May 8, 2014 – Reports of school-aged children experiencing adverse, if not lethal allergic reactions to specific foods has received escalating media attention in the past few years.
Suggestions have been made to ban milk and milk by-products from schools in Canada because the number of children with dairy allergies is much higher than peanut allergies and both can cause the same life-threatening anaphylactic reaction when ingested. Not every food allergy can be eliminated from the school grounds but considering the severity of the allergies some children suffer, there has to be an equitable solution to this very serious problem.
Moshe Ben-Shoshan, a Paediatric Allergy and Immunology Specialist at Montreal Children’s Hospital stated, “We are very focused on peanut and tree nuts, but a milk allergy can be very dangerous and you don’t ban milk, right.”
“In Western countries, dairy is third behind peanuts and tree nuts in a list of foods associated with the most severe allergic reactions in children. In other parts of the world, dairy is either first or third. Children can grow out of milk allergies, which shouldn’t be confused with lactose intolerance, by the age of five.”
School boards in Ontario have integrated policies to deal with food allergies thanks to ‘Sabrina’s Law’, which was passed in 2006. Sabrina Shannon died during her first year of high school in 2003 after eating French fries that came into contact with a dairy product. Schools have created their own strategies and solutions to keep children safe, i.e. awareness programs, hand washing, children eating at separate tables and making schools peanut free.
Canadian Facts and Stats
- Approximately 2.5 million or 7.2% of all Canadians have at least one food allergy.
- Allergies are highest amongst children under the age of three.
- Approximately 300,000 Canadian children under 18 years of age have food allergies.
- More than 40% of all Canadians are dependent on food labels seeking allergen information.
- Peanut allergies affect about 2 in every 100 children in Canada.
- ‘Sabrina's Law’ was passed by the Ontario government in 2005 requiring all publicly funded schools to have an Anaphylaxis Action Plan.
- Peanut and nut allergies are much more common in children than adults, and the opposite is true with fish and shellfish allergies.
- McGill and McMaster researchers co-authored a 2008-2009 study and found that 2.2% of children under the age of eighteen reported dairy allergies compared to 1.7% with peanut allergies.
Each allergic reaction can have different symptoms and anaphylaxis can occur without skin symptoms or hives.
When a body's immune system reacts to a particular protein or irritant, an allergic reaction occurs. A reaction may be caused by literally hundreds of products but food, insect stings, latex and medications are the primary causes. Severe allergic reactions can occur quickly and without warning. Please click on glossary for a complete list of allergy terms and definitions and common causes to obtain a listing of food allergens. A person experiencing an allergic reaction may have any of the following symptoms.
- Coughing and wheezing and hoarseness
- Chest pain or tightness
- Confusion and headache
- Flushed face, hives or a rash, red and itchy skin
- Swelling of the eyes, face, lips, throat or tongue
- Nasal congestion or hay fever-type symptoms including sneezing, runny nose and watery eyes
- Anxiousness, distress, faintness, paleness, sense of doom and/or weakness
- Metallic taste in the mouth
- Nausea, cramps, diarrhea and/or vomiting
Severe Symptoms – can lead to death if untreated
- Difficulty breathing, speaking or swallowing
- A drop in blood pressure, rapid heart beat, shock, and/or loss of consciousness
- Pale blue colour with weak pulse
It is important to note that each reaction can have different symptoms and anaphylaxis can occur without skin symptoms or hives.
There are no cures for any type of allergy. The only way to prevent an allergic reaction is to avoid the specific food or product. Should a severe reaction occur, the appropriate emergency treatment is an injection of epinephrine (also known as adrenaline). It is highly recommended that people with food allergies carry an EpiPen auto-injector. The EpiPen should be administered as soon as the symptoms of a severe allergic reaction appear, followed up with further treatment and observation in a hospital emergency room.
A sensitivity is a food allergy or chemical sensitivity that typically produces a delayed response that may not appear for hours or even days, and therefore does not present an immediate and obvious threat to a child’s life. Chemical sensitivities occur when a person has an adverse reaction to chemicals that occur naturally in, or are added to, foods such as caffeine in coffee, tyramine in aged cheese and flavour enhancer monosodium glutamate. Children that have sensitivities to food or products will experience varied symptoms, such as:
- brain fog
- muscle and joint aches and pain
- gastrointestinal discomforts including bloating and gas
- chronic running nose, congestion, post nasal drip
- itchy skin and skin rashes that look like eczema
A food intolerance does not involve the immune system. Where a small amount of food can cause a reaction with a food allergy or chemical sensitivity, it generally takes a standard or substantial portion to produce symptoms of food intolerance. It is important to note that symptoms of food intolerance vary in degree from person to person and can be mistaken for a food allergy. Food intolerances are more likely to originate in the gastrointestinal system and are usually caused by an inability to digest or absorb foods or components of those foods.
