When Jack Mitman (eight) was three, one factor determined his mother's choice of kindergarten -- it had to be within running distance of the family home.
When the Mitmans, from Waterford, go on holiday abroad the first thing they do is check how far the resort is from the nearest hospital. When Jack flies, he can only travel with certain airlines which must be notified in advance. Now that Jack is a primary school pupil he has a ticket for the school bus, but he can't use it.
Everywhere they go, his parents carry notices in different languages explaining about Jack's peanut allergy.
The first attack happened at a family function when he was just two years old.
"We saw him choking and having difficulty breathing and trying to cough something up," says his father Chris, a banker.
Their toddler, they were later informed, was going into anaphylactic shock.
Anaphylaxis is the body's reaction to an allergen which can be anything from food to latex or a medicine. Symptoms include swelling of the throat and mouth, difficulty in swallowing or speaking, loss of consciousness and even death.
There is no official data, but childhood allergies are on the increase, says Jonathan Hourihan, Professor of Paediatrics at UCC, who runs the only clinic in the country which provides an integrated allergy service for children.
The clinic at Cork University Hospital has a six-month waiting list, deals with about 400 new patients every year and gets a minimum of 50 new referrals a month.
"The number of children with food allergy, rhinitis and eczema continues to increase. We don't know the cause," says Hourihan, who, along with his staff, is currently compiling data on Irish allergy rates.
However, he believes our rates are similar to those in Britain where, on average, between three and six per cent of children have food allergies. Hourihan believes that about two per cent of children have a peanut allergy.
"The number of cases of anaphylax
is has increased by about 700pc between 1990 and 2002 in Great Britain," he says, adding, however, that he believes the real figure could be even higher.
Some experts believe the rise results from a lack of vitamin D, others because of modern high standards of hygiene which mean that antibodies which would traditionally have protected us from worms and bacteria fix on harmless foods instead.
Luckily for little Jack Mitman, he received fast and effective treatment.
"We rushed him to hospital where they told us his throat was closing as he was having a major allergic reaction. He was tested for allergies and we discovered that he was off the charts for peanuts," says Chris.
"A consultant paediatrician told us that he was so sensitive that even if someone opened a packet of peanuts near him or if he came into contact with someone who had been eating peanuts he could get a severe reaction."
Life changed dramatically for Chris and his wife Gina.
"We had to learn a lot -- we did a lot of research and got a lot of training," says the 45-year-old, who recently completed the London Marathon in under six hours and plans to run in the Dublin one in October to promote awareness of the condition and raise funds for Anaphylaxis Ireland.
"It was only when we started researching the condition that we realised the sheer diversity and range of products that could put Jack's life at risk.
"The other night Jack's lip started to swell and we were on full alert."
A reaction can happen immediately or within hours of exposure, says Chris.
Beginning with itchy eyes, a runny nose, rash and blotchy skin it can quickly progress to wheezing, coughing, dribbling, difficulty swallowing, and extreme swelling of the lips and face area.
"At that stage he has to be injected with adrenalin by a special pen (an anapen) and rushed to hospital. The pens can inject a certain amount of adrenalin but they only give out about 15 minutes relief -- if intervention does not happen he could die so when we go on plane journeys we must carry about six pens.
"You don't want to alarm him or the people around him, but he does get scared."
Although Jack's teenage brother Bill doesn't have the allergy, for mum Gina, even simple household tasks can be fraught with difficulty.
"Grocery shopping is a nightmare because so many things carry warning signs about nuts. Once Jack had a corn on his toe. I went to get a plaster and the brand I used had peanut oil in it."
Because of Chris's job, the family moved around the world for years but, says Gina, any house they lived in couldn't be more than 10 minutes' drive from the nearest hospital.
"You want him to have a normal happy childhood but the threat of an attack is always there."
When the family returned to Ireland in 2007 Jack started school. The first thing his parents did was to tell the headmistress about his allergy.
The Department of Education does not issue specific guidelines to schools in relation to anaphylaxis or food allergies, so it was up to the Mitmans to outline the implications.
"We explained what could happen if he was exposed to peanuts or even traces of them. We said that ideally there should not be nuts in the classroom or the school," says Chris.
"The principal took it all on board, and sent a note out to the parents explaining the situation and asking them not to give their child any products with nut ingredients.
"This was the first child we had ever had with a diagnosis like this," explains Janet Twigg, principal of the 111-pupil mixed Christchurch National School in Waterford city.
"The child's GP spoke about what would happen if he had an attack and how we should deal with it. The proper procedures were put in place. It's an awareness issue.
"The GP also brought in the pen to be used in case of an attack -- we keep a number of them in the school and bring them with us when we leave the school with Jack. We've never used the pen. To date he has never had an attack in school."
Schools need a set of clear guidelines from the Department of Education, insists Chris.
"I'd like to see the government provide a proper integrated health service that included anaphylaxis and other chronic medical conditions in childhood," says Professor Hourihan, who points out that, statistically speaking, every school of 200 to 300 people would have between three and five children with a peanut allergy.
"Management of anaphylaxis in school is no big deal because it is about prevention, but, when it happens, anaphylaxis is a more severe response and it can kill, though that is very rare."
There is huge public ignorance about the condition, according to the support organisation Anaphylaxis Ireland.
"Most people I have talked to have never heard of the word anaphylaxis and would not know what it means. When we explain that it's a severe allergy it tends to be interpreted as a bad dose of hay fever," says chairperson Clare O'Brien.
"Most people don't realise an allergic reaction could be so severe that it would be life-threatening. If people do realise it can be life-threatening they assume it's solely down to peanut allergy but there are other allergies that can cause it.
"Anaphylaxis is completely random and absolutely terrifying."
In conjunction with the Diabetes Federation, Brainwave and the Asthma Society, the organisation plans to publish a policy booklet, 'Managing Chronic Conditions at School -- a Tool Kit for Teachers and Parents' which they hope to have in schools by August.
Health & Living