The letter arrives from the principal, telling you that there are several students at your child's school who have life-threatening allergies to certain foods.
The principal is specifically asking parents not to send their children to school with peanut butter or nut butter sandwiches, or snacks that contain nuts. He thanks you graciously for your cooperation.
You get the picture, but your immediate thought is — what am I allowed to pack for my kid's lunch? Followed by, how will I know that I'm sending foods without peanuts, nuts or another allergen that's on the list?
Quite likely, you've only ever glanced at food labels to count calories or check for trans fats. You might even ask yourself: Is all this extra label-reading really necessary?
Gwen Smith is the editor of Allergic Living magazine, a publication for those living with food and environmental allergies and celiac disease.
Let's clear up that last thought first: Yes, what the principal's asking is important because food allergy reactions come on rapidly after even small exposures in some people and are capable of causing vomiting, extreme breathing distress, heart attacks or even death.
In fact, the current allergy laws and directives in Ontario, B.C. and Manitoba were inspired in part by Sabrina Shannon, a 13-year-old who suffered a fatal reaction at school in 2003.
A serious reaction is known as anaphylaxis and the only current "treatment" is avoidance of the allergen. Thus, the principal's request.
Since most elementary school kids eat lunch in their classrooms, he's trying to prevent a scene in which a child who could succumb to a trace ingestion of peanut is surrounded by a bunch of rambunctious classmates waving PB and jam sandwiches and pulling out the Reese's Pieces at snack time.
Back to the grocery aisle
But not to worry lunch-packing parent, it won't be difficult to spot peanut or nuts or another top allergen.
The good news is that Health Canada now requires food manufacturers to spell out the ingredients that are among the top 10 allergens — peanuts, tree nuts, milk, eggs, shellfish, fish, soy, sesame, wheat and sulphites.
Allergic Living's Schools & Resources Hub, including anaphylaxis emergency plans
Anaphylaxis laws and policies in Canada
Health Canada is also almost finished a lengthy process to enact new rules that will require "plain English" (and plain French) terms for these allergens.
In the meantime, be aware that arachide means peanut, casein or caseinate is milk, and marizipan and macadamia are nuts.
Some common products that contain key allergens include: egg rolls made with peanuts, Nutella spread (hazelnut), pesto (pine nuts) and Goldfish crackers (dairy); also, chocolate bars likely contain dairy, and often either peanuts or nuts.
It doesn't happen often, but if your school has decided to keep milk out of one classroom to protect a severely dairy-allergic child, it is easy to find rice or soy milk and yogurt, all of which come in flavours that kids tend to like.
Now, some un-allergic kids do love their peanut butter, which is great. But school is a public place, so tell your child that there are just five meals a week that will require foregoing her favourite spread and she can have it on toast at home as an after-school snack.
Plus, at Allergic Living magazine, we've found that un-allergic students tend to be highly respectful of their hyper-allergic peers.
If a young child is told his friend could "be made very sick" from peanuts, that's usually all it takes to have them on the lookout, and even reminding the teacher who forgets and starts to hand out an unsafe treat.
The allergic parent's role
DID YOU KNOW
- In an anaphylactic reaction seconds literally can count. This is why school staff is instructed to use the EpiPen as soon as there are symptoms, which usually come on shortly after eating. Waiting to see if an allergic reaction "gets worse" can be dangerous.
- The child having an anaphylactic reaction should lie down after getting the dose of epinephrine because blood pressure can plummet, increasing the chances of heart attack. If vomiting, make sure the head is turned down so that the child's airways, which will be inflamed, aren't blocked.
- Children at highest risk of anaphylactic reaction are those who have asthma or who have had a previous serious allergic reaction. While symptoms vary, once a child has had an anaphylactic episode, a subsequent reaction is also likely to be serious.
- Allergic kids do not have "weak" immune systems. In fact, their immune systems are over-zealous, creating antibodies against what should be harmless food proteins. Early Harvard Medical School research suggests that those with allergies may be more resistant in later life to certain cancers.
If you are the parent of an allergic child you will know that the time to start working on back-to-school precautions is August, while others are still enjoying the summer sun.
That is when you make the appointment with the school principal to review the allergy risks and precautions, going over your child's anaphylaxis emergency plan, which had to be signed off on by your doctor.
You should also be asking your principal about the school's allergy risk-reducing measures, such as hand washing after eating.
And you will want to inquire about how regularly the staff — teachers, coaches and lunch room monitors — have been trained on the symptoms of anaphylaxis and administering the epinephrine auto-injector.
Training should be annually at a minimum and shouldn't just stop at the lower grades: Sometimes even an older child does not feel well enough to use the auto-injector pen on his or her own.
You will also want to speak directly to your child's teacher about the basic rules: eating only the safe snacks provided by mom, no food sharing, no eating — ever — without your auto-injector at hand, and always washing up well after having food.
Teachers should also know where the child keeps the auto-injector (pencil case, belt, purse) and where the school will have the back-up injector.
But the most important precaution in this back-to-school period is to review with your child all the allergy rules before classes start. The management of food allergies always begins at home.
At the school
Since a food allergy reaction comes on quickly, educators should be well trained on what to do in an emergency.
You don't want to be fumbling with a child in need or trying to locate the parent on a cellphone.
The protocol is: Give the EpiPen, call 911, then call the parent to say this is what has been done.
Parents should have already signed off on this procedure, that is part of the emergency plan, to give you permission to use the auto-injector if, in your judgment, based on allergy training, this appears to be an anaphylactic reaction.
All school personnel who will be dealing with a food allergic child — from teachers, vice principals to coaches — should have a copy of the child's anaphylaxis plan, which has a photo affixed and instructions on the emergency steps to follow. (Some reactions may require a second dose.)
Principals should be sure to consider who's watching allergic kids at lunch.
Some Canadian school boards still use Grade 5 or 6 students to monitor younger kids.
But when lunch involves a child at risk of anaphylaxis, it should be an adult with emergency training who's keeping watch — whether a casual volunteer, part-time staffer or teacher.
Remember, parents of an un-allergic student won't be happy to find that their child, who isn't even old enough to babysit, is supervising a child who could have a medical emergency around food.
If you're involved in education, you will know that dairy allergies are probably the toughest to manage. They are also common, especially in younger children.
As it is not practical to tell the school community as a whole to forego sending milk, cheese, yogurt or any dairy-containing products (which is most products), the usual plan of action is good hand-washing and to be extremely vigilant about wiping up after a class eats.
At a minimum, though, it is probably good to avoid having "pizza days" as one of the school's regular events. These are smeary, scary days for kids who are dairy allergic.
Many Canadian school boards are adopting "healthy snacks" policies because of obesity concerns and these dovetail nicely with food-allergy policies since there are no fruits or vegetables on the Top 10 list of food-allergy triggers.