My “oh woe is me” voice kicked in: “What a pain this is to deal with. Why does he have so many food allergies? And, why am I always the one asking about his food?” It was the last question that really hit home. I realized that, similar to reading ingredient labels, Julian had to learn how to ask questions himself about restaurant meals.

Kids learn best when you involve them, so my husband and I encouraged Julian to ask basic questions – “Are there peanuts in this?” We graduated to the more complicated questions as he matured: “Do you use the same grill to cook shellfish and steak?” “Do you make the French fries in the same fryer used for foods such as deep-fried shrimp?”’

We found that by taking precautionary steps, we could go to restaurants together safely. Following are the main points we found helpful when dining out with a food-allergic child:

Plan ahead. When possible, call the restaurant at a time that is convenient to speak to the chef or manager. They can point you to the safe meals on the menu. (Stick with simple items with fewer ingredients and fewer coatings, sauces and dips.) Try to dine at off-peak hours as staff will have more time (and patience) to check on menu items. The highlight of the meal – the dessert tray – will be off-limits for most food-allergic children. So to avoid disappointment, let your child take a special dessert or treat to the restaurant so he feels included.

Next: Teach your child

To provide perspective, five allergy associations collaborated on a position statement* regarding the management of anaphylaxis. It reflects the opinion of Canadian allergists and the executive directors of three lay organizations: Anaphylaxis Canada, the Allergy/Asthma Information Association and the Association québécoise des allergies alimentaires.

Collectively, the organization executive directors have four children between the ages of 12 and 25, with allergies to peanut, other legumes, tree nuts, egg and shellfish. We appreciate personally and professionally the concerns of parents who are faced with the grim reality of food allergies: only strict avoidance of an allergenic substance will prevent a reaction, and there is no cure on the horizon. We are aware that besides peanuts and nuts, other common foods – milk, egg, sesame, shellfish, fish, soy, and wheat – can trigger reactions and need to be included in anaphylaxis policies.

And we know that there is a conceptual problem with the idea of a “ban” in public places. It carries with it the notion that safety can be guaranteed if we eliminate obvious allergens from an environment. In the real world, there are no guarantees, which is why education and self-management will remain our priorities.

So what do we recommend to parents advocating for their children’s needs?

Seek “the middle ground”

To start with, don’t shoulder the burden alone. Anaphylaxis policies should be developed with input from allergy experts and take into consideration the factors that can have an impact on the community, businesses, and organizations. These include: who and how many people will be affected by food restrictions, how reasonable it is to expect that an environment can be controlled, and whether the attempt to control it will be permanent or temporary.

There are many situations in life where we make concessions to arrive at “the middle ground”. Strategies that safeguard allergic individuals without placing undue restrictions on the non-allergic community will be the most successful. Policies that seem too unrealistic to implement and monitor will lack credibility and may lead to “allergy fatigue” among the public, and we need the continuing support of the wider community.

A good example of a middle ground approach was an “AA” baseball league game that took place in July in Baltimore. The Food Allergy & Anaphylaxis Network and the Bowie Baysox raised public awareness by designating a section of the stadium for food allergic fans and their families. Stadium employees wiped down seats and swept the ground of the section before the game (peanuts are a fan favourite), and emergency medical staff were on hand. But you’ll notice that this event took place on one day, in one controlled part of the stadium.

Teach children to self-protect

Children must learn to navigate safely in a world with allergens around them. If they do not learn to self-manage, they may be at greater risk. Parents will not always be there. My family has used the weekly grocery shopping trip to teach our 12-year-old, Julian, how to choose safe foods through vigilant label reading and to make him feel comfortable with allergens in his environment. Our grocery store spans 80,000 square feet and has thousands of products that may contain his allergens. It also gets 3,000 customers a day. Julian understands that he cannot control what others eat or touch in the store, but that regular hand-washing can reduce the risk of exposure with an allergen.

September represents a milestone as our son enters a Toronto high school (grades 7 to 12). While Julian will brown-bag it most days, he will occasionally buy a lunch of limited items that we have checked with cafeteria staff, and pick a safe packaged snack from the vending machine. While many parents may think my husband and I are crazy to allow Julian these liberties, we believe he is ready and we expect him to take on more responsibility as he gets older.

