexpectedly. It can affect many parts of the body and can result in breathing difficulties, collapse and, if untreated, in worst-case scenarios, death. Allergies to foods, medications, blood products and the venom of stinging insects such as bees, wasps and ants can result in an attack.

It has to be said that data on the incidence of the problem is quite limited. In the period 2004-05 the AIHW morbidity dataset recorded a total of just over 2,000 hospital admissions for this condition, of which 901 are believed to have been due to food allergy problems and 713 were unable to be accurately outlined in terms of the specific cause. However hospital data do not give the full picture, as episodes of anaphylaxis are largely managed without admission to hospital—for example, in emergency departments.

A South Australian study has estimated that about one child in 170 between the ages of three and 17 has had at least one episode of anaphylaxis. Of the 25 children with anaphylaxis identified in the study, that of some 14, or over half, was due to food allergies. Thankfully deaths are rare. Indeed there is an average of 15 deaths from anaphylaxis per year in Australia across all age groups. But such deaths, as we have heard this afternoon, are quite tragic. They are preventable if quick and effective action is taken to treat a person who is having such a reaction. That necessary action includes first aid, laying a person flat with elevated legs, seeking emergency medical assistance and following standard resuscitation measures if there is no pulse or breathing. Injection of adrenaline may also be required.

The safest way to give adrenaline, outside of a hospital or a doctor’s surgery, is by the use of an auto-injector. In Australia, such devices are available for both adults and children—EpiPen for adults and EpiPenJr for children. These disposable devices deliver one measured dose of adrenaline and are designed to be self-administered or given by people without formal medical or nursing training.

The Commonwealth government subsidises the cost of adrenaline auto-injector devices through the Pharmaceutical Benefits Scheme for those who have been assessed by a specialist doctor as being at significant risk of the condition. The Pharmaceutical Benefits Scheme requires that the injector devices be prescribed only as part of a comprehensive prevention program, which includes an emergency action plan and training in recognising the symptoms of anaphylaxis and the use of the device. It is worth noting that a range of educational materials and suggested emergency action plans is available on the ASCIA website: www.allergy.org.au.

The policies and training that are recommended as part of this motion moved by Ms Burke would assist in both reducing the occurrence of reactions to this condition and ensuring that children who had had such reactions at preschool, primary school or high school would receive prompt and effective management. This would undoubtedly reduce the risk of death from this life-threatening condition.

In relation to subparagraph (d) of the motion: ‘develop an individual action plan for each student’, I think it is worth making the point that the Australian government subsidises the cost of adrenalin treatment for people who are known to be at significant risk. I make the point that it is not clear whether legislative approaches are necessary to achieve the very desirable aim of this proposal. If such approaches are required they would of course be the responsibility of the state and territory jurisdictions. I can advise that the government has sought input by the office of the Minister for Health and Ageing, through the office of the Minister for Education, Science and Training, in relation to further measures which could be taken in schools, which may or may not require legislative backing.

Ann Corcoran (Isaacs, Australian Labor Party, Shadow Parliamentary Secretary for Immigration) Share this | Link to this | Hansard source

In September 2004 two constituents in my electorate of Isaacs lost their son in circumstances that could have been avoided. As we have heard, Martha and Nigel Baptist lost their four-year-old son, Alex, to anaphylaxis, or severe allergic reaction. Alex was allergic to peanuts. I am told that he came into contact with some peanuts at kindergarten, he reacted and, despite efforts by staff to counter the reaction, he died. Alex’s death was preventable, and we must do all we can to ensure that other children do not die from similar preventable causes.

Any allergic reaction, including the most extreme form, anaphylactic shock, occurs because the body’s immune system reacts inappropriately in response to the presence of a substance that it wrongly perceives as a threat. Anaphylaxis is a severe allergic reaction at the extreme end of the allergic spectrum. The whole body can be affected, usually within minutes of exposure to the allergen. It can, as we know, result in death. There are three things that we now need to do to minimise the risk of anaphylaxis or allergy attacks. We need to know more about allergies and why the number of children with allergies is growing and growing so quickly. We need to ensure that people who work with children have the skills and the confidence to react quickly and appropriately when a child in their care has an allergic reaction. We also need to make the community at large more aware of anaphylaxis. We need to be able to recognise an allergic reaction if someone near us has one, and we need to know what we can do until expert help arrives. Often what we do immediately can mean the difference between life and death.