Dairy products produce one of the most common intolerances called ‘lactose intolerance’. People who suffer from lactose intolerance lack an enzyme called lactase, which is needed to digest lactose - a sugar in milk. Symptoms may include:
- abdominal pain and bloating
What is Anaphylaxis?
Anaphylaxis is the most serious type of allergic reaction, which causes the bronchial airways to narrow, blood pressure to plummet, and without an epinephrine injection, can lead to unconsciousness and death. Administering epinephrine quickly is essential because the deadly reaction creates a chemical cascade in the body that becomes harder to shut down, the longer it goes untreated.
Anaphylaxis is insidiously unpredictable. There is no way to know how or when children will react to an allergen.
We recommend children be tested for allergies. If the test comes back positive, make sure you keep an EpiPen in the house and at school. If you don’t know your school’s policy about epinephrine, ask your principal and insist that they keep a few at school or at your child’s day care centre.
There are over 170 food items and products that produce allergic reactions including the nine most prevalent listed below.
- Peanuts, tree nuts including almonds, Brazil nuts, cashews, hazelnuts (filberts), macadamia nuts, pecans, pine nuts (pignolias), pistachio nuts, and walnuts
- Sesame seeds
- Fish (including shellfish and crustaceans)
- Insect Stings
In Case of Emergency
- Give epinephrine (EpiPen® or Allerject™) at the first signs of an allergic reaction.
- Call 9-1-1 or your local emergency medical services and tell the dispatch officer that someone is having an anaphylactic reaction.
- Give a second dose of epinephrine in 5-15 minutes IF the reaction continues or gets worse.
- Go to the nearest hospital right away (ideally by ambulance), even if symptoms are mild or have stopped. The reaction could get worse or come back after using epinephrine. The patient should stay in the hospital (generally about 4 hours for observation).
- Call the emergency contact person (parent, guardian or spouse).
The Emergency Steps listed above were resourced from Anaphylaxis Canada.
Anaphylaxis Canada held its 7th annual community conference ‘Managing Food Allergies: Working Together for a Safer Future’ that included a full day conference available to patients, families, educators, healthcare professionals and other members of the community interested in learning about food allergy and anaphylaxis management.
New EpiPen Law for U.S. School Children with Severe Allergies
Since 1997, childhood food allergies have increased by 50% in the United States. In some severe cases, just inhaling peanuts can lead to a life-threatening reaction. One in four of these allergic reactions occur while the child is at school. Without proper treatment, there is no way to overcome the allergy and save the child’s life.
The U.S. Government is providing financial incentives for states to pass laws allowing schools to stock epinephrine and treat children with life-saving injections even if they do not have a prescription for the drug.
The children most likely to benefit from the new law are those who aren't known to have an allergy but who suddenly go into anaphylaxis.
Currently only 27 states have laws allowing schools to administer Epinephrine to children without a prescription. According to a 2010 study in the Journal of Allergy and Clinical Immunology, researchers suggest that one in thirteen U.S. children has a food allergy and they are not sure why the number of cases is rising.
The American Academy of Pediatrics (AAP) used to advise mothers with children at risk of developing allergies not to introduce peanuts until their children are three years old. However, AAP changed its policy after allergy rates increased due to avoidance and mothers are now told to start introducing peanuts to their children at an earlier age.
With more than 170 known foods that cause allergic reactions, the Center for Disease Control recommends that schools:
- Identify children with food allergies.
- Have a plan to prevent exposures and manage any reactions.
- Train teachers and other school staff how to use epinephrine injectors.
- Plan parties or field trips free of foods that might cause a reaction, and designate someone to carry epinephrine.
- Make sure classroom activities are inclusive.
Food Allergies – Health Canada
Food Allergies and Intolerances – Health Canada
Allergy Kids Foundation – Everything you need to know about food allergies and sensitivities