Food Allergies: Are schools doing enough?

Last spring, Paul Escher's kindergarten teacher planned a “bunny bite” activity: The kids would make Easter treats out of Rice Krispies, butter and marshmallows. These edible bunnies might sound benign, but five-year-old Paul is allergic to dairy, as well as soy, eggs, beef, poppy seeds, peanuts and tree nuts. When his mom, Lorraine Escher, balked at this plan, the teacher suggested Paul make allergen-free cocoa-coconut treats instead. But Escher was worried about accidental cross-contamination and decided to keep him home from school that day.

“I’ve been told that my child could die within two to three minutes from an anaphylactic reaction,” Escher says. She’s acutely aware of how easily the act of nourishing his body could turn deadly. At age three, he almost died after eating a single pistachio. They hadn’t known he was allergic, so when Escher first saw the hives breaking out all over his body, she put him in the bathtub — it didn’t work. By the time the ambulance arrived, Paul’s face was swollen, he was drooling and vomiting, and he’d fainted in her lap while she was on the phone with a Telehealth Ontario nurse. The paramedics administered an EpiPen and rushed him to the hospital, where he was stabilized.

Since then, Escher has taken up the cause, advocating for Paul’s safety. (Her three other children are allergy-free.) She feels that the festive food traditions at his elementary school sideline allergic children’s rights — she calls it “systemic bullying,” because kids like her son feel left out. “I want Paul to feel included.”

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Paul carries an EpiPen at all times and staff at his school know how to use it. He brings his own lunch, and his classroom (where all the kindergarten kids eat) has been designated nut-free to accommodate him, and one other allergic kindergarteners. (His school, outside Ottawa, restricts the relevant allergen on a class-by-class basis. So if no one in grade two is allergic to nuts, for example, grade two kids can bring nut-containing lunches.) Photos of Paul are also posted inside his classroom, the library, school office and staff room, explaining his food allergies. Escher says she doesn’t mind this — it’s the “new normal,” and these measures could save his life.

“We have definitely seen a heightened awareness about the issue,” says Walter Piovesan, the associate director of education at the Ottawa Carleton District School Board, which includes Paul’s school. Piovesan says that every school in his district now has some students with food allergies. In response, the district strives for proper sanitation in classrooms, and staff are encouraged to talk with students and families about precautions and the severity of each kid’s allergies.

But Escher doesn’t think these measures are enough. She’d still like to see Paul’s school ban all outside treats, like birthday cupcakes, and to rethink their holiday celebrations. It might sound extreme, but some schools are already doing this. Last spring, a school district in Maryland adopted a policy forbidding all homemade treats, but allowing store-bought ones, which typically list ingredients (and sometimes whether there are traces of an allergen).

Approximately 2.5 million Canadians are allergic to at least one food. The incidence is highest among young children, with close to six percent affected by a food allergy, according to Anaphylaxis Canada, a non-profit allergy education organization. Food allergies are becoming more prevalent: Research out of the US suggests that the incidence of peanut and tree-nut allergies among kids younger than 18 has tripled in the past 15 years. (And children younger than two are most likely to be diagnosed.)

These numbers are changing the lunchroom culture at North American schools. Some, like Paul Escher’s, do it classroom by classroom. Others create separate, allergen-free safe zones where food-allergic kids can eat. In 2005, Ontario passed Sabrina’s Law, which requires all school boards in the province to maintain an “anaphylaxis policy” that includes staff training and protocol for handling a reaction on school grounds. Alberta, British Columbia, Manitoba and Newfoundland all have legislation or guidelines similar to Sabrina’s Law in place, and Quebec is trying to pass its own version, called Megan’s Law.

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Provincial legislation helps, but it doesn’t dictate how schools and school boards choose to balance safety risks with the prospect of inconveniencing the majority of students (and their parents). Everyone has a different idea of what “doing enough” means, says Laurie Harada, executive director of Anaphylaxis Canada. “People expect schools to have a one-size-fits-all for policies and practices, but that’s not the way things have trended,” she says. Instead, schools assess food allergies in the student body on a case-by-case basis. It’s tricky because there are so many variables — the number of allergic students (with which kinds of food allergies), the students’ ages, the size of the school, whether there’s a lunchroom or common cafeteria, and, of course, the school’s resources.

