When Rupert Hastings first tried peanut butter at just six months old he reacted almost instantly.
Within 20 seconds, he had hives all over his face, which spread to his body. Then his eyes and lips started to swell.
"My friend's a nurse and I messaged her pictures of Rupert's reaction. She said I'd probably take him to hospital, so that's what we did," Rupert's mother, Emily says.
"It was scary."
Now, Rupert is 15 months old and is severely allergic to peanuts and egg, and mildly allergic to Brazil nuts and sunflower seeds.
Emily says the journey has been "incredibly hard".
"We found the information hard to gather and then decipher what was the best course for Rupert and we still don't know what the best course of action is," she says.
They had been seeing an allergist in Brisbane, but are now travelling 1,000km to Sydney to see a specialist in oral immunotherapy.
It's a treatment for allergies, not currently approved in Australia by the Therapeutic Goods Administration (TGA).
"But reading through all the research papers and speaking to some other families who have had really great results on it, I think it's something that we definitely need to explore," Emily says.
"That's something that we have to weigh up as his parents.
"Do we strictly avoid the allergy and the peanut, and he lives his life for the rest of time with an Epipen, constantly avoiding 'may contain' or anything that has peanuts in it?
"Or do we try something and in the process risk anaphylactic reactions, but potentially desensitise him to peanuts so that he has a freer life?"
'We've got a big problem'
Allergic disease is one of Australia’s greatest public health challenges, with one in 10 children developing a proven food allergy in their first year of life.
The most common in the first twelve months is egg, but generally it is outgrown by six years old.
However, three quarters of those with an allergy to peanuts, tree nuts, sesame and seafood carry the allergy into adulthood.
According to data released to the ABC, the number of children being admitted to hospital with anaphylaxis is also rising.
In Queensland alone, there was a more than 300 per cent increase in the number of children between 0-17 years who were admitted to hospital with anaphylaxis and anaphylactic shock due to adverse food reaction in the past decade to the 2022/2023 financial year.
Queensland Health says it is unclear whether this reflects a true increase in allergy prevalence or improvements in awareness, diagnosis, and healthcare practices in the past 10 years.
[queensland graph]However, national figures from the Australian Commission on Safety and Quality in Health Care also reflect a rise in emergency presentations for anaphylaxis — 51 per cent in the five years to 2019/2020.
But there is still a lack of specialist services available to families, and the Australian Department of Health says the only approved treatment available for severe food allergies is adrenaline in emergencies.
The current advice is still strict avoidance of the allergens. For families like the Hastings, it means constantly being on edge.
"It's always on our mind, we have to watch what we eat if we go out to restaurants," Emily says.
"And obviously, we have to pack an Epipen for him wherever we go, so it's something that you can't forget about.
"I'm now back at work, and that's something to consider when he's not in my care — about what can potentially go wrong.
"All those things that you think about normally as a parent, it's then heightened by the fact that this is something that is severe.
"You think about allergies and you think, 'Oh yeah, that would be hard', but until you're faced with it, and it's your own child's life, it's a whole different ball game."
Paediatric immunologist and allergist Dr Jane Peake says Australia is known to be the “allergy capital of the world”.
“We've got a big problem in Australia,” she says.
“There’s still a lot of work to do, but I do think that there’s a lot of inroads starting to happen.”
In Queensland, the only public paediatric multidisciplinary specialist immunology and allergy clinic is at the Queensland Children’s hospital.
In 2023, QPIAS Specialists saw almost 7,000 patients from across the state — 1,595 of them were new patients.
Riley Bloomfield has been travelling from Rockhampton with his mum Nicole for years to see Dr Peake — first for a dust mite allergy, and now for dairy and beef.
"We’d have to come back to Brisbane every six months while he was undergoing that desensitisation [for dust mites] and that lasted three to four years," Nicole says.
"It’s definitely made a difference to his day-to-day life, just for that dust mite allergy. To get rid of that at least has been huge, and that’s all thanks to the clinic here."
Dr Peake says work is underway to educate and upskill general practitioners, paediatricians, nurses, pharmacists and dieticians, to help manage mild allergies, or allergy concerns across the country.
"We do need more allergists and immunologists in Australia and there is a number of doctors in training," Dr Peake says.
"[But] we need to continue to look at how we make best use of our time and so we're always looking at new ways of managing patients.
"One of the positive things that came out of COVID is the fact that we can now do a lot of telehealth consultations. So we're often doing that with patients for the first time, particularly if they live in rural or remote areas."
Inquiry recognised Australia's allergy problem
The exact cause in the rise of Australia's food allergy is still unknown.
Placed under the spotlight in a 2019 bipartisan parliamentary inquiry, 24 recommendations were made to address the critical need for a national action plan.
In 2022, federal government funding saw the establishment of the National Allergy Centre of Excellence (NACE) and the National Allergy Council.
The NACE, now the country's peak allergy research body, will help accelerate research and streamline the start-up of clinical trials across the country.
The Murdoch Children's Research Institute, which hosts the NACE, has become the lead site for several allergy trials, and Professor Kirsten Perrett is the principal investigator on eight.
"For the first time we have an Australian allergy research body, bringing together experts in drug, food, insect and respiratory allergic disease to address this national critical problem," Professor Perrett says.
"This is a critical step forward in our fight against all aspects of allergic disease.
"The clinical trials network helps to give Australian families faster access to emerging treatment options, many of which are already under investigation overseas."
Fifteen-year-old Ted Wardle is taking part in one of the multi-centre national trials called Aravax, which is investigating a novel immunotherapy injection.
He's struggled with a peanut allergy from birth, and says it impacts his daily life.
"If I'm hanging out with my friends I always have to double check what I'm about to eat or sometimes I won't be able to eat the same things that my friends will have," he says.
"It's always a presence… I've got to be careful, I've got to check what I'm about to eat.
"[Otherwise] I get rashes, my throat can close up, I get really itchy – I could die."
The trial is currently looking for four to 11 year olds in Victoria, Western Australia, New South Wales and South Australia.
The injection aims to retrain the immune system to tolerate peanut allergens and reduce the risk of severe reactions.
At MCRI and Queensland Children's Hospital, another peanut trial is underway using a drug patch, VITESSE.
"Which has been very promising," Dr Jane Peake says.
"That was in young children aged one to three. We're now enrolling patients from four to seven."
It works by exposing a small amount of peanut protein via the skin, designed to desensitise a person through repeated exposures.
The trial is currently recruiting four to seven year olds in Victoria, Western Australia, New South Wales, Queensland and South Australia.
'People are looking for that holy grail'
Researchers hope with ongoing support from the Australian government, community and industry partners, they can keep the "momentum going".
"To change the trajectory of allergic disease in Australia, it’s going to take a collaborative approach," Professor Perrett says.
Dr Peake says people often look at Australia as being very "conservative" in the way it manages allergies.
"I think that's because we do seem to have allergies in the more severe end of the spectrum," she says.
"But more importantly, I think we're really very keen to be sure that we're doing safe evidence-based care."
Dr Peake says it isn't a "one size fits all".
"And I think we have to be really careful to select the right patients for any treatment option, and to consider always the pros and the cons of those treatments," she says.
"I think we have a lot of people looking for that holy grail, the cure of their child's allergies, and I think that that's still probably a little bit elusive."
