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PostPosted: Fri Feb 24, 2006 10:12 am 
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Joined: Tue Mar 22, 2005 6:53 pm
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Location: Canada
As katec and Catherine mentioned,
http://www.allergysafecommunities.ca is up and running. This replaces/updates the 1994 guidelines for managing anaphylaxis in child care settings:
http://csaci.medical.org/schools.html

The new guidelines seem to be more comprehensive---and there is a lot of good material there.

But is it just me or is there less of an emphasis on eliminating allergies from the classrooms for young children than there was in the 1994 document---they do mention it as an option that some schools choose, but if I were a principal reading through the document I would think that that really isn't necessary. I can see why they wouldn't want to 'ban' foods and it does get complicated if there are a lot of allergies...but I'm not sure that supervised handwashing sessions would do it. there are some suggestions for allergen reduction in the classroom---i.e. giving out straws with milk. but realistically with very young children won't cheese powder from cheesies and goldfish crackers, etc., get all over? I would imagine that ensuring that 4 year olds wash their hands thoroughly with soap would be a tall order!

I wonder if they are choosing between handwashing and attempts at allergy elimination. i.e. if you ask kids not to bring peanuts to school (which still would not be a "ban"--you can't supervise that kind of thing, but it would reduce the allergens present), the handwashing might seem unnecessary when in reality peanuts might be brought in anyways.....so from one perspective the handwashing would be preferable. but couldn't you ask people not to bring peanuts (as opposed to inspecting lunch bags for peanuts) but realise that that wouldn't make the school peanut free and still have supervised handwashing sessions? And for allergies like milk....well, I don't think schools are going to ban milk. but they could ask kids not to bring finger snacks with milk.....pizza days are dangerous and so are cheesies.

also, whereas the 1994 document mentioned that children can have stomach upsets after contacting residual traces of allergens, I don't see this being stressed here. I wonder why--is there a shift in our understanding of allergies? Or does this reflect the fact that the new guidelines were written in different settings---i.e. this second one is dealing with Sabrina's law.....and, no, the school can't be held legally accountable if kids sneak peanuts into the school.

compare the new document with:

http://csaci.medical.org/schools.html
Quote:
It should be stressed that minute amounts of certain foods like peanut when ingested can be life threatening (7). Several children have had skin rashes and stomach upsets just from simply contacting residual peanut butter on tables wiped clean of visible material (7).


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PostPosted: Fri Feb 24, 2006 11:01 am 
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Joined: Wed Aug 10, 2005 11:21 am
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Location: Cobourg, ON
I think the guidelines are written with the benefit of more knowledge of allergy. What I like about the document is that it stresses that an anaphylaxis policy should be based on sound medical info, respect and reasonable expectations. I think as parents we would like schools to ban many things but in reality it would not be possible. Personally I think the emphasis on education of the whole school community (staff, students and parents) and good policies and procedures is more important than bans which would be difficult to implement and monitor. I thought that there was mention that "peanut bans" in schools with young children did make sense. The document discusses the term "allergen safe environment" rather than "peanut free." If schools are aware of signs, symptoms, have good practices and know how to use an epipen, I think our children are safer than in a schools with a peanut ban without good education and practices (which I think is the norm in many schools right now.)

My daughter is in JK with multiple food allergies including milk. THe hand washing actually goes quite well in jk. The teacher has some older students come in to help and the kids are in a good routine. We think that having milk around our daughter in a supervised setting will help her to learn very valuable life skills: how to live around milk and her friends will learn how to protect her. We know that in a blink of an eye she will be old enough to go to a movie on her own with her friends and we want all of them to know how to keep her safe so that she can have a "normal" life.

I think the document does discuss the issue of the risk of small amounts causing reactions:
" Currently, physicians cannot safely determine which patients may have a mild or moderate allergic reaction and which patients may experience a severe or potentially fatal allergic reaction to a food.
A very small amount of a food allergen ‘‘hidden” in a food or a trace amount of allergen transferred to a serving utensil has the potential to cause a severe allergic reaction. For fish and shellfish, vapor or steam that contains proteins emitted from cooking these foods have been shown to trigger asthmatic reactions and even anaphylaxis.1,2"

I've got to go but, I really like the document and will add more to the discussion later.


