Food Allergies: Managing Risks
By Mary Allen,
AAIA Regional Coordinator, Quebec
This article appeared in the AAIA newsletter in December 1999.
When parents of babies at risk of anaphylaxis call the AAIA for
information, they almost always ask if their child will be safe
at school or at camp, even though these events may be years in the
future. Feeling overwhelmed and anxious, they already recognize
that their child will face special risks.
Risk assessment and risk management are tools extensively used
in business, health care and insurance as a way of examining and
dealing with risk. These tools can be useful to parents of seriously
allergic children who are dealing with new situations. Based on
rational thinking and on factual information, they may reduce anxiety
and lead to a safer environment.
Risk assessment, which determines the nature and degree of risk,
must be objective and based on the best available scientific and
Risk management is the development and implementation of appropriate
interventions, policies and protocols. The goal is not to eliminate
all risks but to minimize them.
It is important to accept that there is always going to be some
degree of risk. Moreover, there is no universally acceptable level
of risk, since what is acceptable to one group or individual may
be unacceptable to another. Those who cannot accept the existence
of even a small residual risk will have a very difficult time letting
their child "out into the world". Difficult as it may
be, parents must come to terms with this. Just as we allow children
to ride in school buses or cross streets despite inherent risks,
we need to send the food-allergic child off to school despite some
risks. And, just as we educate and prepare children to cross a street
safely, we can educate and prepare them and the school to be "allergy-aware".
RISK ANALYSIS TECHNIQUES
1. Identify the major and minor risks
2. Assess the likelihood of their occurrence
3. Find ways of reducing these risks
4. Decide how to deal with the remaining risks
Admittedly, it is not easy to precisely calculate the likelihood
of occurrence of food reactions. When parental anxiety about what
"could happen" starts to go out of control, it may help
to remember that there are thousands of food-allergic people in
Canada and the United States, yet there are a relatively small number
of deaths from anaphylaxis and a relatively small number of serious
In the past, some deaths occurred because medication was not accessible
or was not used
often because the person or the caregivers did not
realize the seriousness of the allergy. For some, uncontrolled asthma
probably increased the severity of the reaction. So by carrying
medication, by treating reactions promptly and by keeping asthma
under control, the risk of death is substantially reduced. Education
and training of caregivers further reduce risk.
Using a school situation as an example, how can the process of
risk management be applied?
Assume a milk and peanut allergic kindergarten child in a school
where the children go by bus, stay in the same classroom all day,
go out for recess and eat lunch in a gym.
Risk #1: the child might deliberately take food from another
child or adult.
Some risk reduction strategies:
· As soon as the allergy is diagnosed, educate the child
about the allergy and train him/her not to accept food from anyone,
unless his/her parent is present and approves it.
· Practise the words which the child can use to tell others
about the allergy, to show his/her Medic Alert bracelet (www.medicalert.ca),
to have the confidence to say "no thank you" to a persistent
person who offers food, even if that person is an adult;
· Inform and train school staff, bus driver, and peers about
· Keep safe "treats" in the teacher's desk or staff
fridge in case of birthday celebrations;
· Have medication accessible and a school emergency plan
· Keep a safe snack in school bag.
Risk #2: the child will inadvertently ingest peanut butter or
milk which another child is eating
or has eaten before coming
Some risk reduction strategies:
· No sharing of food rule (and no kissing peanut butter eaters!);
· Clearly tagged lunch bag;
· Frequent hand washing by everyone;
· Eating in specific locations (no food in classroom?) with
· No peanut or liquid milk in classroom;
· Child carries medications at all times in fanny pack and
is carefully supervised;
· Institute a buddy system.
Other risky situations can be identified and analysed in this fashion.
Writing the risks and strategies out on paper helps to clarify them.
No two school situations are exactly alike, so there is not just
one "right way" of handling all allergies. Parents need
to assess their child's school environment on a case-by-case basis,
in co-operation with school personnel. The scenarios above would
differ if lunch was eaten in the classroom, or if school board rules
require that medication be handled differently.
Parents whose child is the first or only allergic child in the
school will have more work to do than those who come after them.
They may have to educate school personnel about the health risks
before they can work on a strategy for dealing with them. They should
find out if an allergy protocol already exists in their school board,
which would give them a point of reference for their discussions.
If there is no protocol, parents can encourage the Board to establish
one by volunteering to work on it. Even if there is a protocol,
parents still need to have discussions with the principal, the school
nurse, the classroom teacher, the lunchroom supervisors, the gym
teacher and anyone else who will be responsible for the allergic
This process of education and preparation needs to start well before
the start of school and be ongoing, as unforeseen issues arise.
Education, preparation, cooperation and careful planning can create
an environment in which health risks are minimized.
Allergy/Asthma Information Association (AAIA)
Box 100, Toronto, Ontario M9W 5K9
Phone (416) 679-9521 or 1-800-611-7011 Fax: (416) 679-9524
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Consult your family physician or allergist for specific questions
This article courtesy of the Allergy/Asthma
Information Association at www.aaia.ca and the Calgary Allergy Network
web site at www.calgaryallergy.ca. May be reproduced for educational,
non-profit purposes with proper attribution.
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