IT DOES sound, if not “hysterical,” then at least over the top. One single peanut is noticed on the floor of a school bus and the 10-year-old riders are all told to get out immediately, because of food allergy risks.

The anecdote appears in an opinion article, written by Dr. Nicholas Christakis, a professor of medical sociology at Harvard Medical School, and published last December in the British Medical Journal. Christakis uses the bus incident, which took place at his children’s school in Massachusetts, as a starting point for this thesis: accommodations made for food-allergic students are an unnecessary “charade” based on fears that “represent a gross over-reaction to the magnitude of the threat.”

As an expert on how health conditions affect others in one’s social network, Christakis goes a big step farther, raising the spectre that school responses to food allergies bear “the hallmarks of mass psychogenic illness.” In other words, what used to be called “epidemic hysteria”: the eruptions of fear in towns, schools or hospitals based on the threat of contamination involving, the professor says, “otherwise healthy people in a cascade of anxiety.”

His article quickly grabbed the attention of news outlets around the world. He was interviewed by Time magazine, The New York Times, the Los Angeles Times and Canada’s National Post. Media articles were circulated on websites. The blogosphere had a field day. Suddenly it was fashionable to dismiss food allergy as a made-up phenomenon.

Parents seeking accommodations for kids at school were no longer taking sensible precautions – they were portrayed as hysterical, anxiety-ridden and even needing to “feel special”. Food allergy groups and parents of kids living with the risk of anaphylaxis were put on the defensive, while leading allergists only got to add their brief comments on the media debate as responses to Christakis’s statements.

The fallout from one editorial was remarkable. Yet in writing of needless hysteria, Christakis in fact increased the anxiety within the food allergy community. The widespread attention has had a polarizing effect on those on either side of the school accommodations issue, and now, after many advances have been won to protect students at risk of anaphylaxis, at least one major Canadian newspaper is asking: “Can schools bring back the humble peanut?”

Backlash, however, is not entirely new. “There have always been people who are doubtful that food allergy even exists,” says Anne Muñoz-Furlong, founder of the Food Allergy and Anaphylaxis Network (FAAN), the Virginia-based non-profit that focuses on awareness, education and research.

Of course, the condition is real, it can result in severe and even fatal reactions, and it is more common than ever. The Centers for Disease Control and Prevention in the United States last October reported an 18 per cent increase in the number of children with food allergy from 1997 to 2007. Meantime, a study from the Mayo Clinic in December found that anaphylactic reactions to food are responsible for 50,000 emergency visits each year in the United States, up from a previous estimate of 30,000.

With a rise in food allergies, particularly in children, has come a heightened awareness of the need to keep kids with the condition safe when they are away from their parents. School, of course, is where they spend the bulk of their “away” time, and where foods and snacks are part of daily life. This has led to advocacy, followed by measures to reduce the risk of allergic reactions, mandated by law in places such as Ontario, New Jersey and New York state.

“There are a lot of schools that are dealing well with these allergies,” says Laurie Harada, executive director of Anaphylaxis Canada. “And they’re not all hysterical and living in fear. It has become a part of their norm.” Muñoz-Furlong agrees, pointing out that evacuating a bus due to a peanut is a rare and extreme example. “In the U.S., we have two million school-age children with food allergies. They go to school, they participate in class parties and field trips, they’re on the bus and they are mingling – just like every other child.”

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ALL THE SAME, the backlash has grown. The current rumblings date back to January 2008, when Harper’s magazine published an article in which writer Meredith Broussard did not mince words. “The rash of fatal food allergies is mostly myth,” she wrote, “a cultural hysteria cooked up with a few ingredients: fearful parents in an age of increased anxiety, sensationalist news coverage and a coterie of well-placed advocates whose dubious science has fed the frenzy.” She slammed FAAN for its fatality statistics that estimate 150 people a year die from food allergies, but neglected to mention that those figures, which emanated from a Mayo Clinic study in Minnesota, were derived using widely accepted methods.

When Christakis came forward to similarly cast doubt on the wisdom of school accommodations, his words carried considerable weight in the media, since he wrote as a Harvard professor and physician, and did so in the august BMJ. Within the scientific community, however, his views quickly became divisive.

In a letter to the BMJ, Dr. Jonathan Hourihane, a well-regarded Irish pediatric allergist, took issue. Hourihane said, for instance, that the professor had distorted the question of false positive allergy tests: “There is no such thing as ‘meaningless’ allergies to nuts, or else we have to accept the terms ‘meaningless’ asthma and ‘meaningless’ cancer,” he wrote.

Kania, who lives in Victoria, remembers this incident two years ago as “horrible”; he had wanted to make a good impression on the first day. He turned down the birthday cake because of his peanut allergy, but Kania, then 21, didn’t say that. “There were 30 bigwigs standing around and I did not want to be out of place.” In hindsight, it would have better if he had just been upfront about his condition.

Kania’s awkwardness with allergy in an office situation is hardly unusual. While great strides are being made in spreading allergy awareness and precautions in the schools, there is much less support and few allergy-friendly policies in the grownup working world of the business lunch, the office party (with its trays of mystery hors d’oeuvres) and the catered conference. Allergic Living spoke to employees with both food and environmental allergies in a variety of professions to discover how they coped on the job. Some are vocal with their bosses and colleagues about their conditions, but many are not.

Those with environmental allergies or asthma triggers (ranging from dust and mould to VOC paints and other chemicals) often suffer their symptoms in silence in their workplaces. And when it comes to food allergies, many who are at risk of anaphylaxis admit they have taken dangerous chances rather than stand out among their peers.