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PostPosted: Fri Feb 24, 2006 3:07 pm 
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Joined: Wed Mar 23, 2005 1:17 pm
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Location: Hamilton, Ontario
I, also, really like the document. I e-mailed the link to it to all my family members. This is the first time I've really seen, in writing, guidelines that so closely match my own ideas. I have never advocated for a peanut ban in my son's school but I have always asked for a clear plan in case of emergency and greater awareness among the people responsible for my son's care. This document supports everything I have always wanted.


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PostPosted: Tue Feb 28, 2006 10:39 am 
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Joined: Tue Mar 22, 2005 6:53 pm
Posts: 1454
Location: Canada
I'm not saying that I dislike the document--I do think it will help allergic families and will save lives. I've been wanting to explain more about anaphylaxis to my family and friends, and this would be a great document to send. I do have some criticisms, however.

There is a difference in emphasis from the previous recommendations, and I like the rhetoric as well as the recommendations of the earlier document better...although the differences might in part reflect the fact that the earlier document seemed more concerned with peanut allergies and this one is more comprehensive. I am still a bit puzzled by the change---a lot of the same people who wrote document #1 also wrote document #2.

Here's one of the differences:

(this is from the http://csaci.medical.org/schools.html document):
Quote:
In the nursery, day care setting and earlier public school grades where there are peanut allergic children no peanuts, peanut butter or peanut containing foods should be allowed, since it is extremely difficult to avoid accidental ingestion. It should be recognized that this will reduce but not eliminate the risk of accidental exposure.


this is from allergy safe communities:
(under "school anaphylaxis plans"--elementary schools:
Quote:
Some schools have appealed to the community to keep peanut butter and other peanut/nut products out of the school.


The new guidelines will be perfect for most allergic students. But I worry about those who are extremely sensitive--one mother on this website reported that her son went into anaphylactic shock just from sitting in a grocery cart. (she couldn't rule out ingestion here, but still, the amount of protein he had encountered would be the same as encountered on pencil sharpeners, etc. handwashing will hopefully take care of most of the protein, but when children are very young I am concerned that handwashing wouldn't always be thorough enough) Will these new guidelines be sufficient to protect him? The authors do indicate that the anaphylaxis policies need to take individual needs into account, but parents of children who are extremely allergic might not be believed. I am also concerned that those who react to airborne protein will be dismissed as being "unreasonable." (On this note, I thought that some of the rhetoric of the document was identical to the document "Common Beliefs about Food Allergies: Fact or Fiction?" to which they provide a link---the researchers of the study about casual exposure to peanut butter are more cautious in their conclusions. They seem to take people's "beliefs" more seriously even though their findings did not corroborate these beliefs.)


katec wrote:

I think the document does discuss the issue of the risk of small amounts causing reactions:
" Currently, physicians cannot safely determine which patients may have a mild or moderate allergic reaction and which patients may experience a severe or potentially fatal allergic reaction to a food.
A very small amount of a food allergen ‘‘hidden” in a food or a trace amount of allergen transferred to a serving utensil has the potential to cause a severe allergic reaction. For fish and shellfish, vapor or steam that contains proteins emitted from cooking these foods have been shown to trigger asthmatic reactions and even anaphylaxis.1,2"


Kate, I think you might have misunderstood my point here. I wasn't suggesting that the latest guidelines do not warn people about ingesting small amounts of food....but it does not express as much concern about contact reactions. In fact, the article which the authors of allergysafecommunities recommends by Michael Young (see http://www.allergysafecommunities.ca/assets/common_beliefs_faan_2003.pdf)

states that "there is no evidence" that reactions through contacting small amounts of protein would lead to a worsening of the reaction (can't cut and paste here because it is a pdf file) Also, Young is not at all concerned that contacting small amounts of allergenic protein could cause a severe reaction...he states that anaphylaxis does not occur.

