Peanut Allergy - What You Need To Know
Prepared by "Allergy, Asthma and Immunology Society of Ontario"

The Peanut Problem:
Peanuts, a cheap source of dietary protein predominantly ingested as peanut butter, have indeed become one of the world's most allergenic foods. They are, unfortunately, progressively finding their way into more and more food products either directly, or by indirect contamination of food products during the manufacturing process. Peanuts may be designated on a food label in a less easily recognized term such as "hydrolysed vegetable protein" or "groundnuts". It is important to realize that for the sensitive person, this is a lifelong allergy, and that even trace amounts can kill.

What is Anaphylaxis?
Anaphylaxis is the word used for serious and rapid allergic reactions usually involving more than one part of the body which, if severe enough, can kill.

Anaphylaxis is a rapid, severe allergic response that occurs when a person is exposed to allergen, an allergy-causing substance, to which he or she has been previously sensitized. It is brought on when the allergen enters the bloodstream, causing the release of chemicals throughout the body that try to protect it from the foreign substance.

Epinephrine works directly on the cardiovascular and respiratory systems to counter the potentially fatal effects of anaphylaxis by rapidly constricting the blood vessels, relaxing muscles in the lungs to improve breathing, reversing swelling and stimulating the heartbeat. The sooner the allergic reaction is treated, the greater the likelihood of survival.

The availability of epinephrine in an easy-to-use, self-administered drug delivery system has greatly improved anaphylaxis treatment. A self-administered, auto-injector provides emergency treatment without syringes. This disposable system, when simply pushed against the outer thigh, delivers a pre-loaded dose of epinephrine. The rapid action and concealed needle minimize apprehension and provide the lifesaving medication with little or no pain.

The Allergic (Anaphylactic) Shock Reaction
This reaction can begin and proceed rapidly, occasionally proving fatal within minutes. It must be treated with epinephrine immediately at the first signs of reaction. The initial symptoms may appear within a few seconds, or up to two hours after exposure. Extreme allergic reactions should never be minimized. Because death can occur within minutes, anaphylaxis requires immediate attention.

Signs & Symptoms:

• a tingling feeling in the lips or mouth
• sense of foreboding, fear, or apprehension
• flushed face, hives (either where the nuts touch or elsewhere), swollen or itchy lips, mouth, eyes, or tongue
• tightness in mouth, chest or throat
• difficulty breathing or swallowing, drooling, wheezing, choking, coughing
• running nose, voice change
• vomiting, nausea, diarrhea, stomach pains

Symptoms Rapidly Progress to:

• dizziness, unsteadiness, sudden fatigue, rapid heartbeat, chills
• pallor, loss of consciousness, coma, death due to obstruction to breathing or extreme low blood pressure

You will NOT have time to wait for the parent or for the ambulance. The child will be unable to self-administer the medication due to the severity of the symptoms. You will be required to give the child adrenalin through an EpiPen, which is a pre-packaged automatic injector containing adrenalin.A Child with Allergies
Parents must count on your help to lessen the possibility of an allergic reaction, and to deal with a reaction if it occurs.

You can be instrumental in helping the allergic child to feel accepted. The allergic child knows he or she is different from other children, in having to do things or eat things that are different from others. The child's self-esteem may be fragile. If you can make it possible for this child to participate in activities in as normal a manner as possible, then the child will not feel "different". This will go a long way to strengthening the child's positive emotional growth at school.

The child with allergies may have symptoms that directly affect his or her performance in school. Allergic symptoms can be controlled with careful monitoring by the parents and the teacher. Here are some suggestions to help you in the classroom:

Guidelines For Children With Allergies:

• Staff and students should be educated to understand and treat anaphylaxis.
• All school personnel should be aware of these children and the things that cause his or her reactions.
• Keep a picture of the child, a list of his/her allergies and usual reactions in an easily accessible place in the classroom. If you have a substitute teacher taking your class, this information must be readily available to that teacher.
• The EpiPen should be kept in a safe, easily accessible place in the school.
• All food allergic children should only eat lunches and snacks that have been prepared at home.
• The contents of foods in school brought in for special events should be clearly identified. Terms that are not readily helpful such as casein, livetin or hydrolyzed vegetable protein, indicating the presence of milk, egg or peanut respectively need to be taught to personnel handling such foods.
• The use of food in crafts and cooking classes may need to be restricted depending on the allergies of the students.
• Inform the parents beforehand of activities involving food or animals. The parents may wish to give the child medication or substitute foods to make it possible for the child to participate.
• Notify the parents of behaviour changes you notice, or of an increase in any ofthe symptoms mentioned earlier.
  
• BELIEVE THE CHILD. The child will know if she or he is starting to react to something.
• If a reaction occurs, administer the adrenalin by using the EpiPen then telephone 911. Ask for an ambulance. Mention that you have a child who has suffered an anaphylactic reaction, and that you have administered adrenalin. The child must have further medical treatment if he or she has used the EpiPen.
• Children who require an EpiPen will not be able to give it to themselves. Because of the potential severity of the allergic reaction, no child should be expected to be completely responsible for the administration of epinephrine. Assistance must be provided by a teacher or other caregiver.
• PLAY IT SAFE: ADMINISTER THE ADRENALIN. The child will not be harmed by the adrenalin if it was not a genuine allergic reaction. Adrenalin will cause some tremor and increased heart rate, but does not have major adverse reaction.
• The child may require antihistamines for several days following a reaction. These medications sometimes cause drowsiness and poor attention span.
• It should be stressed that minute amounts of certain foods like peanut when ingested can be life-threatening. Several children have had skin rashes, stomach upsets and severe reactions just from simply contacting residual peanut butter on tables wiped clean of visible material. (see Cross Contamination)
• Peer pressure may be large -- One child received anonymous E-Mail saying "I'm Peanut, You're Dead"; another was chased about the schoolyard by a bully brandishing a peanut, while a third had the pouch containing life saving epinephrine taken as a prank.
• The parents of non-sensitive children may selfishly (or for financial reasons) argue that, "Why should my child be deprived of peanut when the problem is that of another child?" Perhaps the answer lies in the counter-argument that if their child had the life threatening reaction, would they not be the first to demand that all peanuts be removed from the child's environment.
• Some individuals also must avoid other foods in the legume family e.g. soya bean, pea, and garbanzo (chickpea) if allergy to these has been previously demonstrated.

Cross Contamination:

It is necessary to prevent cross contamination during the handling, preparation and serving of food. This occurs when other foods, utensils, etc. or the child comes into contact with residual / trace amounts of peanuts or peanut butter. In the food industry, much of the same equipment is used to manufacture many different items and cross contamination will occur. It is important to read the list of ingredients on all labels and look for allergy warnings.

• Surfaces such as tables, toys, etc. should be washed clean of contaminating foods.
• Residue of peanut material on a wiped counter top, cutlery or plates may induce a reaction.
• Residue of peanut material on common equipment; keyboards, handrails, door handles, etc. may induce a reaction.
• Aerosolized peanut material (e.g. opening a sealed jar of peanut butter, or fumes from cooking) may cause asthma in a susceptible individual. Some may experience nausea if people nearby are eating suspected foods.
• Peanut oil may be used for frying and cooking or to thicken chili, or to seal egg rolls.
• Most bakery products are contaminated. It is important to read the list of ingredients on all labels and question the baker(s) or clerks.
• Most ice creams are contaminated.
• Many cereals are contaminated.
• There should be no trading and sharing of foods, food utensils and food containers.
• Handwashing is encouraged before and after eating.
• Avoid contact with all nuts and nut products.
• If you're not sure, error on the side of caution.