Photo: Getty This directive of the Montreal School Commission (CSDM) first came to public attention on May 30 in a local press report. The news created a shockwave in the food allergy community.
The CSDM’s new approach can be summed up in a few words: no more banned allergens or so-called “lunchbox police” – since school staff are no longer authorized to confiscate a student’s lunch due to the presence of a major allergen.
Yet at the same time, the Montreal board invites parents to “contribute to making the school a safe environment by being vigilant in trying not to put foods that set off severe allergies in their child’s lunch.”
The Trouble
with Food Bans
Questions of “banning” any foods at school are delicate and tend to arouse passions. While such a policy reduces the risk of exposure, it also presupposes the cooperation – day after day – of all parents. This includes the careful reading of ingredient lists, searching for substitutes and so on. Even presuming parents whose children are not allergic have good intentions, this is a tall order. As well, it’s extremely difficult to enforce such food restrictions – policing lunches does have its limits.
Let’s admit to another difficulty: with the rise of multiple food allergies, it’s unrealistic to remove all allergens from schools. So how do you choose which to prohibit? Because peanuts and tree nuts are responsible for more than one-third of anaphylactic reactions, and peanuts are implicated in the majority of fatalities, these are the foods most often targeted. They also come in smearable forms such as peanut butter.
But that does not make them the only severe allergens. In Canada, the fatal anaphylactic reactions of Sabrina Shannon and Megann Ayotte Lefort were caused by accidental dairy exposure. Eggs, sesame, shellfish, fish, mustard and kiwi, to name but a few, can also trigger serious reactions. Do we ban all such foods at school?
It’s not difficult to understand the exasperation of parents whose children don’t have any allergies, but who may be asked to follow a long list of restrictions, depending on the allergies of a school’s student population. This raises the spectre of backlash in a school community that is fed up. In that environment, is there not a risk that the allergic students will be the first to suffer?
Putting the Cart
Before the Horse
It’s my view that the outright banning of various allergenic foods is not the best way to create a safe environment for allergic students.
Marie-Josée Bettez This is where serious concerns arise with the CSDM decision to allow the return of peanuts and nuts to schools and to classrooms, a move that could be copied in other jurisdictions.
The Montreal board insists that food sharing is prohibited in its schools and the directive speaks of children being encouraged to wash their hands before and after a meal or snack. That’s a start, but several questions remain unanswered.
These include:
- Are all staff members, including substitute teachers and coaches, aware of the identity of the allergic students in the Montreal schools?
- Is there an anaphylaxis action plan in place for every allergic student?
- Can a student carry his or her epinephrine auto-injector at all times, or where is it kept?
- Does the school’s emergency kit contain additional auto-injectors?
- Are school staff fully trained about anaphylaxis, and how often is that training refreshed?
- Are they able to recognize the symptoms of a severe reaction, and do they know both how to intervene and that doing so is urgent?
- Are the students carefully supervised during meals and snacks?
- Are tables, desks and other contaminated surfaces fully cleaned?
- Does the school place limits on the use of food in teaching?
- Are classroom rewards kept to non-food items?
It is absolutely essential for school staff to be able to recognize the symptoms of anaphylaxis and to take the required emergency measures without delay.
The death of Megann Ayotte Lefort at her Montreal school in 2010 is a painful reminder of what can happen when this isn’t the case. The child began having respiratory issues, but was only given a couple of puffs of her asthma inhaler, despite the fact that she’d eaten shortly before arriving at school. She did not receive the epinephrine injection in a timely manner that might have saved her life. After emergency services were finally called, it was too late for the 6-year-old, whose death was later deemed to be the result of anaphylaxis.
Never again should such a drama occur.
The Need for a
Uniform Protocol
The CSDM’s decision and the ensuing shock in the allergy community to it illustrate the need to adopt a uniform policy in Quebec on anaphylaxis in all schools.
At the moment, food allergy management varies from one school board to the next, and sometimes even from one school to the next within the same board. In this, Quebec is surprisingly behind the times. Neighboring Ontario has legislation that requires all school boards in the province to develop a uniform food allergy and anaphylaxis policy. Other Canadian provinces and U.S. states have also adopted such policies.
As a longtime allergy advocate, I have campaigned for years for a uniform protocol to be adopted in Quebec. With the Allergies Québec organization’s team, I even developed a pilot protocol that was tested in a few Quebec schools in 2016.
It is well past time that things move forward on this file. There are more than 75,000 students with food allergies in Quebec. They deserve the same protection, no matter which school they attend. This is a matter of their security … and of their lives.
Marie-Josée Bettez is the editor and founder of Dejouerlesallergies.com, the well-known Quebec website. The former lawyer is the author of three books, including the bestselling Déjouer les allergies alimentaires, recettes et trouvailles. Marie-Josée frequently lectures on managing food allergies.
