Anaphylaxis through the eyes of the food-allergic child

New research shows young people who have experienced life-threatening anaphylactic shock from specific food exposures have significantly different views of the risks associated with their allergies based on their age and can benefit from discussing their perceptions of the safety of their school environment in improving their ability to cope.

A rise in the perception of food allergy risk parallels the increasing independence and empowerment that comes as children mature into their teen years, with teenagers feeling less confident of their surroundings and the level of information possessed by school personnel and parents than younger children. High schools were perceived as less safe because of the lack of homerooms, unsupervised lunch areas where food fights sometimes take place, and more uninformed staff. Elementary schools were considered safer because of the stronger presence of parents and consistent routines involving supervised lunch rooms, trained personnel, and communication strategies. Interviews revealed the greatest barrier to safe environments regarding food allergies stemmed from uninformed or misinformed friends, school personnel, and other parents. The research provides information for parents and allergic children to help inform school policies around risk management and coping.

The study, "Illustrating Risk: Anaphylaxis Through the Eyes of the Food-Allergic Child," was conducted by Canadian researchers and appears in the January issue of the journal "Risk Analysis" published by the Society for Risk Analysis. The authors include Nancy Fenton of McMaster University, Susan J. Elliott of the University of Waterloo, Lisa Cicutto of the University of Toronto, Ann E. Clarke of McGill University, Laurie Harada of Anaphylaxis Canada, and Elizabeth McPhee of the Community Services Agency in Hamilton, Ontario. The research was funded by AllerGen-NCE, Inc., with the support of Anaphylaxis Canada.

Food allergy affects up to 6 percent of young children and results in an estimated 150-200 fatalities each year in the U.S. and 15-20 deaths in Canada. Accidental exposures are common and occur in homes, camps and restaurants in addition to schools. The study consulted directly with children about their experiences living with and managing a chronic medical condition that requires them to be keenly alert to their surroundings. The study involved 20 children and teenagers and is considered exploratory by the authors, who caution against broader conclusions because of its limited sample size. Ten children aged eight through twelve and ten teenagers, all of whom have potentially life-threatening food allergies, were selected from public schools in Ontario, Canada. Their conditions are severe enough many have to carry an injectable form of adrenaline to treat episodes should they begin reacting to an unanticipated exposure to a food allergen.

Both age groups identified environmental and social barriers that contributed to feelings of isolation, exclusion or being teased. Missing out on school activities, camps, or time with friends was common. "I feel left out because I can't have everything, like my friends and the other people in my family," one 16-year-old said. Close friends provide key support to allergic kids but the subjects identified the greatest barrier to safety as stemming from uninformed or misinformed educators and others.

Young children relied more on parents and teachers to cope, whereas adolescents often anxiously fended for themselves by avoiding risky foods, educating others, navigating confusing food labels and quickly escaping from unsafe places. Some felt disempowered and overburdened and even developed symptoms like constant hand washing or waiting to eat until an adult was present who was available to drive them to the hospital. For teenagers, one successful coping strategy was redefining what is "normal" given their potentially life-threatening reactions to certain food exposures such as tree nuts and some seafood. Lead authors Nancy Fenton and Susan Elliott said the study "provided insight into more effective ways of informing educational and interventional efforts in responding to risk in schools."


Risk Analysis


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