Does this mean we’re abdicating responsibility? On the contrary, we will continue to teach him how to manage his allergies and to advocate for his safety. His experience in high school will serve him well as he prepares for the next transition – university – where he will be an unknown in a crowd of thousands and thousands of students.

Like many other parents, I’d like to have a guarantee that Julian will always be safe, but this isn’t possible. I want instead the solace of knowing that he has all the tools possible to look after himself in a big, hard-to-control world. Despite best efforts, I know that he could have an allergic reaction. I’ll continue to worry. But that’s my job – I am his mother.

* The position statement is available at www.allergysafecommunities.ca (Tools and Information)

Laurie Harada is the Executive Director of Anaphylaxis Canada, www.anaphylaxis.ca

First published in Allergic Living magazine. Click here to subscribe or order an issue.

As world travelers, my husband, Victor, and I want to expose our children to different cultures. Both of us have worked abroad – he in Brazil, I in Japan – and have visited many countries in Europe, Asia, South America and Africa. We would love to take our children to Japan and India, the birthplaces of our ancestors. But we’ve been reluctant to do so because of our son Julian’s food allergies. Given his sensitivity to several foods and the challenge of language barriers, it may be a while before we work up the courage to go to either country.

When we first embarked on this food allergy journey, the world felt like a dangerous place. Taking baby steps, we opted for North American destinations with a high level of food allergy awareness and quick access to medical care.

As Julian matures, we recognize that we need to do more to prepare him to travel without us. Now in Grade 7, it is only a matter of time before he goes to a foreign country with classmates and adults who may be less knowledgeable about his allergies. His ability to self-protect, in many ways, will be his greatest safeguard.

Julian feels that he can fend for himself and points out my tendency to “hover”; his way of saying that I can be over-protective. However, he agrees that to gain more independence, he must speak up more and ask questions about which foods are appropriate.

Recently, my family made its first international trip. We started slowly, visiting England and Ireland, where we could communicate in our mother tongue. The trip helped to build our confidence. International travel with food allergies does require a lot more planning – but it can be done. If you’re thinking of going overseas, here are some tips to consider:

Connect with international allergy associations

Visit www.foodallergyalliance.org, the website for the Food Allergy and Anaphylaxis Alliance, where you will find links to associations from North America, Europe and Asia. Though none will provide a list of safe foods, they can point you to resources about food labeling regulations and possibly food policies on local airlines. Some provide links to services that can translate allergy-related information, which may be especially useful for travelers who don’t speak the local language.

Take extra epinephrine auto-injectors

In case bags are lost, our habit is for Julian to carry two auto-injector devices (as usual) and Victor and I to each carry one backup. We also take a note from the allergist which supports Julian’s need to carry an auto-injector in case we are stopped by authorities. And don’t forget to wear MedicAlert identification, which is recognized internationally.

Be prepared for an emergency

Find out the emergency number in the country or area you will be visiting. (For example, it’s 911 in most Canadian and U.S. locations.) Learn how to operate the local payphones, which are often different outside of North America, and carry change. Remember that you may not have cell phone service abroad so look into renting a local cell phone. Be sure to always have an epinephrine auto-injector available and review how to use it. Some ambulances may not be equipped with epinephrine, and some paramedics may not be allowed to administer it. When selecting a hotel, ask how far it is to the nearest hospital.

Pack your own food for the flight

Only bring foods that have been consumed safely before, and pack extra safe snacks in case of delays. Don’t bring foods that require heating, as airlines do not have microwaves (they have equipment to keep airline meals warm). Although attendants may be willing to reheat food in oven-ready containers or foil after the meal service, you need to think about the possibility of cross-contamination.

Use dining out experiences to train your child

Encourage your child to think through the questions to ask food service staff ahead of time, then role play. When he’s ordering, don’t interrupt, but jump in if his questions are not thorough. Though Julian remembers to ask about the oil and ingredients in French fries, he often forgets to ask whether shellfish, to which he is allergic, is cooked in the same fryer as the fries.

The only negative experience on our trip happened after we landed in Toronto. Security staff scolded us for bringing in one green apple, which I had packed with Julian’s food, and we were held back for more than an hour. Lesson learned: Remember to find out about local restrictions on foods you can take into a country, even your own country. This being our only glitch, we’re now ready to venture onward. Next stop – visiting relatives in Spain!