A collaborative approach, often in consultation with the families of allergic kids and parents of non-allergic kids, seems to work best, says Harada. “If families have input and they come up with what’s going to work in that school environment, you’re going to get better buy-in.” She also says it’s imperative to build empathy within the student body. “When the classmates understand what a child with food allergies is dealing with, they’re often your best ambassadors.” --

Growing up, I didn’t know any kids with food allergies, and when I was pregnant, I hoped my kids wouldn’t have them. But after my son Bennett reacted to egg whites when he was one, and then tested positive for an egg and a peanut allergy, I joined the newly minted tribe of obsessive, food-label-reading moms. We were lucky: Bennett, now five, outgrew both allergies at three and a half, but the experience afforded me a window into the food-allergic world. It’s a realm the uninitiated don’t understand — most parents roll their eyes when moms like Escher decree cupcakes contraband, and others are openly annoyed they have to spread soy-based substitutes on their kids’ sandwiches instead of real peanut butter. Because a girl in my daughter’s grade two class has a peanut allergy, all 100 students in the school — and their parents — must follow the nut ban, too. It’s definitely a hassle. But when it’s your child’s well-being on the line, you’d do anything to keep him safe.

Some experts also question school food bans. Allergy immunologist Moshe Ben-Shoshan, assistant professor in the paediatric department at Montreal Children’s Hospital at McGill University, worries that the current trend of outlawing certain foods at our schools might cause a false sense of security — the administration can say “no nuts,” but they can’t guarantee schools are nut-free. He also believes that food bans could be the beginning of a slippery slope. Given that soy, fish, milk and other items can cause anaphylactic reactions in some kids, where should a school draw the line? (Parents peeved that they can’t pack PB&J would likely be outraged if milk or apples were forbidden.) Instead of eliminating allergens from school grounds, Ben-Shoshan says teachers just need training in how to handle reactions.

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Sarah Cooke is glad her children’s Catholic elementary and secondary schools in Regina have allergy management policies, including nut restrictions. Her son Connor, 15, has a peanut allergy, and has been diagnosed with celiac disease (the inability to digest gluten). Aidan, 12, is allergic to dairy and peanuts, and is sensitive to gluten (it causes gastrointestinal problems for him). Hannah, 9, is also sensitive to gluten and allergic to dairy and peanuts, along with shellfish. Making inclusive meals for her brood has been a challenge, but she has parlayed her food-allergy meal planning expertise into starting a monthly hot lunch program at her kids’ elementary school.

“This way, allergic kids get to participate in hot lunch and don’t feel left out,” says Cooke. The lunch costs between $4 and $8, and Cooke ensures the meal is safe by overseeing the baking, cooking, bagging and labelling.

Cooke had food allergies as a kid, too, and recalls that back then, schools didn’t make any accommodations for her. She wants her children to become self-sufficient and responsible for managing their own meals. “The thing is, these kids need to go out into the world,” she says. “They need to take ownership of the food allergy. I’ve taught my kids, from the moment they could talk, not to accept food from anybody. They ask a trusted adult if something is safe to eat, and if no one is around they say, ‘No, thank you.’”

Cooke’s attitude is refreshingly matter-of-fact. Her kids will always have to read labels and plan ahead, just as she did. But instead of dwelling on what they can’t have, or living in fear of contaminants, they focus on what they can eat, and celebrate the daily ritual of sharing meals. “I don’t want them to be afraid of food. I want them to be aware and proactive,” says Cooke.

I like her rational approach. Rather than shielding her kids, Cooke is arming them with the allergy smarts to minimize their own risk in a world that will never be completely nut-, milk- or gluten-free. Though my son no longer has to deal with his food allergies, Cooke and I still have one thing in common — the desire for our kids to leave the nest equipped to face challenges on their own.

A version of this article appeared in our August 2013 issue with the headline "Food Fight," p. 48