AnaphylaxisManagement

Anaphylaxis,asevereallergicreaction,isagrowingpublichealthissue.Themostcommoncauses
arefoodsandinsectstings.Themostcommonfoodallergensarepeanut,treenuts(e.g.almonds,
hazelnuts,pinenuts,etc.),milk,egg,fishandshellfishandtoalesserextent,sesame,soy,and
wheat.

Morethan600,000Canadians(12%ofthepopulation)arethoughttobeatriskofanaphylaxis
andtheincidenceoffoodallergyinchildrenisbelievedtoberising.Whileanaphylaxishasthe
potentialtocausedeath,fatalitiesarerareandusuallyavoidable.Thekeytoremainingsafeisto
completelyavoidfoodallergens.Educationandawarenessgoalongwaytowardreducingtherisk
ofaccidentalexposure.

Epinephrineisthemedicationofchoicetotreatanaphylaxisandpersonsatriskmustcarryitwith
thematalltimes.Mostdeathsareassociatedwiththedelay,underutilizationorlackof
epinephrine.Poorasthmacontrolisalsoafactor.Theagegroupsmostatriskincludeolder
children,teens,andyoungadults.

Theprimaryresponsibilityforallergenavoidancelieswiththefoodallergicperson(orparentor
caregiverinthecaseofyoungerchildren).Asactualingestionoftheallergenposesthegreatest
risk,basicavoidancemeasuresshouldinclude:

Carryinganepinephrineautoinjector(e.g.EpiPenorTwinject)andwearingamedical
identificationbracelet(e.g.MedicAlert)
Alwaysreadingingredientlabelscarefully
Nosharingoffoods,utensils,orcontainers
Washinghandsbeforeandaftereating
Ensuringadultsupervisionofyoungallergicchildrenwhentheyareeating

Managingafoodallergydoesnotnecessarilyimplythatotherscannoteatorhaveaccesstothe
allergenicfoodwhentheyarearoundtheallergicperson.

Theimportantthingisthattheallergicpersondoesnotingestthefood.Education,
awareness,hygieneandemergencypreparednessarethemostimportantriskreduction
strategiesinmanagingtherisksassociatedwithanaphylaxis.

Therecentlypublishednationalanaphylaxisguidelines,AnaphylaxisinSchools&OtherSettings,by
theCanadianSocietyofAllergyandClinicalImmunology(2005)encouragesschoolsandother
childcarefacilitiestohaveregularstafftrainingandemergencyprotocolsinplace.(SabrinasLaw
requiresthisinallOntariopublicschools.)
1

Manydaycareshavepoliciesthatrestrictcertainfoodssincethechildrenaretooyoungto
understandavoidancemeasures.Carefulconsiderationshouldbegiventotheuseoffood
allergensinactivities,suchascrafts,andinmealpreparation.Asveryyoungchildrenareoften
socializedtosharewithothersandhaveatendencytoputtheirhandsintheirmouths,therisk
factorforthisagegroupcouldbehigh.Avoidancemeasures,oftenrestrictingthepresenceof
allergenicfoodssuchaspeanutandnutproducts,wouldbeappropriateinearlychildcaresettings
wheretherearepeanut/nutallergicchildren.Specialaccommodationsshouldalsobemadeto
protectchildrenwithotherfoodallergiesaswell.

Someairlinesrestrictpeanutsnacksbecauseoftheconcernthattheclosedenvironmentonthe
airplanewillbecontaminatedbyairbornepeanutparticlesifallpassengersareservedthesesnacks
andalsobecauseitisadifficultenvironmentinwhichtotreatareaction.

Manyelementaryschoolsalsohavepoliciesinplacetoreduceriskofaccidentalingestion.Some
schoolschoosetorestrictanallergenicfood,particularlyinsituationswherechildreneatintheir
classroomsorwithoutadultsupervision.Othersestablishallergenfreeeatingzones,forexample,
peanutfreeareaswherepeanutallergicchildrencaneat.Somerestrictallfoodsinanallergic
childsclassroom.