First published in Allergic Living magazine, Summer 2007.
To order that issue or to subscribe, click here.

I was reminded of the time when my son Julian (then 6) unwittingly played with peanuts. We were at the Cottage Life Show and had stopped by an exhibit with birdhouses and feeders. Waiting patiently for me to pick a birdhouse, Julian amused himself by picking up handfuls of feed, letting it sift through his hands, like sand. He did this for a while before I noticed something light-colored amongst the seeds.

Grabbing his hand, I snapped, “Do you know what you’re touching?” As I whisked him off to wash his hands, explaining what I thought to be quite obvious – there were peanuts in the feed – he reminded me that he had never seen “peanuts like that” before.

Not having any small pets, we had never bought animal feed. The peanuts that he recognized were not in pieces, but whole, darker (roasted), in the shell or in peanut butter. I apologized for my outburst, explaining that I had reacted spontaneously, yelling, not out of anger, but out of fear for his safety.

This episode (and several others) taught me that while it is important to teach children how to avoid danger by recognizing their allergens, it is equally important to teach them how to respond calmly when allergens are present in their environment, and how to gently remind others of potential risks. Over the years, I’ve learned to contain my anxiety and bite my tongue when I’ve been tempted to say to my child and others, “But you don’t get it, this could cause an allergic reaction.”

The holiday season presents a challenge for those faced with food allergy. Danger seems to be ever present with an abundance of food: shrimp rings, trays of nuts, dairy-containing veggie dips and sauces, and baked goods and sweets full of many allergens.

While social outings can be anxiety-provoking, try to use food-related events to teach children to navigate safely, to be on guard for both obvious and not-so-obvious risks. Through our behavior and attitude, parents can show children how to inform others graciously about their food allergies. These lessons will carry them through life.

Next page: Laurie’s Holiday Checklist

There is an expression that: “There are those who eat to live, and others who live to eat.” With the obesity rate soaring, clearly, North Americans fall into this latter group. We over-consume. Microwave technology and the accessibility of prepared foods have made it so easy to eat on the run, any time, anywhere.

Years ago, you did not see people wolfing down full meals in public transit; nor was there an excessive amount of food in schools. Treats, once an occasional indulgence, have become the norm with sweet drinks and snacks doled out after children’s sports activities (in my day, it was water and orange slices), and people noshing in their beds mindlessly while watching TV.

This trend to over-consuming has created challenges for families with food-allergic children, as well as for the school administrators responsible for reducing those kids’ risks of allergen exposure. Food has become central to school holiday celebrations, fundraisers and teacher rewards. Many people feel that things have gone too far, especially with the practice of parents sending in treats to celebrate their children’s birthdays in classrooms.

Pamela Lee, mother of a food-allergic son and a Vancouver educational assistant, points out on Allergicliving.com’s Forum that “schools should be a place of learning,” and that “birthday parties should be provided by parents, on the parents’ time, not the teachers’ time.”

While many schools are making greater efforts to encourage healthy eating, it will be a while before sweeping changes are made which result in less food in schools. In the meantime, parents should continue to advocate for safe environments, and do it in a positive way. Some advice from the trenches:

Ask for best efforts, not guarantees.
Perfection, such as asking for a guarantee, is not a goal anyone can achieve. Many parents demand that schools be “peanut-free” or “nut-free”. While a large number of elementary schools have restrictions on these foods, it’s not possible to “guarantee” that everything will be “free from” peanuts, nuts or other allergenic foods. The majority of other parents will make efforts to comply with food policies, especially if they are seen to be reasonable, but mistakes will happen from time to time.

Practice what you want to say.
Write down the three key points you want to discuss with the principal. This will keep you focused on what is most important. Role play with a friend who does not have a food-allergic child. Be sure this is someone who will give you an honest opinion and provide the perspective of those who do not live with food allergies. Your choice of words, tone and body language will all impact the way you come across to school officials.