Studies conducted in the United Kingdom, the United States and Canada show that cases of peanut allergy alone have doubled since 2000. In Australia, the research has been minimal. Experts at Melbourne’s Royal Children’s Hospital have referred to the dramatic rise in cases as an ‘allergy epidemic’. We know that Australia has one of the highest rates of children with allergies. About one in 100 children are allergic to peanuts, as Alex was. We need to start investing in serious research to find out why so many more people are developing this condition. Labor, in government, has already committed itself to funding research into the causes of serious food allergies. I urge the present government to do likewise.

We need to ensure that those working with children are aware of the potential of an allergic reaction and what to do if one occurs. When a child with anaphylaxis has a reaction, time is crucial. In some cases it can be a matter of minutes between life and death. This means that the person caring for that child needs to be fully aware of what can trigger an attack and they need to be properly trained in how to respond. We need to ensure that those who work in child care and schools are trained in how to treat children who go into anaphylactic shock. This motion calls on the federal government, through COAG, to introduce legislation to ensure that this occurs.

Last week the Victorian government announced that it will do just that. Victoria will be the first state to mandate training for childcare workers, kindergarten teachers and school teachers. This is very good news and the Victorian government is to be congratulated on this step. Now we need the rest of Australia to follow suit.

Anaphylaxis also needs to be understood properly in the broader community. We need a community campaign to make us all aware of the dangers of anaphylaxis and the things we can do if someone near us has an allergic reaction. We need to understand that allergies are real and are not to be dismissed as imaginary. I suggest that, as a first step, everyone listening to this debate pays a visit to the website of Anaphylaxis Australia Inc., AAI. AAI was established in 1993 to support and assist those affected by anaphylaxis and it has lots of useful information on its website.

I would like to congratulate my colleague the member for Chisholm for bringing forward this motion today. I would also like to express my admiration for the work the Baptist family is doing. These people could have turned inwards after Alex’s death, but they have not. They are out there doing all they can to ensure that other children do not die in this way. I urge the government to act now, to do the research and ensure those working with children know what to do in the event of an attack, and to start a campaign to properly inform all of us about anaphylaxis. We must do all we can to stop another child dying unnecessarily.

Andrew Southcott (Boothby, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the motion on anaphylaxis, moved by Ms Burke. Anaphylaxis is becoming more prevalent. At least one in 100 children in Australia have had an episode of nut allergy and would be at risk from anaphylaxis. The incidence has doubled over the last 30 years. Fortunately, deaths from anaphylaxis are rare and they are also often preventable if immediate first aid is provided, which may require the use of intramuscular adrenalin through an EpiPen.

This issue has been highlighted by a number of recent cases. There has been a New South Wales coroner’s case involving the administration, on a school camp, of peanut butter to a child with peanut allergy. The coroner has made several recommendations to avoid this ever happening again. Of course, as with all types of allergy, it is very important to avoid the triggers. In most cases these are food; sometimes they are bee venom or a bee sting.

I welcome this motion from the member for Chisholm and her initiative in bringing this motion forward for debate.  I think it would be a great thing if, at COAG, we could see that all schools, preschools, childcare centres and kindergartens have guidelines for dealing with anaphylaxis. The one caution I have is that I am not sure that it would require national legislation. I think it is something that could be done through COAG, through a council of education and health ministers working together.

I should also say that I am indebted to Dr Mike Gold, who is a paediatric allergist at the Women’s and Children’s Hospital, for his help on anaphylaxis and for directing me to Anaphylaxis Australia’s website, which has already been mentioned, and the professional website, the ASCIA website: allergy.org.au.

When we look at schools and anaphylaxis we see that there are no national guidelines for managing anaphylaxis in a school setting. Each state does things differently, and national guidelines would play an important role in making sure that every school and every childcare centre has the gold standard. South Australia was the first state to introduce a uniform policy on anaphylaxis. It was the first state to have EpiPens in schools. I recognise the recent efforts that Victoria has made to make sure that anaphylaxis is much better resourced in the public system.

