Going nuts over nuts?

Nuts are a great source of nutrients and a good ‘brain food’, so why do some schools ask parents not to put them in their children’s lunchboxes?

Each school has an obligation to keep all children safe, and for children with allergies, requesting a nut free zone at school is an easy way to do this.

In May 2013 the Ministry of Health updated it’s recommendation for allergen avoidance in schools, based on the Australasian Society of Clinical Immunology and Allergy (ASCIA) guidelines on the prevention of anaphylaxis in schools and early childhood services. As far as possible the guidelines have taken a practicable and age appropriate stance to enable children to avoid exposure to allergens (triggers) while enabling inclusiveness in all aspects of school life.

The three key objectives are to:

  1. Minimise child/student exposure to triggers (allergens) as much as possible
  2. Ensure staff are prepared at all times to respond appropriately in case of a life-threatening reaction (anaphylaxis)
  3. Ensure children/students with allergies are able to participate in the same educational and recreational activities as their peers

Everyone’s got an allergy these days!

Accurate diagnosis of food allergy is important as excluding a major food group means a child is at risk of nutritional and growth deficiency. It is very important that food allergy is managed in consultation with a registered medical practitioner and Dietitian.

The true prevalence of food allergy is difficult to determine but research indicates food allergy may affect 4–8 percent of children and 2–3 percent of adults. Cow’s milk, egg and peanut are the most common food allergies, while allergy to tree nuts, soy, wheat, sesame, kiwifruit, fish and shellfish are also frequently seen.

What is the difference between allergy and intolerance?

Food intolerance is an adverse reaction to food that is non-immune related and caused by some unique physical characteristic of the person. The symptoms can be similar to some of the allergic symptoms – e.g. abdominal pain, cramping and diarrhoea, but aren’t life threatening. They generally occur only after a threshold level of food is eaten e.g. some people with lactose intolerance can have two cups of milk before they experience symptoms.

Food allergy is an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food. The most common symptoms involve the skin (e.g. rash, hives, swelling and eczema), gastrointestinal tract (e.g. vomiting, abdominal pain, cramping and diarrhoea) and respiratory tract (e.g. rhinitis and wheeze). The most severe reaction is anaphylaxis which can cause death.

While many children will outgrow their allergy to cow’s milk, egg, soy or wheat by five to seven years of age only 10–20 percent of peanut and tree nut allergies resolve.

Why does my child have to avoid bringing nuts to school?

Although the risk of a life-threatening anaphylaxis from casual skin contact, appears to be very low, predicting who will have a severe food allergic reaction is difficult. While in some cases there has been a previous severe reaction, other children will also be at risk of severe reaction depending on the allergen in question, allergen ‘dose’, presence of asthma, and other modifying factors such as exercise.

Bullying by teasing food allergic children with the food to which they are allergic can also occur.

So what else can be done?

Blanket bans on food are not recommended although early childhood services and new entrant classes in primary schools may consider this as a way to reduce exposure in very young children who are more likely to share food.

All teachers need to able to recognise signs and symptoms suggestive of a severe reaction and understand the importance of seeking urgent medical attention.

Educating and enlisting the support of other children, particularly in new entrant levels, is a useful strategy in keeping food-allergic children safe and minimise any bullying. This also enables the progression in older school children to self-management, which is more effective in ensuring accidental exposure doesn’t occur. Allergy NZ have a very good booklet called “Letting go: teaching your food allergic child responsibility” to help parents help their child to take that next step to self responsibility.

Other suggestions to minimise exposure include:

  • Clear labelling on lunch boxes, eating utensils and drink bottles.
  • No trading or sharing of food, drink bottles or eating utensils.
  • Children with food allergies eat lunches and snacks that have been prepared at home or provided by parents.
  • All children wash and dry hands after eating.
  • In pre-school and year one classes, if a child has a peanut allergy or egg allergy then the teacher can request that classmates do not bring whole nuts and peanut butter to school or whole eggs and egg sandwiches. Be mindful, however, that even the best intentioned people can forget.

Helpful resources

Check out Allergy NZ www.allergy.org.nz for teaching tools for parents, teachers, students and the child with food allergies. For example, the No Biggie Bunch is both a catch phrase kids can employ and an attitude kids, parents, teachers and playmates can adopt with fun and ease. “No Biggie” is a positive tool to add to a child’s food allergy toolbox of support. When kids and adults are on the same page and prepared (both with safe snacks and a ready response), the social challenges of food allergies really can be “No biggie!”

For older children, from nine onwards, there is the Medikidz team, which explains exactly what happens during an anaphylactic reactions. This is also a good tool for other students to understand the importance of risk management procedures.

So if your child’s school is a nut free zone it means someone else's child is at risk. Save those peanut butter sandwiches for the after school snack!

By Anna Sloan
NZ Registered Dietitian
BCApS. Dip Diet

References:
S Vale et al. ASCIA anaphylaxis prevention guidelines. Journal of Paediatrics and Child Health 49 (2013) 342–345 © 2013 Australasian Society of Clinical Immunology and Allergy (ASCIA)
NZ Ministry of Health - Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 years): A background paper. Revised 2013.