Parents form support group as they grapple with anxiety caring for children with allergies

SINGAPORE — After their children were diagnosed with severe food allergies, Ms Joanne Seow, 36, and Ms Amanda Chan, 38, found that keeping them safe during mealtimes was just one of the many challenges they would face.

While they learnt ways to deal with the flare-ups, nothing prepared them for the isolation and anxiety that came with raising children who suffer from allergies.

Ms Seow’s older son Isaac Puah, aged seven, is allergic to cow’s milk and tree nuts. Her younger son Isaiah, aged three, is allergic to eggs, peanut, cow’s milk and shellfish.

Ms Chan’s son Riley Yong, who is five-and-a-half years old, has allergic rhinitis. Her younger son Corey, who is three-and-a-half years old, is allergic to eggs, peanut and cow’s milk.

The food allergies are so severe that a small amount of food such as eggs and cow’s milk would set off a dangerous reaction. Corey, for example, can get itchy, painful hives just smelling cooked eggs.

For some people, even indirect contact can trigger an allergic reaction. The American Academy of Allergy, Asthma and Immunology Airborne said that food allergens, from cooking vapours, for instance, can cause symptoms similar to a reaction coming from being in contact with pollen.

Ms Seow, an associate regulatory affairs manager and a pharmacist by training, said: “With clinic visits, there wasn’t enough time to get answers on how to deal with our kids’ allergies during their day-to-day activities. When we shared our experiences with other mums who have allergic kids and asked for advice, they’d tell us, ‘I went through it, you figure it out yourself’. It made us feel alone in this battle.”

With no one to turn to for practical advice and emotional support, Ms Seow and Ms Chan, who is self-employed, decided earlier this year to form a group called Speak — short for Singapore Parents of Eczema and Allergy Kids.

It is a network for families of children with allergies and the first parent-support group supported by the Asthma and Allergy Association (AAA) Singapore, where both women had met as volunteers and became fast friends.

Speak, which holds activities and talks conducted by healthcare professionals, now caters to more than 20 families. The goal is to be the go-to support network for all parents of children with allergies living in Singapore.

CHILDHOOD ALLERGIES BECOMING MORE COMMON

Ms Seow and Ms Chan are among the growing group of Singapore families with children battling allergies.

Allergies occur when the immune system develops an over-reaction to an allergen that is usually harmless to the body. Common types seen in children here are eczema, allergic rhinitis, asthma and food allergies.

While the numbers here have not reached the epidemic proportions of the West, some childhood allergies are becoming more common.

Associate Professor Anne Goh, senior consultant and head of allergy service at the department of paediatrics in KK Women’s and Children’s Hospital (KKH), said that the prevalence of asthma has risen from five to 20 per cent in children over the past 20 years.

Similar increases are seen with allergic rhinitis and eczema, she said. Researchers have also observed a changing pattern in food allergies in the last decade. It affects about 4 to 5 per cent of Singapore schoolchildren.

Peanut allergy, once rare in Singapore, is the most common cause of anaphylaxis in children here, based on a study published in Singapore Medical Journal in May 2014. It is now the second to third most common food allergy in young children, Assoc Prof Goh said.

Anaphylaxis is a potentially life-threatening, severe allergic reaction to allergens and typically requires medical attention — with symptoms including but not limited to breathing difficulties, swelling in the throat, and persistent dizziness or collapse.

Dr Chiang Wen Chin, president of AAA Singapore, said that children usually outgrow egg and milk allergies in the first five years, but peanut and tree nut allergies tend to persist into adulthood.

POSSIBLE REASONS FOR INCREASE IN CASES

A possible theory for the rapid rise of allergies in developed nations is excessive hygiene or cleanliness, Dr Chiang said.

Ethnic differences among different races may also influence food allergy and asthma risk.

The most striking feature observed is human migration, which appears to have a strong influence on food allergy risk, Dr Chiang said.