Suchpoliciesneedtobeindividualizedonthebasisoftheparticularschoolsettingand
particularfoodallergiesandshouldbepartofanoverallanaphylaxiseducationand
emergencyplan.

Itisimportanttonotethatallergysafedoesnotequalallergenfreeasitisimpossibleto
ensurecompletecompliancewithfoodrestrictionsortoguaranteeanallergenfreeenvironment.
Allergysafereferstoaprocessofcontinuallystrivingtoattainalevelofriskmanagementand
ongoingtrainingandcommunication.Theallergicpersonandanycaregiversmustalwaysassume
thattheallergencouldbepresentintheenvironmentandbehaveaccordingly,takingonthe
primaryresponsibilityforallergenavoidanceandbeingpreparedtoquicklytreatanallergic
reactionwithepinephrine.

Theoverridinggoalistoteachchildrenwithlifethreateningallergiestoeffectivelyassessand
managetheriskofaccidentalexposureandtobepreparedtoreactquicklyiftheyhaveareaction.
Withparentalguidanceandcommunitysupport,allergicchildrenmustlearnhowtotakeonmore
responsibilityastheymature.Theyshouldrecognizethatitisnotpossibleortenabletotryto
controlallenvironmentsandthatongoingvigilanceisrequired.

AllergensinPublicPlaces

Acommonlyheldbeliefisthateffortsshouldbemadetoeliminateorrestrictallergenicfoods,such
aspeanutandnutproducts,frompublicvenuesincludingcommunityandrecreationcentresand
arenas,andentertainmentfacilitiessuchastheatres.Theargumentisoftenmadethattheses
measureshavebeenadoptedbymanydaycaresandelementaryschools,sowhynotpublicareas?

Itisimportanttorecognizethatinschoolanddaycaresettingsthecommunityisfairlystable,
whichfacilitatestheimplementationandmonitoringoffoodpolicies.However,inpublicvenues
thecommunityisconstantlychanging,whichmakesitdifficult(ifnotimpossible)toensure
compliancewithpolicies.Asfoodrestrictionsinpublicvenuesmaynotbeviewedasapracticalor
achievableoption,keystakeholdersshouldworktogethertodeveloppolicieswhichareboth
reasonableandpractical,takingintoconsiderationthefollowing:

Whataretherisksofaccidentalexposure?
Whatistheabilityoftheallergicindividualtoselfprotect?
Whatcanbedonetoeducatethegeneralpublic?
Whatmeasurescanberealisticallyputintoplacewhatcanandcannotbedone?
Areemergencyprotocolsandstafftraininginplace?

Policiesinpublicplacesshouldreflectevidencebasedriskanalysisandshouldclearlydefinethe
rolesandresponsibilitiesofallpartiesinvolved.Manyfoodsotherthanpeanutsandnutscan
causeallergicreactionsandconsiderationmustbegiventoensurethatmeasuressafeguardall
individualsatrisk,whilenotundulyrestrictingtheconsumptionofcertainfoodsbythegreater
population.

Itisimportanttorecognizethatevenifaccommodationsforfoodallergicindividualscanbemade
inaparticularsetting,theriskofaccidentalexposuretoanallergenmaystillexist.This
underscorestheneedforongoingselfmanagementstrategiesandemergencypreparedness,which
arethemostimportantsafeguards.

Educationofstaff,coaches,securitypersonnelandthegeneralpublicisalsokey.

*****

Thispositionstatementhasbeenpreparedbythefollowingnationalnonprofitorganizationswith
aninterestinanaphylaxis(May2006):

CanadianSocietyofAllergyandClinicalImmunology
CanadianAllergy,AsthmaandImmunologyFoundation
Allergy/AsthmaInformationAssociation
AnaphylaxisCanada
Associationqubcoisedesallergiesalimentaires

Formoreinformation:
www.allergysafecommunities.ca

AnaphylaxisinSchoolsandOtherSettings(2005)
CanadianSocietyofAllergyandClinicalImmunology
Aussidisponibleenfrancais.

anaphylaxis_management_public_venues_june_06