Raising the Subject

Tracy Hill had wanted to keep her allergies to fish and shellfish quiet at work, “whispered,” she says. Hill, 42, is a radiation therapist at a hospital in Thunder Bay, Ontario. Then one day at a conference, she had a life-threatening reaction to some Mexican food, resulting in an ambulance ride to the hospital. “That taught me a lesson,” she says. “Although I don’t like to draw attention to myself, it’s way better to have that conversation than have a big scene with an EpiPen in your leg and the stretcher coming.”

Dr. Mitch Persaud, a Saskatoon allergist, encourages patients to tell colleagues about their allergies from the get-go rather than waiting until they’re breaking out in hives and wheezing. He says some patients avoid doing so because they feel that their allergies are under control. “I don’t think that’s the approach,” he says. “Mistakes can occur any time.”

When a job requires working with customers, raising the topic of your allergies may require a degree of finesse. Peter Burnside, a 47-year-old Toronto salesman, travels continuously for work and eats as many as 15 meals a week in restaurants, often with clients. When his allergies to nuts, peanuts and barley come up, he tries to explain briefly and then steer the conversation back to his clients. “I wouldn’t want the first thing they think to be, ‘Hey, he’s allergic to nuts.’ Rather, ‘he’s got a great product’ – that’s what you want them to think.” Burnside adds: “You definitely don’t want to appear weak.”

Similarly, Colleen Serban, a 30-year-old photographer from Kenora, Ontario, told Allergic Living that she has to be concerned about whether her hayfever and asthma will cost her business. She strives to avoid photographing clients outdoors during the spring and fall because her medications sometimes cause her hands to shake. “I don’t want them to think I’m not able to do the job.” Serban also photographs weddings and feels embarrassed asking what’s on the menu for dinner shortly after she has landed a contract. She doesn’t want to leave the bride feeling: “I just hired her, and now she wants to decide what our meal is.”

June Traptow can relate. She, too, is a photographer and owns a studio in Red Deer, Alberta. Traptow, 49, has allergies and intolerances to nuts, dairy, gluten and eggs, and is often left scrambling for safe food at the catered events she attends to network with other business owners. She is concerned that when such peers and potential clients learn of her allergies, they may think she’s difficult to please. When they watch her at a meal – perhaps sending back a salad with croutons – some will also become paternal. “They want to look after my food problems, and that becomes an issue of credibility,” she says.

Dr. Donald Stark, an associate professor at the University of British Columbia and a Vancouver allergist, agrees that “people who don’t have allergies aren’t always particularly sympathetic to the allergy sufferer.” They may assume incorrectly, “it’s just a runny nose or a few hives, what are you making a big fuss about?” But he says the only safe route for the person with allergies and/or asthma is to get past the embarrassment and to inform bosses and colleagues about such a condition. Persaud, the Saskatoon allergist, advises the patient with food allergies to explain the allergy basics to co-workers in a pleasant and non-confrontational manner. He says it’s important to let them know that reactions can be life-threatening, and to ask for co-operation to avoid exposure to an allergen in the workplace. As well, he suggests that at least one other person in the office know where the allergic person keeps the epinephrine auto-injector.

Next Page: Accommodating Allergies

TORONTO – April 7, 2009 – How far should our schools go to protect the health and safety of our children? This is the great debate that Allergic Living magazine raises in its Spring ’09 cover story: “Backlash Boards the Bus.”

When medical sociologist Dr. Nicholas Christakis heard that students evacuated a bus at his children’s school because of one solitary peanut, he was appalled. But he didn’t just raise objections with the principal. Instead he wrote a column in the British Medical Journal that branded ALL school anaphylaxis measures as a form of “epidemic hysteria,” and raised the spectre of neurotic parents and educators feeding off each other’s fears in an endless cycle of anxiety.

In its Spring issue, Allergic Living discovers that Christakis struck a chord, that he is far from alone in his opinions that food allergies have cascaded into the realm of societal myth. The topic has become an international media debate with Harper’s, Time, The New York Times, the National Post and numerous bloggers all weighing in. Yet, to the parents of hundreds of thousands of children in Canada with dangerous – and very real – food allergies, the views being expressed are often frightening, divisive and hurtful.

The highly contentious debate prompted Allergic Living editor Gwen Smith to zero in on the heart of the matter in the latest issue: Why do people love to hate food allergies? The magazine finds widespread attention to Christakis’s opinion is having a polarizing effect, with those in the contrarian camp now suggesting that school anaphylaxis precautions are doing more harm than good, while allergy advocates emphatically defend the need to protect vulnerable allergic students.

A Mayo Clinic study released in December found that food allergic reactions in the U.S. resulted in 50,000 emergency room visits, up from 30,000 in 1999. Can anyone reasonably argue that food allergies do not present some measure of health concern?

The shadow of doubt is perhaps rooted in frustration over small inconveniences and isolated situations, such as the school bus incident, which are exactly that: isolated. Smith contends that what’s getting lost in the hyperbole is the rationale and the reasonableness of food allergy measures. The fact is: they save lives.

Click to view an excerpt of Backlash Boards the Bus in the Spring issue of Allergic Living.

Also in the Spring issue: The science behind oral allergy syndrome. About 10 per cent of Canadians have a confounding condition that causes intense reactions to fruits and vegetables. Read all about it.

Allergic Living is available by subscription (www.allergicliving.com) and at Chapters outlets, Shoppers Drug Mart and London Drugs.

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For more information about this article, or to arrange an interview with Allergic Living editor
Gwen Smith, call Beth Sulman at 416-628-5602 or bsulman@hccink.com

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