Class Reaction
Making schools safer for allergic kids

Janet French

It was snack time in an Edmonton kindergarten when the new girl next to Christian Wigger ate a peanut butter sandwich. Her parents may not have realized that the entire school had been designated “peanut-free”—to protect the five-year-old boy from his life-threatening allergy. Christian soon began feeling sick to his stomach and then keeled over, unable to talk. “He must have touched just a trace,” says his mother, Ana, of her son’s severe reaction in November 2004. Christian belongs to the 1% of children in North America who have an anaphylactic (acute) allergy to peanuts. School staff thought the child had come down with the flu, but when Ana arrived at the school and heard about the peanut butter sandwich, she rushed the boy into her van and, sweating and swerving, made for the nearest hospital. Although Christian had had anaphylactic reactions before, these symptoms were new.

Photo : Bernard Clark

An immediate injection of the hormone epinephrine (also known as adrenalin) could have eased Christian’s reaction. And he did have an epinephrine auto-injector at school, but it was kept locked in a cupboard and staff couldn’t find the key. Luckily for Christian, he reached the hospital in time.

“The incident left my son shaken; it left me shaken,” says Ana. “And from that point on, I realized I had to be extremely articulate with the schools in getting them to understand his situation.” Considering her boy’s near miss, Ana wept when she later heard about Sabrina Shannon, a 13-year-old Pembroke, Ont., girl who paid the ultimate price for the lack of emergency response plans in our schools.

Allergic to soy, dairy products and peanuts, Sabrina died in September 2003 after having an extreme reaction to french fries from her school cafeteria. Tongs used to serve the fries may have been contaminated with cheese from poutine. Unfortunately, Sabrina thought she was having an asthma attack, so her auto-injector pen stayed in her locker while she fell unconscious in the school office.

The teen’s death prompted Ontario MPP Dave Levac to table a private member’s bill requiring all Ontario schools to have a specific emergency plan in place for each student with severe allergies. Soon dubbed Sabrina’s Law, the bill came into effect last January.

Now Christian’s parents want a similar law enacted in Alberta and have already met with the province’s education minister, Gene Zwozdesky, who agrees that Alberta needs more consistent policies. Allergy plans differ from school to school, Ana notes. “Yet we live in a very mobile society. I should be able to locate anywhere in Alberta and have the same sort of care for my child as I would in his current school.”

Out on the west coast, Pamela Schroeder, a Vancouver mother of a peanut-allergic nine-year-old, Aaron, is pushing for a made-in-B.C. Sabrina’s Law. Although the city’s school board has guidelines for dealing with anaphylactic kids, not all schools follow them. “The situation is based on how well the parents can advocate for their child and how seriously the principal takes allergies,” she says.

Under new provincial legislation, however, schools would be legally obligated to put in place a detailed prevention and emergency plan similar to the one arranged for Aaron. B.C.’s opposition New Democrats are now drafting a bill to that effect.

The allergy situation is bad enough for young, controllable children like Christian and Aaron, but when kids enter the peer-pressured teens, new worries arise.

“The problem in high schools is that teenagers have a lot more freedom of choice, and they do not always make the right ones,” says Dr. Christine McCusker, who is a pediatric immunologist at Montreal Children’s Hospital. “So the goal of being ‘allergen-free’ in a high school, where kids can come and go, is basically not attainable.” In this setting, kids are at a much higher risk of contact with allergenic foods and, not surprisingly, teen students are having more reactions than school-aged pupils. More than half the subjects in one American study of 32 anaphylaxis deaths were teens or young adults. A U.S. poll found that 26% of teens don’t always carry their auto-injectors.

Teens, after all, are risk takers and under the influence of peers may clam up about their allergies for fear of looking vulnerable or seeming different from their friends. “The last time you reacted was when you were a baby, as a general rule, so now you don’t really think much of this food-allergy thing,” McCusker says. “And because of their developmental stage, teens are more likely to take risks: you happen to be immortal.”

But the message has to be sent to adolescents. As McCusker tells her teenage patients, “It’s probably a bit more embarrassing to fall to the ground, have difficulty breathing and be taken off in an ambulance than it would have been to say, ‘By the way, I’m allergic to peanuts. Do you mind not giving me any?’”

Justen Russell, a 16-year-old Grade 10 student in Calgary, knows how deaf an ear authorities can have. He has anaphylactic allergies to eggs, shellfish, fish, peanuts and tree nuts. When he was shopping around for a high school last year, the principal at his first choice told him he should finish his school days from home via computer. “It was pretty annoying,” Justen says, “because most of the high-school experience is actually being with people. You don’t want to be at home alone on a computer.”

Although Justen’s mom, Bonita Hoffman Russell, spoke with his new “peanut-free” school about his allergies, the teen kept bumping into classmates with peanuts in hand. He admits it isn’t easy to ask peers to throw away their snacks. “I’ve had a few who were pretty annoyed. I just don’t hang out with them now.” Justen packs his own lunch and wouldn’t even set foot in the school cafeteria, let alone eat its food. But since he also criss-crosses Canada for school debates, his parents must constantly explain why nuts can’t be served at social events. “People assume that because Justen’s older, he can manage this; but people in anaphylactic shock can’t give themselves needles,” Bonita says.

