By Wendy Harris
Brenda and Dan Hobbs knew from the
beginning there was something unusual about their son David. As an infant, he reacted in
dramatic ways to Brendas breast milk, depending on what she had eaten during the
previous days. When he nursed, his skin would sometimes turn blotchy or be covered
instantly with red dots.
So it was really no great surprise when
an allergy specialist confirmed that David was highly allergic and like many
children with severe allergies had asthma, a specific allergy to eggs and could be
highly allergic to peanuts.
This last possibility was confirmed
shortly afterwards when David was given a cookie by a generous bakery shop assistant. He
took a bite and almost immediately started to gag and drool. Dan raced him to a hospital
emergency ward where, as the childs symptoms gradually faded, doctors corroborated
Dan and Brendas worst fear David had had an anaphylactic reaction to peanut
butter in the cookie he was given.
Anaphylaxis, sometimes called allergic
shock, is a severe allergic reaction that, if untreated, can lead to rapid death. Like
less severe allergic reactions, it happens when the bodys immune system responds to
harmless substances as though they were harmful invaders. But instead of developing a
runny nose or a rash, anaphylactic sufferers respond with an extreme systemic reaction
that may begin with itching, hives, vomiting, diarrhea and swelling. Within moments, the
throat closes, choking off breathing and leading to unconsciousness and death.
Food allergies are most likely to kill
people if they have asthma or dont get epinephrine quickly enough. Epinephrine, also
known as adrenaline, is a hormone produced naturally by the body in response to stress and
is the only drug that can stop anaphylaxis symptoms. It works on both the cardiovascular
and the respiratory systems to constrict blood vessels and relax the muscles of the chest
to improve breathing.
While peanuts are the leading cause of
food-induced anaphylaxis, many potentially life-threatening foods are out there. Tree
nuts, milk, eggs, wheat, seafood, soy and sesame have all been implicated. Besides food,
other common culprits in triggering extreme allergic reactions are drugs, insect stings,
latex, hormone supplements and even exercise.
With his condition confirmed, Dan and
Brenda set about ordering a life for David that precluded his contact with peanuts or
peanut products of any kind. That meant checking the labels of every item of food that
came into the house, warning friends and family, eliminating many restaurants and
bakeries, monitoring Halloween candy and watching David like a hawk until he was old
enough to start assuming some of the responsibility for himself.
When he was very young, they taught
David never to accept food from anyone before checking with his parents. They carefully
outlined Davids allergy to playmates parents, explaining that even minute
amounts of peanut butter or products could trigger a reaction. They even changed daycares
when they grew concerned that other parents were not taking the allergy risk for David
Most importantly, they kept an EpiPen
in their medicine chest and bought David a fanny pack in which to carry another one.
EpiPens are pre-measured doses of epinephrine which must be injected immediately at the
first indication of anaphylaxis. Because it is usually injected directly into the thigh
muscle, children as young as six or seven can be taught to administer the drug themselves.
However, in an emergency, they may not have the presence of mind to do so.
Asthmatic children experiencing
anaphylaxis are sometimes treated with asthma inhalers or antihistamines. While these
drugs may be useful as adjuncts, they are not a substitute for epinephrine. Even if all
symptoms appear to be resolved after an injection of epinephrine, a child should be
monitored for at least four hours but preferably for up to 24 hours.
David ended up in a daycare where
everyone was already aware of his allergies. It wasnt really until he moved to a
west end school in Grade 1 that his parents had to raise the issue. The principal there
had already encountered some children with severe allergies and set up a special spot not
too far from the main lunchroom for David and a few other allergic children to eat. And he
assured Brenda and Dan that the school would do its utmost to keep David safe.
The principals assurances did not
prevent David from having to endure the teasing of his less diplomatic classmates. Dan can
remember times when David came home from school upset because his friends taunted him with
either real or imaginary peanut butter sandwiches. "We had to make sure that the
teacher was on board and that she recognized that this was the worst kind of bullying
because, basically, they were threatening him with death."
Davids story is not unique.
According to Dr. Peter Vadas, head of the division of allergy and clinical immunology at
Torontos St. Michaels Hospital, the prevalence of allergies, including
life-threatening ones like Davids, has doubled in the last 10 years. And
theres no slowdown in that escalation.
Dr. Vadas says the fact that the
incidence of allergies is rising so dramatically in developed countries of the West is no
accident. He says there is solid evidence showing that as our society becomes increasingly
cleanliness, the human immune system
has shifted away from fighting bacterial and viral infections and towards attacking foods
that are usually benign.
On top of that, says Dr. Vadas, it is
generally accepted that childrens early exposure to potential allergens can trigger
future allergies. And more children are being exposed to the ubiquitous peanut at a
younger age. Peanuts and their byproducts are everywhere in foods, cosmetics and
pharmaceuticals, and the shells are even used for stuffing bean-bag-type chairs.
About a decade ago, the sudden surge in
highly allergic children entering school systems across the province caught many educators
off guard. At that time, few school boards had policies in place dealing specifically with
anaphylactic children or children with other less lethal allergies.
