Anaphylaxis in Schools 3rd Edition
Anaphylaxis in Schools 3rd Edition
Anaphylaxis in Schools 3rd Edition
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Avoidance of Peanut and Tree Nuts<br />
Appendix G<br />
A study conducted <strong>in</strong> Montreal schools estimated the prevalence of peanut allergy to be up to 1.7%. 1<br />
Another study based on self-reported data across Canada confirmed this estimate. 2<br />
Peanut allergy requires str<strong>in</strong>gent avoidance and management plans as it is one of the most common<br />
food allergies <strong>in</strong> children, adolescents, and adults. 3 Reactions to peanuts are often more severe than<br />
to other foods. Peanut has been a lead<strong>in</strong>g cause of severe, life-threaten<strong>in</strong>g, and even fatal allergic<br />
reactions. 4,5 Despite appropriate counsel<strong>in</strong>g on peanut avoidance, the majority of subjects followed<br />
for 5 years experienced adverse reactions from accidental peanut exposure. 6 Very small quantities of<br />
peanut, when <strong>in</strong>gested, can result <strong>in</strong> a life-threaten<strong>in</strong>g reaction.<br />
Peanuts are legumes and grow underground. They are not botanically related to tree nuts. The tree<br />
nuts <strong>in</strong>cluded <strong>in</strong> Canada’s list of priority food allergens are almonds, Brazil nuts, cashews, hazelnuts,<br />
macadamia nuts, pecans, p<strong>in</strong>e nuts, pistachio nuts and walnuts. Individuals who are allergic to peanut<br />
may not be allergic to tree nuts, and vice versa. However, it is possible to be allergic to both. Those<br />
who are allergic to peanut or tree nuts are generally advised to avoid both due to possible crosscontam<strong>in</strong>ation<br />
of peanuts and nuts dur<strong>in</strong>g process<strong>in</strong>g/packag<strong>in</strong>g and the risk of confusion between<br />
different nuts.<br />
In the high school environment, teens at risk of anaphylaxis must adhere to key safety rules. Where<br />
food is concerned (any food), this <strong>in</strong>volves read<strong>in</strong>g food labels carefully and tak<strong>in</strong>g special precautions<br />
such as ask<strong>in</strong>g foodservice staff about the preparation and handl<strong>in</strong>g of food at the cafeteria, if they<br />
purchase their lunch at school. Students with food allergy should eat with a friend and advise others<br />
quickly if they feel they are hav<strong>in</strong>g an allergic reaction. They should not eat if they do not have their<br />
ep<strong>in</strong>ephr<strong>in</strong>e auto-<strong>in</strong>jector with them.<br />
Foodservice companies have a responsibility to tra<strong>in</strong> their staff to understand the risk of crosscontam<strong>in</strong>ation<br />
<strong>in</strong> the purchas<strong>in</strong>g, preparation, and handl<strong>in</strong>g of food items. Foodservice staff should<br />
participate <strong>in</strong> regular school staff tra<strong>in</strong><strong>in</strong>g on anaphylaxis management; they must be aware of students<br />
at risk for food allergy.<br />
Avoidance of Milk and Egg<br />
While many young children outgrow an allergy to milk and egg with<strong>in</strong> the first decade of life, some will<br />
cont<strong>in</strong>ue to rema<strong>in</strong> at risk of anaphylaxis, and should therefore follow key safety rules such as carry<strong>in</strong>g<br />
ep<strong>in</strong>ephr<strong>in</strong>e at all times. Anaphylactic reactions to milk and egg can occur when relatively small<br />
quantities are <strong>in</strong>gested. Therefore, the allergic child must avoid all traces of milk and egg.<br />
Elementary schools have adopted different strategies to reduce the risk of exposure for milk- and eggallergic<br />
children.<br />
<strong>Anaphylaxis</strong> <strong>in</strong> <strong>Schools</strong> & Other Sett<strong>in</strong>gs<br />
Copyright © 2005-2014 Canadian Society of Allergy and Cl<strong>in</strong>ical Immunology<br />
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