So before the barrage of angry parents swarm the comments section, full disclosure: I myself have a nut allergy. Allergic to cashews and pistachios to be exact, which are apparently the best nuts out there, or so I’ve been told by my friends, much to my chagrin. I’m also a doctor, an EpiPen-carrying allergic-to-the-fanciest-nuts-out-there doctor who somehow ended up as a Social Media Manager. But that’s not why we’re here.

Earlier this month, we published a story on meal-prep ideas for kids heading back to school. Two of our suggested recipes included loose nuts and peanut butter respectively – then all hell broke loose.

Of course, it’s perfectly understandable – firstly, choking hazards, and secondly, what parent wouldn’t want to protect their child from allergens, particularly if they’re too young to know better? If managed poorly, allergies (and subsequently, anaphylaxis) can be fatal. That’s not to say there haven’t been efforts to curb this danger – many schools in Malta and Gozo have followed the trends abroad and adopted a nut-free policy for certain classes or the whole school, banning nut products in schoolchildren’s packed lunches.

What really pushed me over the edge, were the messages we began receiving from parents, with everything from claims that inhaling a peanut’s “aroma” could kill a child with a nut allergy within 30 minutes, to the outrageous messages that nut allergies are the most severe around.

I was livid. Not just because these claims are completely unfounded and not backed by evidence-based medicine, but because they tantamount to fearmongering. But that got me thinking: where are parents getting their information on allergies from? Are nut-free zones truly the answer? And why is everyone so obsessed with nut allergies and not other food allergies?

We’re here to break it all down for you.

What is an allergy?

In its most basic sense, an allergy is a reaction the body has to a particular substance called an allergen. Some of these include dust mites, animal dander, latex, insect bites or stings (e.g. bees), medications, household products, pollen (as in the case of allergic rhinitis/hay fever), mould, and food. The most common food allergies include milk products, eggs, wheat, soy, peanuts, tree nuts (e.g. almonds, cashews), fish and shellfish.

Most offending allergens, more often than not, are completely harmless, however in some cases they are perceived by the immune system of particular people to be an antigen. In the normal workings of immunology, an antigen is any molecule capable of triggering an immune response; in persons with specific allergies, the allergen is recognised as a potential threat and the body mounts a counter attack in the form of an allergic reaction (the immune response).

In this regard, it is also important to differentiate between an allergy, sensitivity and intolerance to particular foods. An allergy is an immune response as explained above, which can further be subdivided into the fast-acting IgE-mediated allergies (immune response involving a type of antibody known as IgE) and the more delayed non-IgE-mediated allergies (an immune response involving systems other than IgE antibodies); a sensitivity refers to a susceptibility to being exaggeratedly affected by a substance (e.g. palpitations from coffee); an intolerance covers the unpleasant symptoms that can arise from consuming particular substances (e.g. diarrhoea after eating) – intolerances are not influenced by the immune system and the consumption of small amounts of the substance might not trigger an intolerant response at all.

What causes a food allergy?

Theories as to how allergies have come about are varied and the topic is still under study. More often than not, there is a family history of particular allergies, and these are sometimes associated with conditions like asthma and eczema.

A rise in people with allergies, particularly in Westernised countries, has also been noted but is also unexplained. Hypotheses for the rising prevalence include environmental factors and the widely-reported hygiene hypothesis. The latter, which itself has divided the scientific community, posits that an overly-clean and sanitised environment reduces the number of germs the immune system has to combat, causing it to overreact when introducing otherwise harmless food, etc.

Allergic reaction vs. anaphylaxis

Allergic reactions exist on a spectrum of immune responses, with the most extreme form being anaphylaxis. Common symptoms in allergic reactions include sneezing, itchiness or redness or watering of the eyes, a red itchy rash, vomiting or diarrhoea, wheezing, chest tightness, coughing, a blocked or runny nose, swelling of the lips, tongue, eyes or face, and worsening symptoms of asthma or eczema.

In severe cases, anaphylaxis (or anaphylactic shock) can occur. Aside from the above symptoms, confusion and anxiety, lightheadedness, a fast heart rate, breathing difficulties, clamminess and loss of consciousness can occur.

Anaphylaxis is a medical emergency which requires immediate attention. Persons known to suffer from severe allergic reactions are often instructed to carry auto-injectors with adrenaline (referred to as EpiPens). A trip to the hospital is always in order regardless of successful EpiPen injection or not; but regardless of the lifesaving injection’s availability at the time, some people do not feel comfortable administering the injection – whether it’s to friends and colleagues, or to schoolchildren.

And therein lies problem number one: fear.

Debunking allergy myths

There’s a genuine fear surrounding allergies, especially when it comes to schoolchildren. I began speaking to young parents, teachers, school administrations – the common practice I seemed to come across was schools have adopted some form of a nut-free policy.