But the 1994 document states:
Quote:
Several children have had skin rashes and stomach upsets just from simply contacting residual peanut butter on tables wiped clean of visible material
This sounds like a mild anaphylactic type reaction to me :? They stress that stomach upset was caused *just* from contacting residual peanut butter.

Another concern about contact: I'm pretty sure I read somewhere.....and I believe it was in the Journal of Allergy and Clinical Immunology, but I'm not 100% sure... that there was a study done on children who are peanut allergic to see what factors are correlated with an increasing severity of allergy. they found that children who had a reaction through contact were more likely to experience a worsening of the allergy....the researchers thought that this would make sense because proteins which pass through the gastrointestinal barrier are usually tolerated....it might have something to do with the way in which allergens trigger an immune response in the skin. Until I find the article, no one can quote me on this...but I do not believe that contact reactions are proven not to have a "cumulative effect." For one thing, one can develop an allergy through skin contact.


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PostPosted: Sun Mar 05, 2006 3:25 pm 
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Location: Cobourg, ON
My daughter has experienced a number of reactions from skin contacts. Casual contact is a great concern for our family and I have read a great deal and discussed this point with her doctors at Sick Kids. My understanding of anaphylaxis (aside from airborne fish particles) is that it is only caused from ingestion of the allergen or it has to get into the blood stream someway ( through rubbing eyes). My daughter has developed rashes, hives and some swelling from casual contact with her allergens. These reactions were localized to the site where the milk or peanut touched her skin. Our doctor has told us that local reactions like this will not develop into anaphylaxis unless it gets into her. So we wash her carefully when a local reaction occurs.

I think the authors have looked at what has caused fatalities and serious reactions at schools. There is a study listed on the Anaphylaxis Canada site which looked at reactions in Toronto schools. It found that the reactions were caused from trading food at school and eating unsafe food because labels were not checked. Casual contact was found to cause some local reactions but not anaphylactic reactions. This study helped to ease our concerns some. Perhaps this is why casual contact is treated differently in this new document.

I think the job of a parent with an allergic child will never be done - in terms of following up school issues even with Sabrina's law. A school can have a great policy and lots of information (like from this new document) but if no one reads it or monitors it - it is useless. At least now, if a board or school is uncooperative there is a law which can be used to force compliance.

I do not think that schools will start allowing peanuts again and I do support peanut free schools. I think there is a repeated message in the document about not feeding allergic children which I think is very important. I am pushing our board to adopt into their policy that all allergic children should only eat food provided by parents and that supply teachers should not provide any food to children in their care.


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PostPosted: Mon Mar 06, 2006 12:32 am 
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Joined: Tue Mar 22, 2005 6:53 pm
Posts: 1454
Location: Canada
Thanks for the response. I do see how the details of how to deal with allergies in the school is a grey area.

Our family's experience with contact reactions has been sort of similar, but they haven't been that frequent---I have had very few contact reactions (only 2 as far as I know--but it is difficult to tell what the cause was since I do get hives sometimes). I am more concerned about my sister, though, who has had large hives + asthma after sitting at a table where people had been eating pecan pie a few minutes earlier. Also, she has respiratory problems when people eat peanuts around her--but nothing like anaphylaxis. My other sister of late also has been having mild reactions when people eat peanuts around her.

I do think this document will go a long way to help protect allergic students and (if the word gets out) to spread awareness about allergies---it addresses all of the problems that our family had with the school system (a long time ago). (I had a reaction--though not anaphylaxis--from nearly sharing food (fortunately I spit it out immediately). When my sister was In junior high, kids pinned her down in the lunchroom and smeared peanut butter on her. One of the girls later threatened her with death by peanuts.