Susan Yip, the past president of the
Anaphylaxis Network of Canada, recalls that when her now 17-year-old son entered
kindergarten, he was the first and only anaphylactic child the school of 600 had ever had.
She talked to his teacher who had never heard of life-threatening allergies
as well as to the principal and as many parents as she could to try to raise awareness so
that her sons daily environment wouldnt kill him.
DOESN'T GO AWAY
"In the beginning, people thought
I was talking about a little discomfort, a temporary problem," she says. "They
didnt realize these allergies are life threatening. They kill and they dont go
away and theyre forever."
That climate of ignorance has changed
substantially during the last 10 years. Awareness was sadly raised by several tragedies.
The Ontario Coroners Office reported seven deaths of school-aged children from
allergic reactions to peanuts, tree nuts and sesame seeds between 1986 and 1991. More
recent figures for anaphylactic deaths are not available, but a registry is currently
being established in Ontario.
In 1994, a student on a field trip to
Algonquin Park died from trace amounts of peanut butter which had been transferred to a
jam jar. That same summer, a child attending camp in Montreal died after eating a cheese
sandwich that had been stored in the same bag as a peanut butter sandwich. The amounts of
peanut butter that killed these children can be measured on the head of a pin. Some
children are so sensitive that even the smell of peanut butter can cause problems.
Health Canada recognized the growing
magnitude of the problem and published Anaphylaxis: A Handbook for School Boards in 1996
in both English and French. It was sent to every school board in Canada and to many in the
United States and has served as the foundation for many of the policies and procedures now
The anaphylaxis handbook details what
school boards and individual schools can do to protect their children. It suggests that
schools develop policies in three general areas:
communicating with and educating
the entire school community, including parents, teachers and students,
about who the anaphylactic children are, how to prevent exposure and how
to use EpiPens in an emergency
avoiding the main allergens
primarily peanuts at the same time as seeking to strike a balance between
rights of all students to eat what they like and the allergic
childs right to a safe school environment
developing emergency response
procedures based on treatment protocols prescribed by the childs doctor
in case of accidental exposure usually, an immediate epinephrine
injection, a fast trip to a hospital and
follow-up epinephrine every 10 to 15 minutes if breathing difficulties
During the years since the handbook was
released, schools and school boards have responded in different ways, depending on the
needs of the individual students.
Diana Rawsthorn, principal at Earl
Kitchener School, has about 390 students, four of whom have severe peanut allergies.
Protecting those children, she says, is a shared responsibility borne by all the teachers,
parents and students. And while Rawsthorn says she would never declare her school
"peanut or nut-free," she has requested that parents not send peanut butter
sandwiches to protect her allergic students.
"Weve tried to educate the
community and engage their support... In the end, the kids are the best police of it. They
understand what things are dangerous... Children have come to me and said My
mothers packed a peanut butter sandwich. What should I do?"
As the parent of three children without
allergies, Justine Elliott says communication with Earl Kitcheners staff has been
key in her agreement not to send peanut butter to school. She says armed with the
understanding of how deadly the peanut allergy is, she wouldnt ever consider it.
"Peoples reluctance to comply is really based on ignorance," she says.
In Barrie, Lou Brandes, principal of
Ferndale Woods Elementary School, a K-8 school with 900 students, has gone a few steps
further to protect the eight children who have peanut allergies there. Early in the fall
for the past four years, Mr. Brandes has sent home
newsletters requesting that parents not
send any foods with peanut products to school. At the same time, he calls assemblies and
mounts a full education program for the students, with guest speakers and videos, and kids
do a range of activities surrounding the subject.
"At the beginning, there was a lot
of resistance (to not sending peanut butter and jelly sandwiches to school). Thats
when we decided to educate the kids. We only got complaints the first year. Kids are
really our best ambassadors for this... We call it reducing the risk, with the
understanding that we cant guarantee a peanut-free environment."
Suzanne Stiegelbauer, co-ordinator of
the pre-service elementary teacher education program at Ontario Institute for Studies in
Education at the University of Toronto, says while there is no specific training about
children with allergies for teachers, it should be addressed during their practicums.
"Its an experiential
thing," says Stiegelbauer. "As always, they need to be aware of the issues
relative to their profession and relative to a safe environment. As teachers, theyre
going to run into all kinds of situations, including children with allergies. Theyll
need to know what to do."
The cornerstone of anaphylaxis
prevention is to avoid the offending substance. As an alternative to food bans, which can
provoke not only divisiveness in the school community but create a dangerous false sense
of security, parents should be told about the life and death seriousness of the allergies
in the school.
Children should be taught never to
share food or food containers. Allergic children should eat, if possible, in a segregated
setting to minimize the risk of contact, and eat only food that has been sent from home.
Food for special celebrations like Halloween, Christmas or childrens birthdays
should be scrupulously monitored or, if necessary, avoided by the allergic child.
Frequent handwashing should be
encouraged. Students and staff who have eaten peanut butter and havent washed their
hands can leave residue on school bus handles and seats, desks and chairs, toys, balls,
skipping rope handles, markers or pencils and computer keys.