Photo : Bernard Clark

The allergy-proofing of Canadian schools may still be in its infancy, but step by step and reaction by reaction, awareness is increasing. And in the next few years, many more schools will likely have allergy policies and action plans to prevent and manage anaphylactic events.

But for Pamela Schroeder, who still recalls the scream of the ambulance siren after Aaron reacted to a buddy’s granola bar, having an allergic child will always mean adjusting your life around him. “In everything we do, we think about how it will affect his allergy,” she says. “I used to think I’d be able make everything perfect so Aaron would never have a reaction, but I know there are going to be accidents throughout his life.”

Anaphylaxis

This an acute, sometimes life-threatening allergic reaction that can involve several body systems. Its signs include flushing, skin hives, swelling of the lips, tongue and throat, difficulty breathing, stomach upset and diarrhea. It is sometimes preceded by a sense of impending doom known as angor animi.

True allergic reactions—as opposed to irritations and intolerances—are handled by the body’s immune system. They occur when the immune system identifies innocent foreign substances, such as proteins in foods, as potentially harmful (similar to the way it learns to recognize and attack infectious bacteria). Such substances are called allergens. The main immune defences against allergens are the mast cells in the nasal passages and respiratory tract. When an allergen is identified, the body produces a lot of little Y-shaped watchdogs known as immunoglobulin E (IgE) antibodies against it, which attach themselves to the mast cells. Think of IgE antibodies as the lookouts in the crow’s nest of an old-time sailing ship.

When these antibodies recognize an allergen, they grab it, which alerts the mast cells to break open and release inflammatory chemicals such as histamines and leukotrienes. These chemicals mount an attack on the invading substance, but their protection comes at a price. What started out as protection, becomes the opposite (anaphylaxis comes from the Greek for “excessive” or “reverse protection”) and the patient experiences the unpleasant and sometimes life-threatening symptoms of a severe allergic reaction.

If a severe reaction is left untreated, a patient can experience shock, rapidly dropping blood pressure, pallor and unconsciousness. Furthermore, reactions are not predictable. They can happen immediately after exposure and escalate rapidly, or be delayed and deceptively mild at first. In rare cases, anaphylaxis is fatal.

The Experts’ Advice

As the law moves to make schools safer for allergic kids, here are 10 things our panel of experts says you can do now.

1. Look for a school with an allergy policy and, better still, an action plan. Some schools designate classrooms, lunch tables and even buildings as peanut- or nut-free, but the best protection is a detailed emergency response plan, says Montreal’s McCusker. “If the school knows how to recognize and manage an allergic reaction, the child is much safer than if it pays lip service to allergen-free.”
2. Download the U.S. Food Allergy and Anaphylaxis Network plan from its website, McCusker advises, available at www.foodallergy.org. Have it filled out by an allergist and present it to the school, making sure that all staff—including teachers, monitors and bus drivers—know which of your children has allergies and what his triggers are. In Canada, the Allergy and Asthma Information Association has made a similar plan available, but charges you $15, plus shipping and handling, for the manual. Order it online at www.aaia.ca. Get your child a MedicAlert bracelet or necklet.
3. Advocate for the training of all school staff and supervisors in the use of an epinephrine injector. Young pupils’ auto-injectors should be kept in a visible location, never under lock and key, says McCusker. Older allergic students should know how to use and always carry an auto-injector.
4. Start advocating for your child early. “Don’t show up on the first day of school with a bag of EpiPens and announce that your child has allergies,” says Dr. Sandeep Kapur, a pediatric allergist at the IWK Health Centre in Halifax. Discuss your child’s allergies with staff at a school orientation in the spring, then meet with teachers before classes begin in September.
5. Be flexible. Avoid launching into a dogmatic list of demands, says Kapur. Ask about the school’s existing allergy policies and see if your child can fit into them. “You have to come with a very clear list of needs but be willing to hear what the school’s opinion is,” McCusker adds. “It may not be the same as yours, but the school doesn’t want to have to call 911 anymore than you do.”
6. Think practically. Often it’s not feasible to ban a particular food from the school, notes Kapur. Banishing every trace of milk, for example, from hundreds of student lunches would be next to impossible. An allergen-free eating area or lunchroom and an allergen-free classroom could suffice. He also notes that there is little scientific evidence to suggest that allergic reactions decrease when schools ban offending foods.
7. Instruct allergic kids never to share others’ food or eating utensils, McCusker says.
8. Work out a few good schoolyard comebacks, especially for the teenage years. “Hey, would I give you cyanide? That peanut could be just as bad for me.”
9. Don’t be known only as “that parent with the allergic child.” Pamela Schroeder has become involved in planning school events, easing her mind and showing staff another side. “Let the teachers see the well-rounded part of you, so you’re not just coming across with allergy as your one big issue,” she says.
10. Do a show and tell. Both Pamela Schroeder and Bonita Hoffman Russell make annual trips to their children’s classrooms to tell the kids the dos and donts of allergies, the signs to watch out for and the importance of keeping an epinephrine injector on hand.