Food intolerances are ruining things for people with allergies

We all know someone who doesn't eat something. Unfortunately, it's not because they're deathly allergic, and in the opinion of medical geographer Susan Elliott - they're ruining things for the people who have allergies. Susan argues Canadians need to take allergies more seriously.
A voluntary recall of Allerject has caused a spike in demand for EpiPens, a similar but not identical product. (Mark Zaleski/Associated Press)

A food intolerance is not an allergy, and more Canadians need to understand that. 

Yes, Susan Elliott says, intolerances to things like gluten can cause discomfort. But "true" food allergies, the kind that cause anaphylactic reactions, can kill you.

It happened last fall, to a student at Queen's University, and this spring, a restaurant owner in the U.K. was sentenced to six years in jail when a customer died from eating a curry that contained peanuts. And there's the man, allergic to fish, who survived an anaphylactic reaction after being served salmon in a Quebec restaurant earlier this year

Susan Elliott says those stories demonstrate that many people don't take food allergies seriously enough.

Elliott, a medical geographer and professor of public health at the University of Waterloo, is currently doing research to determine if allergy rates are growing in this country. Based on data from other countries, she suspects they are.

Her previous research shows that, while 7.5 per cent of Canadians are allergic to the big eight food allergens (nuts, tree nuts, fish, shellfish, sesame, milk, eggs, and soy), about half of Canadian households are affected, directly or indirectly, by food allergies. That means either someone in the house is allergic and needs to be accommodated, or someone in the family's circle is —  a family friend, for example, or a student in a child's class. 

With good education, we will know the difference between a true allergy that could produce an anaphylactic reaction, and an intolerance, which, yes, is very uncomfortable and causes symptoms and is not nice, but is not going to kill you.- Susan Elliott, University of Waterloo

Even those affected by food allergies don't necessarily understand them. New research, for example, shows that only ingesting peanuts will trigger a peanut allergy — not, for example, smelling the peanuts someone is eating in the row behind you on a plane. 

"There are a lot of people though, who still believe that if I smell peanut butter, I can have an anaphylactic reaction. So there's a lot of knowledge translation we can do —  taking the science that we know, and making that science useful for the people who need to know those things," says Elliott. 

To transfer that knowledge, and to make sure all Canadians take real allergy risks seriously, Elliott wants to create a national allergy strategy. 

She joined 180 guest host Stephen Quinn to talk about the strategy, and the effect of food intolerance on the more serious issue of allergies. 

The full interview is available in the audio player above. The following portions have been edited for clarity and length.

When it comes to people who do have those very serious life-threatening allergies, what effect do intolerances, or those trendy allergies, things like people being allergic to gluten or avoiding dairy, what impact does that have on the population that has a life-threatening allergy? 

I think it gives people a tendency to not take allergies as seriously as they should, a true allergy as seriously as they should. So for example, we've done a lot of research on how does having a severe allergy affect children from a social perspective. There's a lot of social isolation, that kid can't go to birthday parties, or sleep overs, or camps. There was a story in the Globe and Mail recently of a young teenager who was thrown out of cadet camp in New Brunswick because she had allergies and the camp couldn't deal with them. 

So all of those things are happening to children, and we actually did a study where we asked children to draw an illustration of what is it like to have a serious food allergy? And we published a paper, the paper got lots of media attention, and we followed the comments that came back to the newspaper about that newspaper article, and most of them were negative. Most of them were not taking food allergies seriously, were putting all of the onus on the individuals, saying, "You know, everybody should have the right to have peanut butter sandwiches at school," that sort of thing. It was a real kind of suck-it-up attitude. That was really surprising to me. 

Gluten-free food has become mainstream, as many Canadians say they are intolerant to the protein.

I've spoken to parents whose children have allergies, and what surprises them about it, is they keep having to make this argument that: "You're talking about my daughter's life here, versus your child's wish to eat a peanut butter sandwich."

Absolutely, and that's the thing about an anaphylactic reaction. It's very low probability, it doesn't happen very often, but it's very high risk. You don't want to lose your child, you don't want to take a life. And those anaphylactic reactions are so preventable. We could put some public policies in place that would really maximize choice and minimize risk for food allergic individuals. 

For example, in the United States, it's now mandated that every school has to have EpiPens on site. So if a child shows up at school without an EpiPen, it doesn't matter, there are EpiPens on site and staff are trained to use them. In Canada, our teachers and our school staff are meant to be trained in how to use an EpiPen, but they're not kept on site. They're not kept on site in food courts, in restaurants, or other public places. Trains, or airplanes, for example. That would be a really easy thing we could do to reduce adverse reactions, and the impacts of adverse reactions. 

You, in the end, want to create a national allergy strategy. What would that look like, and what would it entail to create such a thing? 

We actually have put together an umbrella of ten different projects that would begin to put us on the road of a national food allergy strategy for Canada. One area is looking at food policies in universities, because 10 to 15 years ago, all of the children with food allergies were quite small. Now they're growing up and they're in university. And universities in Canada virtually have no policies around food allergy...

Andrea Mariano, a first-year student at Queen's University who had food allergies, died after an anaphylactic reaction on campus in September, 2015. (Handout/Queen's University )

One of the [projects] I'm really excited about, is we actually haven't done in Canada a good economic impact study. What is the economic impact of food allergy in this country? And I think that's the way to get stakeholders like restaurant groups and hotel groups on board. There's a lot of food-allergic families in this country who do not eat in restaurants and do not stay overnight in hotels and don't travel because they're very worried about the risk to their food-allergic family member. I think that has an economic impact on that industry, and if, as our survey intends to show, and I think it will show, that there's an increase in food allergy, and there's a trend for it to continue, that's a bigger and bigger portion of economic hit for those industries. 

So, as part of the national food allergy strategy, we will do an economic impact analysis.

And what would the strategy do about people being served foods they're allergic to in restaurants (as happened in Quebec earlier this year)? 

If there was an EpiPen on the site, and if there was someone who knew how to administer that EpiPen, the outcome of that might have been quite different. In that situation too, and the food allergy support groups in this country are very clear, and very consistent with their messaging, it's not just the responsibility of society. You have a responsibility as well. So that man, as far as I know...he had an EpiPen, but he left it in his car. He didn't have his EpiPen with him. We need to convince people to keep their EpiPens with them all the time, and make them affordable for the people who can't afford them. 

Peanut is perhaps the best known food allergen.

And in the meantime, can we convince people, who suggest that they're allergic to things when they actually aren't, to stop doing it? 

That's a really interesting question, I've recently learned that, unfortunately, there are young people who are using food allergies as a mechanism for supporting their eating disorders. Young girls with anorexia, for example, are using food allergies so they don't have to eat. 

I don't think we're going to get rid of all of it, but again with good education —  it sounds like a trite public health message, but it's true —  with good education, we will know the difference between a true allergy that could produce an anaphylactic reaction, and an intolerance. Which, yes, is very uncomfortable and causes symptoms and is not nice, but is not going to kill you. 

Click the play button above to hear Susan Elliott's interview with guest host Stephen Quinn. 


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