<strong>Anaphylaxis</strong>:A <strong>Handbook</strong> <strong>for</strong> <strong>School</strong> <strong>Boards</strong>September 2001OverviewThe pressure on school boards to develop policies to meet the needs of children with life-threatening allergieshas continued to grow since the first edition of this handbook was published in 1996. This is due to both anincrease in public awareness and an increase in the number of cases of anaphylaxis reported in Canada.<strong>Anaphylaxis</strong>, the medical term <strong>for</strong> “allergic shock” or “generalized allergic reaction”, can be rapid anddeadly. It can develop within seconds of exposure, beginning with itching, hives, or swelling of the lips orface. Within moments, the throat may begin to close, choking off breathing and leading to death. In 1994, astudent on a field trip to Algonquin Park in Ontario died from trace amounts of peanut butter that had beentransferred to a jam jar. A child attending camp in Montreal died after eating a cheese sandwich that hadbeen packed in the same bag with a peanut butter sandwich.Although precise figures are difficult to obtain, Canadian physicians report that the number of affectedindividuals is rising, and that by far the most common culprit is the peanut. A recent study of food allergies inthe Ottawa and Vancouver areas indicated that 36 percent of those with food allergies were peanut-allergic,compared to U.S. studies showing fewer than 25 percent in the 1980s. The same study showed that 21percent of those with a peanut allergy were anaphylactic. 1The two tragedies described above illustrate several important facts about anaphylactic reactions: traceamounts of the allergen can be fatal; children are at greatest risk when they are removed from the regularroutines of home and/or school; and life-saving response must be immediate to avert tragedy. The experienceof allergists also suggests that, while younger children experience reactions more frequently, reactions in olderchildren are more likely to be fatal because of their increasing independence and their reluctance to carrymedication. This was confirmed by a study of 32 fatalities, in which more than half were adolescents.Although peanuts are by far the most common allergen causing anaphylaxis in school-agedchildren, they are not alone. Children can have equally severe, life-threatening allergies to manyfoods. <strong>School</strong> systems must be aware that anaphylaxis is a life-threatening condition, regardless ofthe substance that triggers it. In addition to peanuts, tree nuts (almond, brazil nut, cashew, macadamia,hazelnut or filbert, pecan, pine nut, pistachio, walnut), cow’s milk, eggs, fish, shellfish (crustaceans andmolluscs), soy, wheat, and sesame seeds have been identified by an expert committee on food labelling(Agriculture and Agri-Food Canada and Health Canada Food and Drug Regulations) as the most likely tocause severe anaphylactic reactions in Canadians. 21