Tracking and Increasing Public Awareness for Food Allergies in Children

Ms He Ting Ru asked the Minister for Health how is the Ministry working with other agencies such as schools and those in the food preparation industry to increase public awareness of the potentially lethal nature of severe food allergy reactions.

Sir, the Growing Up in Singapore Towards healthy Outcomes (GUSTO) in 2017, showed that the overall prevalence of childhood food allergy in Singapore was low, between 1% and 3% in children aged 18 months to four years in age. This is generally lower than the prevalence reported in other jurisdictions. The National University Hospital (NUH) and KK Women's and Children's Hospital (KKH) plan to carry out another study to determine the current prevalence of food allergies in children.

There are also a number of inter-agency efforts in place to increase awareness on how to better prevent and manage food allergies. For the food industry, KKH is working with the Singapore Food Agency (SFA) to raise awareness among food handlers on food allergen risks by enhancing the content covered in the Workforce Skills Qualification (WSQ) Food Safety Course. In schools, our public healthcare institutions have been working with the Ministry of Education (MOE) and Early Childhood Development Agency (ECDA) to train primary and preschool teachers on emergency treatment of children with severe allergic reactions.

To better educate the public on food allergies and preventive measures, KKH and the Health Promotion Board (HPB) are developing more resources on managing and living with food allergies to complement existing materials available on Parent Hub. NUH has also been educating and supporting patients and caregivers on food allergies, in partnership with polyclinics, patient support groups and non-profit organisations.

Thank you, Mr Speaker. I thank the Senior Minister of State for the reply. I would like to declare that I have a family member who is affected by severe food allergies.

The thrust of my question is to understand whether, for example – I understand that in the last five years, there has been found to be a worldwide increase in prevalence of food allergies, especially in children. So, I am just wondering whether we have similar data in Singapore, because I note that a Straits Times article that was published recently, also stated that, for example, in 2014, I think there were 300 cases seen by one of the hospitals, and by 2020, it has gone up to 10,000.

So, again, trying to understand how much of that is due to, I guess, actual increase or how much of it is just increased public awareness? It will be helpful for us to know.

The second question really relates to the food handling industry and people who handle food in general. It has just been my experience that sometimes, even when we make it known in advance that we do have food allergies among one of the diners, there are times when, on occasion, we have actually been served with the allergen in question, when we specifically said that one of us is severely allergic to it. That is obviously far from ideal when it was a very near miss on one occasion when the food was literally almost put into the mouth. So, I hope that more awareness can be raised around this issue.

On other occasions, we have also been met with incomprehension from either from food waitresses or food handlers who literally do not understand what we are trying to tell them. So, I think that more work needs to be done from this perspective.

Other countries have taken the route of, such as food labelling where common allergens are displayed. And I think you do actually find it in some restaurants and some chains – they do have common allergens clearly labelled on menus. So, I think that is something that we could also look at.

And again, the Senior Minister of State earlier mentioned MOE and ECDA. I think if I am not wrong, ECDA has training for preschool teachers, where they train the use of the EpiPen. That is great because that by extension, that means that early childhood educators are aware of how to spot food allergies and how to handle that.

But I think, again, from my understanding of the situation, certain schools are probably a bit more advanced in terms of the public education and the initiatives that they have taken, especially in the primary school level, to educate, both students and teachers, and also the food handlers within the canteens, about their importance; because even though the numbers might be small, each one incident can be potentially life threatening.

So, I hope that the Senior Minister of State can also let us know about when they are expecting to roll out more of these national initiatives.

Sir, I thank Ms He Ting Ru for her questions and the points that she has made. I think we would all agree, and I certainly do, that we should continue to educate and raise awareness on matters such as this. Indeed, the various agencies and training providers for the workers, whether they are food handlers or early childhood educators, people in a position of responsibility around food and vulnerable people – this is an issue and it is something that we will have to continue to do and to continue to improve on, and learn from the lessons. So, for the second part of her question, there is no disagreement. Indeed, the work is ongoing.

With respect to the first part of her question about the prevalence, it is not so straightforward to draw an inference or a clear conclusion on the basis of the numbers, partly because awareness, as she has pointed out, is rising, and so, what we may be seeing is an increased detection of cases that were already present. Secondly, our population continues to grow slowly. You have to normalise for that. So, the absolute numbers may not necessarily be the correct reflection.

More importantly, our dietary patterns and the practices around how we raise our children have changed quite significantly over the last two generations. In two of these factors, one, for example, is the issue of when to introduce allergens into the diet. So, do you start feeding at the age of six months, one year or late? And the current guidelines are such as between the ages of four and six months, children should be introduced to normal food and potential allergens so that they can adapt to them. It was not always so that that was the guidance and so the people who are my age and, perhaps, a little bit younger, were brought up under a slightly different approach. So, that will lead to a change in our prevalence.

Similarly, how we deal with hygiene in the environment. We have now come to the realisation that there is some benefit for young children to be exposed to, for example, outdoor environments and unstructured play, and places which, perhaps, my generation were used to, and which the generation in between would have seen as inappropriately dirty and not adequately sanitised. We now know that there is some benefit for children to play in the outdoors, with some degree of dirt – this is known as the hygiene hypothesis.

Why am I highlighting these two things? Well, we do need to pay attention to this issue of allergies in general and we do not want our population to be inappropriately exposed to some of the risks. We are taking appropriate steps and the most important thing that we can do is provide the right kind of guidance.

Having said all that, we do have some numbers suggesting that while the incidence of positive skin prick tests – so, trying to confirm the number of people with positive allergies – has increased, those with serious allergies requiring admission, potentially treatment, appears to be a stable incidence as a proportion of the population, ranging from 6.1 per 100,000 children in 2014, to about 8.5 in 2023. [Please refer to "Clarification by Senior Minister of State for Health", Official Report, 15 October 2024, Vol 95, Issue 143, Clarification section.]

And so, it is not necessarily rising in an alarming fashion, something to pay attention to.