What is clear is that while schools and
teachers can plan, take action and hope for the best, they must at all times be prepared
for the worst. All teachers should be made aware of which children are at risk and trained
to administer epinephrine. Identification sheets with the childs name, photograph,
specific allergy or allergies, early warning signs and specific medical treatments can
either be posted with permission of both parents and child or readily
available. Medication should be clearly labeled and easily accessed during an emergency
not in a locked cabinet.
According to Anaphylaxis: A Handbook
for School Boards, there are no contraindications to the use of epinephrine for a
life-threatening allergic reaction. In other words, if there is any reason to suspect an
anaphylactic reaction is taking place, and if epinephrine has been prescribed as the
treatment protocol, caregivers should not hesitate to administer the medication.
Moreover, according to Cynthia
Peterson, who researched the legal context for the Ontario Public School Teachers
Federation in 1996, teachers have a legal responsibility to provide a level of care and
supervision that could be reasonably expected of a prudent parent. That legal duty extends
to not only protecting a child from exposure to allergens but also administering emergency
medication during a crisis.
This level of care and supervision is
all well and good for younger children. But once they hit puberty and start looking for
ways to take risks and perhaps rebel a bit, the careful child may transform into a teen
who flirts with dangerous foods.
Vivien Goss is a high school geography
teacher at Langstaff Secondary School in Richmond Hill who has a nine-year old
anaphylactic son. She says she is concerned not only about her son on his direct path to
teenagehood but also about the students she teaches daily.
Goss says policies are necessarily
focused on children in elementary schools. In high school, where children and their peers
havent necessarily known each other their whole lives, those same policies become
vaguer and must be refocused to apply to teens.
When a vulnerable student enters high
school, parents should let the school know that their child has a life-threatening
allergy. Students should also consider wearing a MedicAlert bracelet identifying their
allergies and symptoms.
Most critical of all, students should
carry an accessible EpiPen with them at all times and the teacher should be made aware of
where it is.
Of course, not all allergies are
deadly. Allergies are, after all, an abnormal response to normal substances. The
substances in the classroom environment can be anything from scented markers, stickers,
molds or mildew, carpets, chalk dust, animals, paint fumes, dust, pollen, perfume and a
variety of foods. The non-fatal responses can range from sniffling, coughing, puffy eyes,
skin rashes or eczema, itchiness, irritability, headaches, disruptive behaviour, abdominal
cramps and vomiting.
Some doctors have suggested that
antihistamines used to treat milder allergies may have an adverse affect on a childs
ability to learn or on behaviour because the drugs affect the central nervous system. The
anti-asthma drug theophylline has been correlated with reports of inattentiveness,
hyperactivity, irritability, drowsiness and withdrawal behaviour and may be a contributor
to learning disabilities. Corticosteroids, which are also commonly prescribed, can have
It is estimated that about one in five
of the general population suffers from some type of allergy. Asthma, which often goes hand
in hand with allergies of all kinds, is one of the most common chronic illnesses of
childhood. Many of the symptoms of asthma and other allergies can be considerably reduced
by limiting exposure to allergens and irritants.
Thats where people like Chris
Broadbent, health and safety manager for the Toronto District School Board, play a huge
role. Broadbent regularly does battle with a host of indoor allergens that could have a
negative impact on learning in the classroom. During the spring, he says, there was
extensive flooding which meant that carpets had to be removed and replaced with vinyl
flooring to prevent the widespread growth of mildew and molds. In Toronto, where growing
student populations have caused the proliferation of portable classrooms, that problem is
particularly acute. Broadbent says that many portables have had to be closed because of
The concern for clean, allergen-free
air extends to what sorts of maintenance and cleaning products are used in the schools.
Broadbent says he is bombarded by people selling "everything from snake oil to a
cure-all for everything" and is constantly sifting through the information to come up
with environmentally and allergy-friendly products.
Meanwhile, David Hobbs is now 12 years
old and heading off to University of Toronto Schools for Grade 7 this year. Once again,
his parents will have to raise the alarm to make sure the awareness level about deadly
allergies is high. Since his brush with death as a toddler, David has had no anaphylactic
episodes. But he must always be vigilant and always be prepared.
"It doesnt get in the way of
my life," he says philosophically. "It just sets me apart as an individual...
All my friends are always really careful. The only time I feel ostracized is when I
ostracize myself to protect myself... I guess Ill always have to be careful."
Anaphylaxis: A Handbook for School
Boards can be ordered from the Canadian School Boards Association in Ottawa at
613-235-3724. Some web sites that may be helpful: Anaphylaxis Network of Canada: www.anaphylaxis.org; Allergy Asthma &
Immunology Society of Ontario: www.allergyasthma.on.ca;
Allergy Asthma Information Association;
www.nuconnexions.com. Lou Brandes,
principal of Ferndale Woods PS in Barrie, is happy to make the resources he uses available
to anyone interested. He can be reached at 705-733-5636 or by fax at 705-733-0723.