For example, a survey on peanut and tree nut allergy in Singapore and the Philippines found that ethnicity and place of birth were important risk factors.

Children of either Asian or white ancestry, who were born in Western countries, had a 3.5-fold increased risk of peanut allergy compared with those born in Asia, Dr Chiang noted.

Ethnic Asian children born in Western countries had a five-fold risk of tree nut allergy compared to Asia-born Asian children. By contrast, white children born in Asia had a significantly lower risk of nut allergy than expatriate white children, she added.

While there are effective ways to manage symptoms, the stress of caring for an allergic child can be overwhelming.

With anxiety a recurring theme among these families, Speak’s next group session later this year will be conducted by a psychologist, Ms Seow said.

Her own anxiety hit an all-time high after her older son Isaac, aged seven, had his first anaphylactic reaction at around seven months old. The severe life-threatening immune response could have killed him.

“The episode really shook us. He lost consciousness after ingesting just a quarter of an egg yolk. Thereafter, we watched him closely every day,” Ms Seow said.

SAFETY IN SCHOOL

Besides raising awareness of childhood allergies, Speak is also pushing for legislation change to keep allergic children safe while in school.

The first step would involve making it mandatory to train staff members in school to manage allergic reactions, Ms Seow said.

Unlike in countries such as the United States, there are currently no standardised guidelines and protocols on managing allergies across schools here, Ms Seow and Ms Chan said.

Mr Tham Kine Thong, director of school operations policy at the Ministry of Education, said that parents of children with serious medical conditions, such as anaphylaxis, are encouraged to discuss with the school how best to manage their children’s conditions.

Under certain circumstances, teachers can support in administering emergency medication, such as EpiPen (an injection to reverse allergic symptoms), to manage severe allergic reactions in students, Mr Tham said.

“This would include cases where the student’s parents have previously declared the student’s medical condition to the school, the teacher has been authorised by the parents to help administer such emergency medication and has undergone the requisite training to administer the medication, and the administration of such emergency medication is in accordance with the approved instructions of the student's doctor,” Mr Tham said.

“As an individual might have specific requirements and personal responsibility is important for safety, parents should guide their children to manage their specific condition in an age-appropriate way,” he added.

Speak’s founders feel that some schools are not doing enough.

Ms Chan said: “When we first started exploring pre-school options for my son back in 2017, we realised quickly there was an immense lack of awareness of allergies, especially food allergies.

“From experience, maintaining a collaborative stance with all caregivers is crucial — it keeps them safe and allow them to thrive in school.”

Ms Chan said that she was fortunate to have found a pre-school with supportive staff members and teachers, who go the extra mile to manage her son’s allergies.

“The school cook will make Corey’s lunch first, then cook for the rest of the students if eggs are involved. Other parents have also become more inclusive when they become aware of his allergies, and give me advance notice for birthday parties, so that I can bake him something that does not contain eggs, dairy and peanuts,” Ms Chan said.

By contrast, Ms Seow had to push for her older son Isaac’s pre-school teachers to get special training to use EpiPen in an emergency situation and recognise symptoms of an allergic reaction.

The boy was also alienated because of his allergies, she said. For example, he was asked to sit alone at every refreshment break.

“That created another set of issues as he developed social anxiety. He was afraid of everything, from meeting new people, loud noises to changes in situations,” Ms Seow said.

“Thankfully, the primary school my son is now in takes his allergies seriously after we highlighted the severity. The teachers also include him in food-related activities after taking the precautions, as they don’t want him to feel left out,” she added.

Even as the mothers hope to educate schools on childhood allergies, they understand the importance of teaching their children to recognise that certain food is off-limits for them.

“We know that our children can never be the same as other kids. As they grow older, we cannot be the one to keep them safe all the time. They need to understand and ‘own’ their allergy management, protect themselves and act quickly during an allergic reaction,” Ms Seow said.

For more information on Speak, visit www.facebook.com/groups/speakallergysquad/.