I asked a principal of a primary school in my electorate what her school did in relation to anaphylaxis and she informed me that all teachers at that school have done a first aid course and know how to use an EpiPen. I cannot say whether this is the experience in all schools, but certainly that one school I visited had a very well thought through policy on allergy.

It is very important that all teachers have training in recognising a child with anaphylaxis, and treating it. We also need policies to help children avoid their triggers. Staff and teachers need to be trained to recognise anaphylaxis and use the EpiPen. One issue here is that there is no standard first aid course. In South Australia it is done by St John Ambulance and the Australian Red Cross.  Often the quality of the first aid training depends on who is doing the training.

Another issue is the public funding of facilities which evaluate and test people with allergies. This is a responsibility for the states and territories but these services are often not well resourced and there are waiting lists for children with anaphylaxis.

There are four steps in dealing with the issue of preventing food anaphylaxis in schools, preschools and childcare centres. Firstly, it is important that the centre has medical information about the child at the time of enrolment, including a signed anaphylaxis action plan. Secondly, we need to educate the carers on the importance of avoiding triggers and using EpiPens. Ideally, education of all staff should be by qualified professionals and reinforced every year. Thirdly, every centre—every school—needs strategies to avoid triggers. This depends on the child, their peers and all school personnel. Fourthly, we need age-appropriate education of the child.

When we look at food, it is very important that there be no sharing of food. At the school level, a policy of risk minimisation for certain foods, especially peanuts and tree nuts, should be followed. This includes removing items containing nuts from school canteens. Nuts should not be taken on school camps. For children under seven, classmates of students with peanut allergy should avoid bringing sandwiches with peanut butter in them. I commend this motion to the House for bringing prominence to this issue.

Harry Jenkins (Scullin, Australian Labor Party) Share this | Link to this | Hansard source

I congratulate the member for Chisholm on bringing this motion on anaphylaxis forward. I also congratulate her for giving prominence to this issue because I think it is an example of where members of this parliament, through their personal experience in their role as community leaders, can lead community awareness and community education. And that is a very important aspect of this private member’s bill.

The term ‘anaphylaxis’ may be a mystery to a lot of people but through contact with children that have anaphylaxis events comes an understanding that it is an allergic reaction to certain things. By further discussion we arrive at an understanding that those allergens can be quite wide. There is a need in each individual case to have a particular understanding of the anaphylaxis incident.

The common incident that most people understand is a reaction to nuts, peanuts in particular. Through that understanding there is a knowledge that there is a need to have care, where there has been an allergic reaction identified, to take preventive action. So, whilst we acknowledge the incidence of anaphylaxis and whilst we acknowledge the tragedies that have occurred, we also acknowledge the good work that is being done by a great range of people in trying to make sure that the community education and awareness is heightened.

Some of the studies from overseas—particularly North American and European studies—indicate that there could be 2,500 to 4,000 new cases per year in Australia. Death from anaphylaxis is less common—an estimated mortality rate of one per three million population. Hospital emergency department data show a death rate of about one per 100 to 200 episodes of anaphylaxis presentation.

But the purpose of much of this motion is to make sure that preventative action is taken and that we have an understanding of each individual’s circumstances so that we can put in place an individual action plan for each person. That is especially important in schools, so that where there has been a previous event, and where we are able to identify the cause, there is an understanding throughout the whole school or preschool community to ensure that things are put in place to minimise the chances of there being an event.

Then the next step in the cases where there is an allergic event is that we understand that the first aid that is taken is very important. Of course one would call emergency services and seek an ambulance to attend as quickly as possible, but we need an understanding that, if people have the knowledge and therefore can act with confidence and assuredness, there is a great deal that can be done in the first few moments after the event is identified.

The training that is talked about is important in giving people that confidence. This is not something that can be done a little bit just at the start of the year where the devices such as the EpiPen might be introduced to people, where they might have a go with a pseudo one to see how it works. There is a need to talk the action through in a real-life situation, because there can be nothing more important than a person being able to be confident about the simple actions that will be taken that are of such great importance in preventing further progression of the anaphylactic events.