Treat ignorance as an opportunity to educate.
Before a school meeting, offer to provide information about food allergies, such as DVDs or brief printed materials for review. When background is provided ahead of time about the potential severity of allergic reactions, this will allow more time for discussion. Remember that there will always be naysayers who make insensitive comments. You can’t change them, but you can change the way you react to them. Don’t let them get you down. As others come on board, the negative voices will be drowned out.

Create bridges, not walls.
When things are not going well, ask yourself: Could my own behaviour be part of the problem? A mother I knew had her husband speak with the principal, recognizing that her behaviour had created a barrier. He was able to break down the wall. Later, the mother was able to build a bridge through  changing the way she interacted with the principal – who started consulting her on the school’s anaphylaxis policy.

Similarly, at parent meetings, some have found it helpful to have a friend, whose child doesn’t have food allergies, present other reasons for reducing the amount of classroom food, from the mess to other health concerns such as obesity or diabetes.

The long and short is that the parents who can be brutally honest with themselves are the most likely to succeed at gaining protection for allergic students. They’ll also help to raise awareness of just how food-centred our schools have become.

While we’re being frank – we have all tripped in our desire to protect our loved ones; our anxiety can sometimes make us act inappropriately. What we need to do is learn from our mistakes. We should also celebrate the small wins, and take every occasion to say “thanks” where appropriate.

Laurie Harada is Executive Director of Anaphylaxis Canada, www.anaphylaxis.ca. For more information on schools and anaphylaxis, also see: www.allergysafecommunities.ca

After I got over the initial shock, sadness and anger with this card we’d been dealt, I began to accept the fact that I could not change Julian’s situation, but I could do a lot to reduce the potential for risk. As a take-charge mother, I spent hours calling food manufacturers to learn about their products, meeting the school principal to develop a management plan, and educating others how to read a food label and to use an auto-injector. When we ate out – whether at a restaurant or someone’s home – it was typically me who asked questions about the food, often calling ahead to make inquiries. Before I went on a business trip, I stocked the house with groceries and prepared meals. In the early days, this was a lot of work which added to my already busy schedule and increased my level of stress. I became resentful that I was doing it all.

It was during a TV interview about allergies that Victor and I took part in, that I had my “Aha” moment. On camera, he admitted that while he took precautions to keep Julian safe, he had ridden on my coattails with respect to our management strategies. This was his way of saying: “Laurie does most of the work.” The comment made me realize that I was just as guilty for  this imbalance; I’d enabled Victor to be more laissez-faire – by simply taking over. My behaviour must have sent a message to Julian, too, that “Mom would do it all.”

That evening, we had a family discussion. I expressed my hopes that both Victor and Julian, then 7 years old, would do more. What if something happened to me or our family situation changed? (Not a pleasant thought, but almost 40 per cent of marriages do end in divorce.) We agreed that if Julian wanted a new food product, he would have to read the label to determine whether we should buy it. If Victor purchased the product, he would call the manufacturer if it was a company we did not know.

When we went to restaurants, Julian was encouraged to ask about menu items. My husband and son learned how time-consuming it could be double-checking food items, and hopefully they appreciated the past efforts of “mom, the martyr”.

But they also built their own confidence in reading food labels and advocating for Julian’s safety. I learned to keep quiet, and let them figure things out for themselves (and that’s no small task when you think you know better). It turned out to be a huge relief not having to do everything.

Looking back at those early years, my husband and I should have done things differently. To parents starting out on their food allergy journey, I offer these lessons from the marital trenches:

• You and your partner both brought your child into the world. Learn as much as you can and develop management strategies together.
• Have one set of rules which your food-allergic child and others can follow. This is especially important where there are two households, due to divorce. If you don’t get along with your ex, remember to stay focused on the child’s safety and put personal differences aside. Food allergy rules should not dissolve into a case of “who’s the better parent”.
• Go to key appointments together – medical, school, other – so that you hear the same information. This lessens the chance that one parent is expected to be the keeper of information.

As we learned to be better teammates on food allergy management, I came to appreciate that my husband’s calmer approach was complementary to my more uptight style. It was not always bad to be laissez-faire as long as we stuck to key rules. In fact, Victor has helped me to learn to let go. While I wanted to say “no way” to a boys-only camping trip in the interior of Ontario’s Algonquin Park when Julian was 10, Victor proved that with careful planning, Julian could spend five days in the wilderness eating safely – no cell phones, no hospital in sight, and no hovering mother around.

