As many of my readers know, I live in Ontario, Canada, which I believe is the heart of food allergy and anaphylaxis safety protocols for Canada and the rest of the world. This is due to the work of Sara Shannon, mother of Sabrina Shannon, a child who unfortunately died at age 13 from a severe allergic reaction. As her daughter lay dying, Sara pledged to make school life safer for students with food allergies, and the result is Ontario legislation that is elegant in its simplicity and which inspired similar legislation throughout Canada and some of the United States.
Sabrina’s Law is set out in the legislation’s explanatory notes as follows:
The Bill requires that every school board establish and maintain an anaphylactic policy, which must include, among other things, strategies to reduce risk of exposure to anaphylactic causative agents, a communication plan for the dissemination of information on life-threatening allergies, regular training on dealing with life-threatening allergies, a requirement that every school principal develop an individual plan for each pupil who has an anaphylactic allergy and a requirement that every school principal maintain a file for each anaphylactic pupil.
The individual plan for a pupil with an anaphylactic allergy must include details on the type of allergy, monitoring and avoidance strategies and appropriate treatment, a readily accessible emergency procedure for the pupil and storage for epinephrine auto-injectors, where necessary.
Employees of a board may be preauthorized to administer medication or supervise a pupil while the pupil takes medication in response to an anaphylactic reaction, if the school has up-to-date treatment information and the consent of the parent, guardian or pupil. If an employee has reason to believe that a pupil is experiencing an anaphylactic reaction, the employee may administer an epinephrine auto-injector or other medication that is prescribed, even if there is no preauthorisation to do so.
The Bill provides that no actions for damages shall be instituted respecting any act done in good faith or for any neglect or default in good faith in response to an anaphylactic reaction, unless the damages are the result of an employee’s gross negligence. The Bill preserves common law duties.
Click here for the full text of Sabrina’s Law, 2005.
Although Sabrina died from exposure to milk protein, by having a good look at risk of exposure to allergens in school, many Canadian schools became peanut and nut free. This is due to huge numbers of people allergic to peanuts or tree nuts (about 1/4 people with food allergies), how highly allergenic they are (1/8000 of a peanut can cause a reaction), and how difficult the oily residue is to clean off surfaces. You can read a scientific study about how to properly clean off peanut butter and all traces of its residue by clicking here.
Canadian schools are careful not to say they “ban” peanuts and nuts, since they don’t want to imply that there are no traces of nuts on site, and they don’t want to need to inspect school lunches to police this. They do successfully create what I call a “traces of nuts” environment. People no longer bring peanut butter sandwiches to school or Snickers bars, or anything else that clearly contains nuts. Labels are read on packages, and any item that says “may contain traces of nuts” is to be enjoyed at home and not consumed at school. With a large school population, snacks with traces of nuts inevitably do enter the school, although a very close eye is kept on classrooms that have allergic students. Should those snacks be brought into class, they’d likely be noticed and sent home every time in those rooms.
When school wide allergy policies are adopted, the parent population becomes used to these precautions, and it becomes normal for everyone. The recent picketing of parents in Florida regarding precautions put in place in one classroom for one grade one student demonstrates that a safe environment can’t be created one classroom at a time and only when there happens to be an allergic student in the class. Classroom parents feel imposed upon, they don’t understand why they suddenly need to change their normal lunch and snack packing routines, the allergic child is subject to unbearable scrutiny, and an adversarial situation can develop.
In addition to excellent legislation, what we’ve also done right here in Canada is to adopt precautions to protect peanut and tree nut allergic children everywhere they go. Since schools have excellent policies in place, so do many summer camps, restaurants, and children’s sports organizations. It becomes normal to consider the safety of a snack sent along for the soccer team to enjoy and to see a notice from the team coach advising of team mates’ allergies. You can’t get to this level of compliance and tolerance introducing allergy policies in class rooms on a case by case basis.
I truly don’t understand why the Food Allergy and Anaphylaxis Network (FAAN) and its Canadian counterpart, Anaphylaxis Canada, don’t recommend school wide peanut allergy safety as the best policy. There is no reason to preserve peanut butter and jelly sandwiches in school lunches, when there are lots of other safe, healthful, and inexpensive choices to send. I could not let my son sit in a room with someone eating peanut butter or engage in class activities with students who just ate it: The risk of exposure is simply too high, and when I hear the statement that restricting it creates a “false sense of security”, my blood boils.
Nut safe school wide policies in no way create a false sense of security; instead, they reduce a “true sense of danger”. School administrators and allergy parents know that a “nut free” school cannot be policed and insured 100%. The school still should strive to be “nut safe”, to limit the allergen and create an environment that’s safer and manageable for teachers, staff, and allergic students.
This article on the ACAAI website by Allergist Dr. Jeffrey Miller clearly confirms that anaphylaxis (life threatening allergic shock) can occur from substances on the skin: “When trying to determine the cause of an anaphylactic reaction, physicians and patients generally consider substances that had been ingested or injected, but may fail to consider agents that had been applied to the skin. However, the systemic absorption of many topically applied substances is well known, and in fact is used as the drug delivery system of choice (via transdermal patches) for such items as nicotine, scopolamine, and hormone replacement therapy. It must therefore be remembered that any topical application that is capable of causing systemic absorption is also capable of provoking systemic IgE mediated allergy—and not just cell-mediated contact dermatitis.” To read Dr. Miller’s full article, click here.
It really is much safer not to bring peanuts or nut products in packed lunches or in food brought into the classroom for sharing during snack time or class celebrations. There were two recent tragedies in classrooms from food allergies. On 28 January 2011 Rehan Butt age 7, suffered two episodes of full cardiac arrest after a substitute teacher handed him a chocolate with a hazelnut inside it. The chocolates had been brought to the classroom by a classmate’s parent to share with the class to celebrate her child’s birthday. Despite receiving an EpiPen injection within 10 minutes, Rehan had a severe allergic reaction and was rushed to hospital and hooked up to a ventilator to help him breathe. His allergy was well known to staff at his school, which he’d attended for 3 years.
Another tragedy occurred on December 17, 2010 in a Chicago grade 7 class room. Katelyn Carlson, age 13, had a known peanut allergy as did another classmate. To celebrate the last day of school before Christmas Break, the teacher decided to order in Chinese food from a restaurant, and called ahead to ask that they not use peanuts. One peanut allergic child ate the food and was fine. Katelyn began to have trouble breathing from trace amounts of peanut protein in the food, and she did not have an EpiPen prescribed to her. She waited 15 minutes for emergency crews to arrive while receiving c.p.r., and within hours she was dead.
With the cooperation of parents of all students, tragedies like these can be avoided. It is in the best interests of each school’s allergic students, the teachers and staff who supervise them, and the rest of the students to help them avoid tragic mistakes and the horrific events that can follow them.
At my son’s school, we were recently faced with a challenge by a very small number of parents (two) who wanted to bring peanuts and nuts back into the school, not only in their children’s lunches but also in food to be shared by the entire class, as long as they are clearly labeled. They requested time before the Parent School Council to make submissions, I was called in as an expert parent, as was a nurse from our health unit. After hearing submissions, reviewing the legislation, and looking at our old policies, the school principal prepared revised policies, and I was well pleased.
Our new school policy can be viewed by clicking here, which provides that peanuts and tree nuts, even in trace amounts, still are not to be brought into school. All communication on allergy issues is to come from the principal for consistency and clarity, parents of all students now have to sign this authorization form to allow their children to eat food brought in for sharing (he feels a huge number of parents will opt out), and there are provisions to handle other allergens like latex as needed. My hope is that sharing this policy will help improve the safety of all school children with allergies.
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