Food Allergy, Teens: The Danger Years
TREVOR SCHOFIELD is one lucky guy. We are sitting at the Schofield family’s dining room table with his mother, Diane, discussing how he has outgrown his peanut allergy. Now in Grade 12, Trevor actually has to eat peanuts to build his tolerance. The talk turns from his newfound life of liberation to what life was like as a teenager at risk of anaphylaxis. In the course of discussion, an uneasy truth emerges: Trevor was taking risks well before his allergist pronounced that he was no longer peanut allergic.
Trevor admits that he didn’t like to feel different from the rest of his classmates. He was less than vigilant about reading food labels or asking at a friend’s house if food was peanut-free. And what about his epinephrine auto-injector? As he refused to wear the belt holding his EpiPen by high school, how had he carried it around school?
At first, he says that he shoved it into the pocket of his jeans. Then Trevor admits: “I really didn’t feel like carrying it in my pocket. Actually, I just left it in my locker for the first semester of Grade 11.”
His mother stares at him. “That’s a scary thought,” she says. “I didn’t hear that before.”
“Why would I tell you?” he says, smiling. Before and through much of Trevor’s Grade 11 year, the Schofields had travelled from their home in Pembroke, Ontario, southeast to nearby Ottawa for appointments with an allergist so that Trevor could undergo peanut challenges. He was supposed to assume he was allergic until the doctor told him (in the second semester of Grade 11) that he no longer had to carry his EpiPen. “After the first appointment, I just stopped bringing it with me,” Trevor fesses up. Did he just instantly think he was OK? “I thought I was fine,” he says.
“Dr. Schofield,” Diane says, shaking her head.
One who is not surprised by this story is Dr. Antony Ham Pong, an allergist in Ottawa. He deals with many teenagers in his practice, most of whom say they will carry the auto-injectors he prescribes. He’s quite certain that a lot don’t. He hears teens gripe about having to carry the auto-injector, about how it doesn’t always fit into jean pockets or into a girl’s small purse. “Or that it’s just too bothersome to remember to take it,” he says.
Most parents worry about their children with life-threatening allergies when they are in the early grades. They make sure they’ve learned the precautions to take: only eat food from home or approved by your parents, never share food, always carry your auto-injector. In a study of families coping with the threat of anaphylaxis, Deena Mandell, a social work professor at Wilfrid Laurier University, and her colleagues found that parents described younger children as careful about allergen avoidance. But what Mandell found merited further study was “that parents do not appear to be unduly concerned about the level of caution in their adolescent children.”
This is a mistake says Ham Pong. He cites a grim reality: “For the life-threatening allergens, the highest risk of dying is as a teenager.” This was shown in a study of anaphylactic deaths in Ontario between the years 1986 and 2000. Of the 20 deaths attributable to severe reactions to peanuts and tree nuts – most were girls aged 14 and 15. Similarly, a U.S. study released in 2001 looked at 32 fatal food reactions and found only three children under 10 had died. But 17 of the deaths, more than half, were adolescents.