Food bans – Part 1: Why many medical experts think food bans in schools go too far

Bans on foods, especially nuts, have become common on schools, and across entire school boards, in recent years. One consequence: the near-disappearance of the lunch box peanut-butter sandwich that the parents of today’s children remember. But it’s not hard to find experts in children’s allergies who say they’re not warranted. 

Anaphylaxis is a serious, potentially fatal allergic reaction, usually to a food or insect bite. Peanuts, tree nuts and milk products are common food allergies. In the case of a food allergy, the food needs to be actually eaten to cause any significant reaction.

While the condition is life-threatening, anaphylaxis deaths of young people are very rare.

After Sabrina Shannon, a Pembroke, Ont. teenager – died in 2003, Ontario legislation required school boards to have an anaphylaxis policy and a plan for students with known food allergies.

Since then, Ontario has seen one more: in 2013 Maia Santarelli-Gallo, 12, died after an allergic reaction at a mall in Burlington, Ont. (Updated June 4.)

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Schools, faced with a dangerous and unpredictable problem, have often gone further than the law required, banning nut products, including peanut butter, from the school entirely.

Some boards, like Ontario’s York Region District School Board, Canada’s third-largest school board, went further than that, banning nut-free peanut butter substitutes, for fear they could be confused for the real thing.

A school-wide, or board-wide, food ban is the point where handling an allergy stops being simply a matter between the pupil, their parents and the school, but starts affecting the wider community.

But many experts doubt whether it helps.

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“When we set rules and guidelines, we need to act through baseline evidence, and not according to the way we feel, because our feelings might be misleading,” says Moshe Ben-Shoshan, a pediatric allergist at Montreal Children’s Hospital.

“Although we might feel that banning certain foods from schools might be protective of children, our studies show that accidental exposure to peanuts in peanut-free schools is not lower, compared to those that do not prohibit peanuts.”

Edmond Chan, who heads the allergy and immunology department at BC Children’s Hospital, agrees:

“The misconception would be that a food ban, practically speaking, helps you to achieve the outcome you’re looking for.”

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“It’s not that the intention’s not good, it’s just that realistically, from a practical point of view, can you truly reduce the chance of accidental exposure by having a food ban? The data that we have suggests that it’s not an effective intervention.”

Susan Waserman, who teaches medicine at McMaster University in Hamilton, Ont., sees a role for bans in settings with very small children – day cares, and the lower grades in elementary school:

“I have never been a big advocate of bans, but I think that for younger children, toddler-age, day care, where you have a lot of young children who can’t be counted on to sort of watch for themselves, to keep their hands and desk surfaces clean, not enough staff supervision, then it makes sense to ask parents to not bring certain foods into the classroom.”

For Waserman, it makes sense to relax restrictions as children mature.

“Most risk from peanut is from ingestion,” she says. “Just sitting beside somebody who is eating a peanut butter sandwich, if you don’t touch them, don’t touch the surfaces, don’t share any of the stuff that’s with them, if somebody is sort of competent in managing those sorts of things, then probably anybody eight years of age and up, in that ballpark, could be counted upon to do it.”

Ben-Shoshan points to an irony – since exposing children to foods at an early age makes an allergy less likely, a culture of avoidance tends to make allergies more common, creating a self-reinforcing loop.

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“I don’t think that banning something will contribute to increased health, necessarily, because those who are allergic know to avoid it, and how to treat (a reaction) if it happens, and those who are not allergic, by avoiding it, might increase the risk of developing an allergy, and demonizing peanuts as a nut allergen that will cause death might increase the level of anxiety among the population, and then they might start to avoid peanuts, and in an unaware way increase the risk of peanut allergy.”

In 2010, the American College of Allergy, Asthma and Immunology came out against peanut bans in schools, saying that “it is not reasonable or possible to expect schools or airlines to be peanut-free,” and that “consideration should be also given to the freedom of the vast majority of non-allergic persons.”

And in a recent study of accidental exposures of peanut-allergic Canadian children to peanuts, more exposures happened in schools prohibiting peanuts than in schools allowing them.

The Canadian School Boards Association discourages food bans:

“Emotions have run high in some boards when attempts have been made to “ban” peanut butter,” say the organization’s anaphylaxis guidelines. “In fact, experience suggests that the outright banning of any substance is not only controversial, but it is also less successful than cultivating understanding and enlisting the voluntary support of members of the school community.”

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Whether there is a justification for a food restriction in a school (the organization avoids the word ban‘) depends on the details of the situation, says Anaphylaxis Canada’s Laurie Harada.

“How old are the kids? What are their food allergies? Where do they eat? Is there adult supervision? People want us to give them a black-and-white response, a yes/no answer, and it’s a complex matter.”

“The best policies are going to come about when the local community is involved, because someone can make a broad policy, and stick it in locally, and it doesn’t fit. It’s not going to be well-respected, or maintained, and you want something that people are going to buy into and support, and can be maintained.”

Too sweeping a set of restrictions triggers resentment and frustration, she says:

“Where you see the backlash is where people feel that what I’m asking the whole community is not realistic, or not something that can be maintained. We’ve seen schools where they’ve asked families not to bring in anything with – and the list is the top eight allergens. They’re saying: Don’t bring in anything with these things: peanuts, nut, eggs, milk, meat, soy, blah, blah, blah. These families are saying: what can I send my kid to school with?”

Food bans in our schools – Read the entire 5-part series here:

NEXT: Why are peanut allergies seen more in high-income families?


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