At first glance it makes sense – the number one way to avoid triggering an allergic reaction is to avoid the allergen in the first place. The policy seems to have been instated to avoid accidental anaphylaxis. Routes of accidental allergy posited have included inhalation of nut particles, touching food surfaces, skin contact, and spit.

This is where problem number two rears its head: misinformation.

Myth #1: nut allergies are the worst kind of allergy

FALSE

An allergy’s severity is in no way related to the kind of allergen you are exposed to. Everyone’s immune system is different, and by extension, the immune response will be different.

Myth #2: touching, inhaling or salivary contact can cause anaphylaxis

FALSE

What appears to be the most commonly circulated myth about allergies, there have been absolutely no conclusive studies which show that contact with an allergen, saliva/drool, or inhaling of food particles or aroma can trigger anaphylaxis. Yes, symptoms of wheezing and itchiness can occur, but to date, no anaphylactic reaction from salivary contact with food allergen has ever been documented at a school. Anaphylaxis secondary to a food allergen is almost always triggered by ingestion of the offending substance.

Claims that touching food surfaces and food contact cause anaphylaxis have been used as the basis for nut-free zones in the past; this itself causes us to question the whole rationale behind their introduction the first place. True, distancing the allergen from those affected is decreasing the likelihood of an allergic reaction, but is it solving the problem?

Myth #3: nut-free zones in schools are 100% effective

FALSE

Despite all the measures instated in schools, whether it’s a classroom-specific or school-wide ban on nuts, there is absolutely no way to ensure that a child will be completely protected from allergens.

When contacted to discuss allergy policies, the Ministry for Education has stated that schools are encouraged to be aware of students with allergies and to take the appropriate measures to accommodate these students. While no policy or guideline is in place dictating what approach each school should take, training is provided to schools on request however it is at the discretion of each school to decide what will be done to tackle allergies.

Furthermore, why the focus on tree nuts and peanuts? Milk, egg and fish allergies are just as likely to trigger anaphylaxis if ingested, so why is no one up in arms about that?

A false sense of security

Numerous studies have been conducted into the effectiveness of instating nut-free zones in schools. In most cases, the odds of accidental exposure at school are extremely rare, with a higher chance of experiencing an allergic reaction or anaphylaxis at home or at a restaurant.

So why is there a ban at all? Other studies have shown that even with a ban there is a reduction not a complete elimination of nut products. Furthermore some hypothesise that a nut-free policy creates a false sense of security, leading to increased food sharing and a lowered guard around food. At the end of the day, the real world does not have a ban on food products to fit the needs of each allergy – it is the duty of each person to be on the lookout for possible triggers and inform those around them accordingly, or at the very least if they’re not in a position to do so themselves, those responsible for their care should know what to do.

There is way more we can do to prevent severe allergic reactions

A ban on nut products in schools on its own is certainly not the answer. No significant difference was noted in the rates of accidental exposure in schools with or without a ban on nut products, so in broad strokes, this policy does not work.

There are a number of other interventions that have been proposed to help curb reactions where possible:

1. Teach children how to effectively wash their hands before and after meals
2. Introduce a policy on food-sharing
3. Instruct teachers on how to accommodate children with allergies and be sure to avoid allergen use where possible in the classroom (e.g. cooking classes, arts and crafts)
4. Instruction for teachers and staff in administering lifesaving medication (including EpiPens) to children with a possible allergic reaction/anaphylaxis
5. Introduce a formal guideline for schools with a focus on allergies, education, and allergy management

In conclusion, there is no one way to eliminate allergens from schools completely, nuts or otherwise. What we can do is educate teachers, carers and students with the proper information on food and allergies. In cases where children are too young, responsible parties like teachers and staff should be taught how to spot the warning signs and effectively administer lifesaving treatment where possible and how to proceed with seeking medical attention.

If we can teach a young Type 1 diabetic to self-inject insulin, or teach a severe asthmatic child to use an inhaler, there’s no excuse to not teach older children to at least ask about food.

What are your thoughts on the way allergies are handled in schools across Malta and Gozo? Do you agree with the current system or do you feel more can be done? Let us know in the comments section below and on Facebook

A number of international papers and studies were used to research this article. Should you be interested in perusing the papers, feel free to get in touch on [email protected]

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Matthew Baldacchino

Self-titled resident SJW and expressionless in-house Head of Internal Marketing. Matt loves prepping vegan and vegetarian food, consumes way too much coffee, and has an unhealthy penchant for storyboarded Instagram Stories. When he's not trying to figure out social media policies, marketing strategies or cracking SEO conundrums, you can catch him as the host of Basically, Livestream Of Consciousness or Lovin Daily. Hit him up if you've got a story about the environment, arts and culture, health, politics and activism, or LGBTQI+ issues. He's also a doctor, but we don't talk about that.