So I applaud the member for Chisholm. I hope that this can be looked at at COAG. I applaud the indication by Premier Bracks in making this an issue that he is willing to put resources towards so that 70,000 teachers and childcare workers can be trained in the precautionary first aid actions if there is an anaphylactic event. We emphasise the need for parents and children to understand their circumstances and to have a strategic plan in place that is shared with all those who come in contact with the child to make sure that we prevent those things. But the most important thing is that action can be taken on this and we should be confident in training people that that action can be taken and will be taken.

Mal Washer (Moore, Liberal Party) Share this | Link to this | Hansard source

Like the previous speaker, I thank the member for Chisholm for bringing this important issue before the House and I thank all the previous speakers for their great interest. Anaphylaxis is a serious rapid onset allergic reaction that can cause death. Severe anaphylaxis is characterised by life-threatening upper airway obstruction, bronchospasm and/or hypotension. Studies have shown that food allergy is the most common cause of anaphylactic reactions in children. Although almost any food can trigger an allergic reaction, most reactions are triggered by eggs, cow’s milk, peanuts, tree nuts, soy, wheat, seeds or seafood. In adults, insect venom, such as that of the honeybee, wasps and Australian native ants—the jack jumper ant in particular—and medication can also cause problems. The myrmecia ant species, or jack jumper ant, is worth mentioning as in areas where it is present one in 50 Australian adults has reported an anaphylactic episode following stinging. In some cases cofactors can play a role in provoking an anaphylactic reaction. This so-called ‘summation anaphylaxis’ can explain the occurrence of intermittent anaphylactic episodes, despite frequent allergen exposure. In young people especially, physical activity is one of the most common cofactors contributing to anaphylaxis.

Although allergic reactions to food are common in children, severe life-threatening reactions such as anaphylaxis are uncommon. In Australia the prevalence of food-induced anaphylaxis in preschool aged children was one in 170 and in school aged children one in 1,900. In fact, a survey of 4,000 children showed 90 per cent of anaphylactic food reactions occurred in preschool aged children. However, more than 90 per cent of the fatal reactions to foods occurred in children aged five years and over.

Although anaphylactic episodes are rare, schools must have policies in place to deal with a life-threatening situation should it arise. With quick, effective action the severity of the reaction can be easily managed and a potential tragedy averted. Most state and territory government education systems have this in place already, except, unfortunately, the Northern Territory. Information about and guidelines for the management of anaphylaxis are at present in these schools. These policies recommend individual healthcare management plans for students who are at risk. The ACT, New South Wales and South Australian policies provide the most comprehensive information about anaphylaxis and its management. But, as the previous speaker said, this should be a national policy.

Any policy introduced would need to include the following four steps. First, the school must obtain medical information about each child. This must include clear identification such as a photo, documentation of the allergic triggers, documentation of the first aid response and any prescribed medication and contact details of the doctor who signed the documentation. As food allergies can change, this medical information needs to be reviewed every one to two years. Second, education of those responsible for the care of children concerning the risk, prevention and action that needs to be taken in the event of a child having a severe allergic reaction must be provided. This would include instructions on the use of an adrenaline auto-injector device such as an EpiPen.

Third, there must be the implementation of practical strategies to avoid exposure of susceptible children to known triggers, such as no trading or sharing of food; prevention of cross-contamination during the handling, preparation and serving of food; and restricted use of food in crafts, cooking classes, science experimentations and so on. Fourth, there should be age-appropriate education of children with severe food allergies.  Obviously, in childcare centres and preschools children are dependent on carers for providing a safe environment.

I strongly urge state governments and private education sectors that have not implemented comprehensive policies to do so.  Deaths from anaphylaxis are preventable if quick and effective action is taken. It is unforgivable for any child to be at risk due to unnecessary ignorance or inadequate policy. The motion is one of excellence.

Duncan Kerr (Denison, Australian Labor Party) Share this | Link to this | Hansard source

May I acknowledge the excellent contributions by members on all sides of the House in relation to the motion proposed by the member for Chisholm. 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.