Marcus Terranova was treated for asthma but it was a food-related anaphylactic reaction that claimed his life. Photo: Supplied
It is a parent’s worst nightmare.
A call from school. Eight-year-old Marcus was thought to be having an asthma attack. But he wasn’t.
When his dad, John Terranova, arrived at St Ives North After-School Care facility he could see parents were “standing around in shock with blank faces”.
Undiagnosed allergy: Marcus Terranova. Photo: Supplied
Marcus had been struggling for breath after playing after-school sport. The Ventolin wasn’t working. He had gone to the office and said: “It’s my asthma.”
He was taken by ambulance to Royal North Shore Hospital but by then there was nothing else that could be done. Marcus was being treated for asthma but it was a food-related anaphylactic reaction that claimed his life.
Now Mr Terranova, from St Ives, has decided to speak out following the recent release of the National Allergy Strategy, which recommends allergy and anaphylaxis management and training for all staff in schools and childcare facilities. It also recommends national protocols for allergy testing for health professionals and food allergen safety management and training for food service staff.
Hospital admissions for anaphylaxis have increased five-fold in the last 20 years and 10 per cent of infants have an immediate food allergy, the report says.
The tragedy occurred two years ago this month, but Mr Terranova believes that others can learn from the experience of his family.
As he struggled with his emotions, he recalled reaching the after-school facility and seeing police cars and ambulances.
“I was thinking this is a bit of an overreaction. A paramedic said: ‘We are doing the best we can for him.’ I was sitting in a kid’s chair thinking they were giving him some help and didn’t want me to get too worried about it.
“I’d started to zone out. When I saw him wheeled out that’s when I knew that things were not good. They were giving him CPR. I remember saying, ‘Please God, spare him’. He really was an angel, that boy. I live in the hope that there is a heaven and one day I’ll get to be with him again.”
As a baby Marcus had severe eczema and at 12 months was found to be allergic to peanuts. At the age of four he developed asthma and other allergies.
On the day he died his uneaten lunch was found in his school bag apart from a chocolate chip biscuit, something he had eaten on previous occasions without problem. The after-care facility had prepared a fruit platter with “nibblies” but at the time nobody suspected an anaphylactic reaction so, understandably, no questions were asked about the food.
The Department of Education told Fairfax Media that it undertook a full investigation and found that St Ives North Before and After School Care had not breached its obligations relating to the management and administration of medication.
A report from the allergy unit at the Royal Prince Alfred Hospital sent to the coroner last September, following the 2013 attack, said Marcus had eaten recently and the most likely allergen to have triggered the reaction was peanut or possibly an undiagnosed allergy to cashews or kiwifruit.
The report states: ‘Had Marcus been assessed by an allergist before he started school it is likely that he would have been considered to be in a ‘high-risk’ category, in which case an EpiPen [an adrenaline auto-injector] would have been prescribed and an … action plan provided for the [after care] school.”
Mr Terranova said although Marcus had some allergies he didn’t believe he was at risk of anaphylactic attack. He apportions no blame to the after-care facility which he said had been “fantastic”.
“When your child is first diagnosed as having allergies I think there then needs to be a management plan for that child,” he said. “He was seeing a dermatologist but the connection between his eczema, asthma and the allergy was not investigated.
“The focus was always on the asthma. Somewhere along the line someone should have joined the dots.”
Mr Terranova advised parents who have children with allergies to have them tested on a periodic basis.
“Unless you have regular checks you could have a potential time bomb ticking away. We didn’t know that his allergies had probably gotten progressively worse. Had we known we would have had an allergy management plan. The after-care school would have been notified about that and they would have known if Marcus presented with breathing symptoms that he was to be injected with an EpiPen.”
Michele Goldman chief executive of the Asthma Foundation said that deaths from asthma had stabilised between 300-400 a year and that the decline had levelled off in recent years.
“Current approaches are not working, we need to try something different,” she said. “Let’s increase the focus on prevention.
“Let’s take a systemic approach as Finland has so we can make a real dent in tackling this issue over time.”
Professor Richard Loh co-chair of the National Allergy Strategy said if it was uncertain whether an attack was asthmatic or anaphylactic then it should be treated as anaphylactic with injection of adrenalin from an EpiPen. He said there were different policies about use of EpiPens and training from state to state.
“It would be really good if all the interested parties could meet and share ideas together,” he said.”You don’t need confusion in a potentially life-threatening situation.”
What happens in NSW:
At pre and after-school facilities it is the responsibility of the parent to provide an adrenaline auto-injector as part of the child’s medical management plan if their child has been diagnosed at risk of anaphylaxis.The auto-injector should be stored with the child’s medical management plan in a secure unlocked central location.
Under the National Law for early childhood education and care services, at least one educator who has completed approved first aid, anaphylaxis and asthma management training must be in attendance at any place where children are being educated and cared for by the service, and be immediately available in an emergency.
In NSW all public schools are required to keep as part of their first aid kit at least one general use adrenaline auto-injector in addition to an adrenalin autoinjector that will be provided to the school where prescribed by a child’s treating doctor.