Laurie Harada is Executive Director of Anaphylaxis Canada, www.anaphylaxis.ca For more information on schools and anaphylaxis, also see: www.allergysafecommunities.ca

From the Winter 2010 issue of Allergic Living magazine.
To order that issue, or to subsribe, click here.

I remember clearly the day that our first-born child, Julian, started junior kindergarten. It was 1998, and he was so proud to be going to “the big school”, carrying his new backpack and wearing the Elmo outfit that his grandmother had given him to mark this special occasion.

Me, I was ready to cry. Not just because JK represented a new milestone – my 4-year-old was growing up – but out of fear that he might have an allergic reaction at school.

Julian had been diagnosed with peanut allergy only six months earlier. My husband Victor and I were still getting used to the routine of reading food labels, preparing safe meals, and remembering to carry an epinephrine auto-injector everywhere.

Now, as our son moved out of our protective bubble and the watchful eyes of his babysitter, we had to advocate with more people to ensure that he would be protected at school where he would soon spend the better part of the day.

Our journey into the brave new school world began with registration. Victor and I met with the principal and the teacher to review some basic measures that would help to keep Julian safe.

Though we were reassured that the staff would do its best to safeguard our son, I continued to feel anxious every morning as I handed him over to his teacher, breathing a sigh of relief at noon when I was greeted by his smiling face at pick-up time. My son, meanwhile, loved his teacher and enjoyed his new friends and activities.

That first year was very difficult. Every time the phone rang I was afraid it was the school calling to say Julian had had a reaction.

Already stressed with the burden of trying to anticipate where food might pose a risk, my anxiety escalated when the mother of a peanut-allergic child said, in a judgmental tone: “I can’t believe you didn’t know peanut butter is often used as bait in mouse traps! Haven’t you asked the school to remove them?” What an irresponsible mother I was. How could I not know this?

As I added mouse traps to the growing list of what I thought to be high-risk situations, my own reality check began to set in. I started to question whether I was losing sleep over the wrong things. For instance, just how likely would it be for my 4-year-old to touch a mouse trap containing peanut butter and have a serious allergic reaction?

What seemed more productive than
stewing over “what-ifs” was minimizing
the risks at school.

I reminded myself of what his allergist had said: While anaphylaxis has the potential to cause death, fatalities are rare. What seemed more productive than stewing over “what-ifs” was minimizing the risks at school.

While casual exposure to peanut could be an issue, I realized that Julian’s chances of staying safe would increase if I focused more on two things. The first was conditioning him to follow key rules (no sharing food with others, always carry your auto-injector), and the second was getting the school to formalize its anaphylaxis plan, ensuring that staff were trained and that the school community was aware of the food policies.

I felt the school community would be willing to help as long as I asked for accommodations that were reasonable. To do this, I needed to calm down.

Victor and friends whose kids did not have food allergies acted as my sounding board on the school communications I drafted for the principal. With their feedback, I learned to write succinctly, and in a way that expressed the seriousness of anaphylaxis without scaring or turning people off with too much information.

My “reviewers” quickly pointed out where I needed to reconsider my expectations, reminding me that people would make mistakes; they would overlook things like “may contain” warnings on food labels as they weren’t accustomed to reading labels the way I did.

After Julian was not invited for a couple of play dates, and was un-invited to a birthday party, I learned the hard way that my explanation to other parents that “even trace amounts of peanut could be harmful” may have led to misunderstandings.

I had not put risks and precautions (such as having an auto-injector available) into context for them; I’d simply alarmed them. Some parents felt they could not keep Julian safe in their homes.

I realized how important it was to watch that my concerns would not scare people or douse Julian’s enthusiasm for the school experience. As he learned to take on more responsibility, and as the anaphylaxis policy became more entrenched, my anxiety lessened. Thanks to the support of the school community, Julian sailed through his elementary years and I came through with my sanity intact.

I must admit, though, that faced with the teen years (he’s now 14), my anxiety is peaking again. Anyone have any tips to calm down the anxious mother of a food-allergic teen?

Laurie Harada is the Executive Director of Anaphylaxis Canada.

Next: Working With the School