An Auckland woman regularly parked near Auckland City Hospital to give her daughter tiny amounts of peanut butter when she was a baby. Photo / Doug Sherring
Parents are parking near hospitals and GP practices before giving their children food to test for a serious allergic reaction.
Allergy NZ says it gets phone calls from parents who have carried out "food challenges" on their children in hospital carparks, because of growing wait lists with specialists. And the situation is particularly bad in the regions.
Families have told the Weekend Herald of GPs advising the best option is to test foods on their children when near a hospital.
But Allergy NZ chief executive Mark Dixon said doing so could feel like "Russian roulette" to parents with kids who have severe allergies - and the safest place for the food challenges was in hospital, not carparks.
"People are being asked to take risks because of capacity issues."
Food allergies reactions such as eczema, nausea and vomiting, to life-threatening anaphylaxis, which sends the body into shock.
Children can grow out of some allergies, but others persist into adulthood.
A food challenge or feeding test can determine if allergen sensitivity has changed or gone away. At hospital, challenges are done by an experienced nurse, who gives increasing amounts of the food over about six hours. Most reactions resolve without treatment, or with antihistamines.
If skin and blood tests indicate a reaction is unlikely then specialists can advise that some foods be trialled at home.
In some areas it can take about a year to book a hospital food challenge after a referral from a GP.
A North Island woman, who asked not to be named, said her daughter's doctor advised her more than once to consider trialling food near the hospital.
Her 10-year-old daughter has had severe allergies, including to peanuts. Hospital food testing over the years has shown she's not allergic to walnuts, pistachios, cashews and almonds. However, her GP indicated the chances of getting more hospital-based challenges were slim.
"There are still a vast amount of nuts that she could be highly allergic to. It's about wanting to narrow it down from 30 things she could die from, to just three things.
"[Her GP] suggested if I wanted to try any of the other nuts for her, to go and sit in the hospital carpark and do it. This isn't a reflection on him not being professional, it's just the state of the system."
Kylie, who asked for her surname to be withheld, regularly parked near Auckland City Hospital to give her daughter tiny amounts of peanut butter when she was a baby.
Her difficulties started when she found her 3-month-old daughter covered in severe eczema, which was something eventually traced to a nut allergy, after Kylie had eaten a variety of nuts the night before.
A private specialist mapped out two years' of gradual exposures that successfully lessened some allergies. That involved small exposure to about 10 foods, which were deemed safe enough to do at home every week. Food challenges to measure progress were done at hospital.
Nervous, Kylie did the weekly peanut butter exposures near hospital, sometimes in the carpark, sometimes on a bench.
"You have an action plan that points out the worst-case scenario symptoms - hives, itchy throat, shortness of breath. If any of those signs happen you would do [an adrenaline shot]."
After one she ran inside with her daughter, now 5.
"I was being probably a bit overdramatic, but it's quite hard to know if they are having an attack because they are just quiet."
Christchurch teacher Bex Roberts is severely allergic to peanuts and fish, and her daughter is allergic to kiwifruit and has a risk of anaphylaxis. Four years ago and before her two children started school Roberts wanted to know if they shared her allergies.
However, her GP couldn't supervise food challenges, and said they wouldn't get in at the hospital as there wasn't evidence they had allergies. In the end, Roberts' husband took the children, 2 and 4, to a bench near the hospital and gave them peanut butter sandwiches. Fortunately, they weren't allergic.
"The doctor basically said, 'You are better to be right near the hospital where people do breathing tubes for young people all the time'.
"With anaphylaxis, kids can go downhill so quickly. I understand why my doctor didn't want to take that on."
Neither the Ministry of Health or the New Zealand Medical Association (NZMA) were aware of food challenges or trials being done outside hospitals or doctors' clinics.
A ministry spokesman said food allergies were common and referrals to paediatric services could be high and services needed to rank them according to seriousness and balance them against the resources that were available.
Hospitals, including Starship, aimed to increase food challenges over summer when there were fewer unwell children, the ministry spokesman said.
"Food challenges for infants and children where home introduction of a food would be advised but parents prefer a hospital-supervised challenge are often triaged to this category of 'summer catch-up', or are offered a cancellation slot as they become available."
Dr Jan White, NZMA chairwoman of the General Practitioner Council, said parents were strongly encouraged to talk to their doctor before taking any action.
"As much as we want to support our patients, we do not have the necessary space, staff or funding to face this sort of challenge in the community, and would recommend that people wait to see a specialist and undertake the food test challenge in a controlled environment."
Auckland DHB staff were aware some parents were giving their child new foods while near the hospital. Dr Mike Shepherd, Starship child health director for medical and community, said parents worried about introducing new foods at home should first talk to their GP.
"It's important to introduce foods, including common allergy-causing foods such as eggs or peanuts, by 12 months of age."
New health spending was a feature of this week's Budget, and a large chunk - $1.9 billion over five years - was going on various mental health initiatives and capital investment for hospitals.
National's health spokesman Michael Woodhouse said he was aware of families going private to get their child to see an allergy specialist, and news of food testing in carparks was concerning.
"The fact that this would be going on is an extraordinary example of the lengths being taken to circumvent what are growing pressures in our DHBs.
"And cost-pressure money for DHBs that was in the Budget is going to do nothing to assist that."
Allergies in New Zealand
• The Growing up in New Zealand study has found at least one in 10 children are doctor-diagnosed with a food allergy by the age of 2.
• Allergy NZ says recent research suggests the risk of allergy onset later in life can be reduced by giving a child a wide range of foods from about 6 months, but not before 4 months, while continuing to breastfeed.
Trialling food at home 'not worth the risk'
Jessica Hammond has two children, both of whom have allergies with a risk of anaphylaxis. When her youngest was 5 she had a severe reaction to a pistachio food challenge at Wellington Hospital.
"She had adrenaline, it didn't work. She had to have oxygen and salbutamol [a medication to open airways] and stay in hospital overnight.
"My other child was with me. It is terrifying. It's awful. You feel really sick, and it's one of those things - because the little kids are there - I remember clearly telling myself, 'You can cry later'."
Hammond said she felt well served by her DHB and trusted her children's specialist. However, she's decided not to act on advice that other nuts are safe to trial at home.
"There's a level of anxiety. You just look at the costs and benefits and I think, well, they're just never going to have pecans or walnuts or almonds."
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