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PostPosted: Mon Mar 06, 2006 2:41 pm 
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Joined: Wed Aug 10, 2005 11:21 am
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Location: Cobourg, ON
How awful for your sister. Fortunately in the last year, my daughter has not had many contact reactions at all and none at school. Many of these reactions happened when we were first learning about her allergies.

I hope this new document will be widely read by parents and people who have allergies and discussed! Aside from the school info, it has good information on anaphylaxis in general. It put together a lot of information that we have received from different sources into one document.

What I really like about the document also is the tone and emphasis on policies based on respect, sound medical info and realistic expectations. There is also an emphasis that children can attend schools safely with allergies and schools can manage their needs. There are practical ideas to help reduce exposure (putting straws in milk cartons to prevent spills). For us, dealing with multiple allergies it is reassuring and positive. Now to get these recommendations put into practise is the next job!


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PostPosted: Mon Mar 29, 2010 5:25 pm 
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Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6476
Location: Ottawa
If you haven't checked this website out yet you should...if you have, take another look. CSACI has updated the website. They've included an Anaphylaxis Emergency Plan that you personalize and print!

"The information and most of the resources on this website are taken from Anaphylaxis in Schools & Other Settings, 2nd Edition, a document developed by the Canadian Society of Allergy and Clinical Immunology (“CSACI”) in collaboration with patient allergy associations and allied healthcare professionals."

http://www.allergysafecommunities.ca/pa ... p?catid=11

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Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Wed Mar 31, 2010 1:31 am 
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Posts: 190
Location: B.C.
How is the new information communicated to the schools? Is it sent to each school board and then handed to a superintendent to see that it is communicated to the principals? Who is responsible to make sure this is communicated and that plans are indeed implemented.
today I was horrified to see a bowl of mixed nuts sitting on a staffroom table in an elementary school. Teachers walked in and scooped little handfuls to munch. Ironically a sign on the wall by the table displayed pictures of the medic alert students. These are not callous people.They are just not aware of how this little munchie could be a problem for the students they are going to go back to teach.
A student teacher sitting at the table mentioned it made her uncomfortable. I moved it away from her toa less conspicuous spot and washed the table. There was a bit of discussion and lightbulb moments from a couple of teachers who realized this type of snack shouldn't be in an allergy aware school.


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PostPosted: Wed Mar 31, 2010 10:42 am 
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Joined: Tue Mar 22, 2005 11:17 pm
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Ack! :frightened No doubt someone is going to grade tests on that table and hand them back. I doubt if each teacher will wash his/her hands before going back to class.

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Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Wed Mar 31, 2010 10:59 am 
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Joined: Mon Feb 07, 2005 6:39 pm
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Location: Toronto
Cathie re
Quote:

Who is responsible to make sure this is communicated and that plans are indeed implemented.


That depends on the province. As I understand it, in B.C. and Ontario, the onus is directly on the principal to follow the latest Anaphylaxis in Schools & Other Settings Guidelines. But you're right, implementation isn't turnkey. It depends how long it takes to get updated guidelines into the schools.

Did Allergy Safe Communities include a summary of updates on the site? I haven't had time to look. If not there, Allergic Living will follow up to find out. I'm not really aware what has changed here.

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Allergic to soy, peanut, shellfish, penicillin


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PostPosted: Wed Mar 31, 2010 11:12 am 
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Joined: Tue Mar 22, 2005 11:17 pm
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Location: Ottawa
This is what I recieved from Anaphylaxis Canada:
Quote:
Dear Registrant,

The Canadian Society of Allergy and Clinical Immunology, in collaboration with several allergy associations including Anaphylaxis Canada, is pleased to announce the updated English and French versions of the Allergy Safe Communities websites. Based upon the new second edition of the consensus guidelines Anaphylaxis in Schools & Other Settings, the websites reflect current research and provide best practices for the community. The sites also feature a variety of downloadable resources, including a fillable version of the Anaphylaxis Emergency Plan for individuals.

For more information, please visit www.allergysafecommunities.ca and www.securite-allergie.ca.

For your information,
Anaphylaxis Canada

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Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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