Food allergies are a growing public health concern, with approximately 1.2 million Canadians at risk. The surge in allergic disorders, and the risk of life-threatening anaphylactic reactions has elicited a flurry of media coverage. At the heart of many articles are lobbying efforts to restrict peanut and tree nuts in schools and public venues. Journalists often ask allergy experts: “Should peanuts and nuts be banned?” They expect a “yes” or “no” but, the truth is, there is no simple answer.
To provide perspective, five allergy associations collaborated on a position statement* regarding the management of anaphylaxis. It reflects the opinion of Canadian allergists and the executive directors of three lay organizations: Anaphylaxis Canada, the Allergy/Asthma Information Association and the Association québécoise des allergies alimentaires.
Collectively, the organization executive directors have four children between the ages of 12 and 25, with allergies to peanut, other legumes, tree nuts, egg and shellfish. We appreciate personally and professionally the concerns of parents who are faced with the grim reality of food allergies: only strict avoidance of an allergenic substance will prevent a reaction, and there is no cure on the horizon. We are aware that besides peanuts and nuts, other common foods – milk, egg, sesame, shellfish, fish, soy, and wheat – can trigger reactions and need to be included in anaphylaxis policies.
And we know that there is a conceptual problem with the idea of a “ban” in public places. It carries with it the notion that safety can be guaranteed if we eliminate obvious allergens from an environment. In the real world, there are no guarantees, which is why education and self-management will remain our priorities.
So what do we recommend to parents advocating for their children’s needs?
Seek “the middle ground”
To start with, don’t shoulder the burden alone. Anaphylaxis policies should be developed with input from allergy experts and take into consideration the factors that can have an impact on the community, businesses, and organizations. These include: who and how many people will be affected by food restrictions, how reasonable it is to expect that an environment can be controlled, and whether the attempt to control it will be permanent or temporary.
There are many situations in life where we make concessions to arrive at “the middle ground”. Strategies that safeguard allergic individuals without placing undue restrictions on the non-allergic community will be the most successful. Policies that seem too unrealistic to implement and monitor will lack credibility and may lead to “allergy fatigue” among the public, and we need the continuing support of the wider community.
A good example of a middle ground approach was an “AA” baseball league game that took place in July in Baltimore. The Food Allergy & Anaphylaxis Network and the Bowie Baysox raised public awareness by designating a section of the stadium for food allergic fans and their families. Stadium employees wiped down seats and swept the ground of the section before the game (peanuts are a fan favourite), and emergency medical staff were on hand. But you’ll notice that this event took place on one day, in one controlled part of the stadium.
Teach children to self-protect
Children must learn to navigate safely in a world with allergens around them. If they do not learn to self-manage, they may be at greater risk. Parents will not always be there. My family has used the weekly grocery shopping trip to teach our 12-year-old, Julian, how to choose safe foods through vigilant label reading and to make him feel comfortable with allergens in his environment. Our grocery store spans 80,000 square feet and has thousands of products that may contain his allergens. It also gets 3,000 customers a day. Julian understands that he cannot control what others eat or touch in the store, but that regular hand-washing can reduce the risk of exposure with an allergen.
September represents a milestone as our son enters a Toronto high school (grades 7 to 12). While Julian will brown-bag it most days, he will occasionally buy a lunch of limited items that we have checked with cafeteria staff, and pick a safe packaged snack from the vending machine. While many parents may think my husband and I are crazy to allow Julian these liberties, we believe he is ready and we expect him to take on more responsibility as he gets older.
Does this mean we’re abdicating responsibility? On the contrary, we will continue to teach him how to manage his allergies and to advocate for his safety. His experience in high school will serve him well as he prepares for the next transition – university – where he will be an unknown in a crowd of thousands and thousands of students.
Like many other parents, I’d like to have a guarantee that Julian will always be safe, but this isn’t possible. I want instead the solace of knowing that he has all the tools possible to look after himself in a big, hard-to-control world. Despite best efforts, I know that he could have an allergic reaction. I’ll continue to worry. But that’s my job – I am his mother.
* The position statement is available at www.allergysafecommunities.ca (Tools and Information)
Laurie Harada is the former executive director of Food Allergy Canada, www.foodallergycanada.ca.