Specific food allergens

This section provides information about the most common food allergens, and examples of how they are being managed in school settings.

Peanut and Tree Nuts

Reactions to peanuts are often more severe than to other foods. Very minute quantities of peanut, when ingested, can result in a life-threatening reaction. Peanut has been a leading cause of severe, life-threatening, and even fatal allergic reactions.^{1, 2}

Peanut allergy requires stringent avoidance and management plans as it is one of the most common food allergies in children, adolescents, and adults.³ For more information on strategies like food restrictions and food lists, see Restrictions & lists.

Peanuts are legumes and grow underground. They are not botanically related to tree nuts. The tree nuts included in Canada's list of priority food allergens are almonds, Brazil nuts, cashews, hazelnuts, macadamia nuts, pecans, pine nuts, pistachio nuts and walnuts. Individuals who are allergic to peanut may not be allergic to tree nuts, and vice versa. However, it is possible to be allergic to both. Those who are allergic to peanut or tree nuts are generally advised to avoid both due to possible cross-contamination of peanuts and nuts during processing/packaging and the risk of confusion between different nuts.

In the high school environment, teens at risk of anaphylaxis must adhere to key safety rules. Where food is concerned (any food), this involves reading food labels carefully and taking special precautions such as asking foodservice staff about the preparation and handling of food at the cafeteria, if they purchase their lunch at school. Students with food allergy should eat with a friend and advise others quickly if they feel they are having an allergic reaction. They should not eat if they do not have their epinephrine auto-injector with them.

Foodservice companies must train their staff to understand the risk of cross-contamination in the purchasing, preparation, and handling of food items. Foodservice staff should participate in regular school staff training on anaphylaxis management, and they must be aware of students at risk for food allergy.

Milk and Egg

While many young children outgrow an allergy to milk and egg within the first decade of life, some will continue to remain at risk of anaphylaxis, and should therefore follow key safety rules such as carrying epinephrine at all times.

Anaphylactic reactions to milk and egg can occur when relatively small quantities are ingested. Therefore, the allergic child must avoid all traces of milk and egg.

Elementary schools have adopted different strategies to reduce the risk of exposure for milk- and egg-allergic children.

Strategies to reduce the risk of milk

Ask families not to send in milk products to classes where there are milk-allergic children.

Exempt classes with milk-allergic children from milk programs.

Allow milk products in classrooms where there are milk-allergic children and implement risk-reduction practices such as:

Give children straws to put in bevel topped milk containers (distributed through milk programs) and teaching them to close the top once the straw is inserted.
Ask children to bring milk from home in a plastic bottle with a straw.
Have children at risk sit at a table where spillable milk products (e.g. milk, yogurt) are not being consumed.
Have children at risk sit at the same table but not directly beside classmates who have spillable milk products.

On “pizza days”, some parents of milk-allergic children take their kids home for lunch (where they have this option). Others send their child with a homemade milk-free pizza or an alternative meal so that they can still participate.

Note: Special care should be taken after pizza lunches to ensure that children properly wash their hands and mouths, and that surfaces are properly cleaned.

Strategies to reduce the risk of egg

Ask children to enjoy eggs and egg salad sandwiches at home.

Seat children with egg allergy away from those who bring eggs for lunch or snack (e.g. hard boiled, egg salad sandwiches) or whose food may contain eggs (e.g. mayonnaise).

Avoid egg in cooking classes or craft activities. (This includes egg shells and egg whites and yolks, either cooked or raw.)

Select special activities that do not involve the use of real eggs (e.g. use plastic or wooden eggs for crafts or Easter egg hunts).

Fish and Shellfish

Fish and shellfish allergies can cause severe and life-threatening allergic reactions; therefore, strict avoidance must be practiced. These terms may be confused and misunderstood, leading to the unnecessary avoidance of the entire class of food from the sea, or "seafood". The term "fish" refers to all edible finfish, both fresh and salt water species; and "shellfish" from fresh and salt water includes scallops, clams, lobster, shrimp, etc.

Individuals with a specific allergy to any of these species are advised to consult with their allergist about possible sensitivity to other species.

The risk of accidental exposure through cross-contamination in the storage and handling of these foods can be high. Allergic consumers should look for “may contain” warnings on food ingredient labels and be especially careful when purchasing these foods.

Sampson HA, Mendelson LM, Rosen JP. Fatal and near-fatal anaphylactic reactions to foods in children and adolescents. New England Journal of Medicine 1992;327:380-4.
Bock SA, Munoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. Journal of Allergy and Clinical Immunology 2001;107:191-3.
Sampson HA. Update on Food Allergy (Review). Journal of Allergy and Clinical Immunology 2004;113:805-19.

Updated March 1, 2010