'Dangerous' allergenic foods should be allowed in schools, experts say

Parents who have children in kindergarten or lower elementary school must think that government officials in charge of schools have lost their minds or that their computers have been hit by a cyberattack. 

After years of preaching that young children should eat healthful foods, they are now being told by the Education Ministry that they must not bring to class milk; yellow cheese including grilled-cheese sandwiches; cottage cheese; soft white cheese; peanuts, peanut snacks like Bamba or peanut butter; fish; beef; bread with sesame seeds; butter, halva, nuts; mayonnaise; crackers or “health bars” with sesame seeds; cereal with almonds; and granola. 

The letter says they can bring carob spread; non-dairy spreads; pareve chocolate spread; cornflakes; jachnun; pita; pesto without nuts; jams or jelly; avocado or olive spread; honey and silan (date honey); and fruits and vegetables. 

The reason given is the growing number of food allergies suffered by children, which often pass at older ages and that require helpers to watch them in kindergarten or first and second grades so they don’t go into anaphylactic shock and immediately need an Epipen (adrenaline or epinephrine) shot. Even many high schools bear signs at their entrances that they are a “peanut-free school” – even though 15- to 18-year-olds know by then not to eat peanuts. 

“It’s a very emotional subject, because it involves little children and food, and while there are some correct facts involved, there are also others that are not so correct,” said Prof. Alon Hershko, immediate former president and current board member of the Israel Association of Allergy and Clinical Immunology (IAACI) and chairman of the Department of Internal Medicine C of the Hadassah-University Medical Center in Jerusalem’s Ein Kerem. 

In an interview with The Jerusalem Post, he said that for many years, the concept was that the kindergartens, schools, the relevant government ministries, and parents would decide on the issue. 

Should allergenic foods be allowed in schools?

“We as the relevant association – with some 70 or 80 members who are allergy specialists – didn’t think we should go into it. The directives worked for a while, but then, all kinds of problems arose. It sounds fair that if even one child in kindergarten or in class is allergic to milk or some other food, it should be barred from the institution. There are other sources of protein like ‘alternative’ milk (even though it’s significantly more expensive).”

But soon young children were found to be allergic to peanuts, eggs, tuna, and other kinds of fish, tehina and sesame seeds, hummus, and other nuts. There are also some children allergic to wheat, so there go all the sandwiches in some classes,” he continues. “What do you do when so many are allergic to something?” 

In the US and various European countries, the government tried to prohibit bringing such foods to class, but it didn’t work. What is healthful and can still be allowed? Even the allergic child can’t eat all these foods, said Hershko.

“There was a day-care center in the North with 50 or 60 children and 10 had allergies. Fifteen kinds of food were barred, and they had to close the center because the children couldn’t eat proper, nutritious meals.” 

The allergic child may be blamed and shamed. Sometimes, children who have no allergy go to a separate room in school so they can eat what they like, leaving the allergic child isolated. 

Three weeks ago, the Israel Association for Allergy and Clinical Immunology – chaired by Prof. Arnon Elizur and affiliated to the Israel Medical Association – issued a powerful position paper that was sent to the Education and Health ministries, the IAACI’s members, public health experts, and parents’ organizations. 

 It was aimed at describing the distress arising from parents and children who come to allergy clinics, and repeated questions on the subject, before the beginning of the school year. 

“This statement of opinion is based on extensive medical and scientific experience from Israel and the world and reflects the approach, accepted worldwide, to food allergy in the education system.” 

Food allergies, they wrote, “make headline news every morning, whether due to the difficulty experienced by allergic children and their parents in their daily activities – or within the educational system and the background of tragic cases of fatal reactions. Around the beginning of the school year, there is a concern every year among the allergic child and his parents that they stay for many hours in an uncontrolled environment without parental supervision. These concerns are natural and understandable. In the State of Israel, there is currently a ban on introducing allergenic foods into the classroom, or to school, which is intended to help the allergic child.”

This ban, they continued, “is based on two assumptions: There may be severe reactions following contact or smelling of allergenic food, and such a ban will reduce the risk of dangerous allergic reactions at school. Are these assumptions correct? Position papers published in recent years by international medical associations show that these assumptions are wrong.”

As for children with food allergies being “at risk of reactions when eating the allergenic food,” these may be multi-systemic and even severe reactions, but it isn’t possible to predict which of the allergic children will develop a severe reaction, and even if a child experienced only mild reactions in the past, it doesn’t mean that the next time he will not experience a severe reaction, the allergy and immunology specialists explained. 

“Therefore, the allergic child should be careful not to eat the food to which he is allergic. However, children with food allergies are not at risk of multi-systemic or severe reactions due to touching or smelling allergenic foods. Contact may cause a mild and slightly unpleasant skin rash in the area of contact, as happens in the skin tests that are regularly done for these children in allergy clinics. Regarding smell, there may be slight reactions to allergenic food particles that are airborne in unusual situations, such as cooking fish near a child with a fish allergy. 

“Many studies have shown that apart from this, there are no reactions to foods by sniffing. Therefore, the fact that other children around him eat the food to which he is allergic does not endanger the allergic child, as long as he understands that he must be careful to eat his food. This means that the allergic child depends mainly on himself, he has power and control over the allergy, and this knowledge can help reduce concerns.”

Thus, the association disproves false information published on the Education Ministry website that claims that just touching or smelling allergenic food is “dangerous.” 

THE POSITION paper continued that “according to international associations, a blanket ban on the introduction of allergenic foods into schools has not been proven to reduce the risk of an allergic reaction. First, such a ban is not really absolutely applicable and unenforceable. Allergenic food may be found in various food products covertly, especially in Israel, where there is still no law for labeling allergenic foods.

“The result is that, while the child feels secure in the thought that the allergenic food is not in his environment, he actually feels a false security. Second, creating an allergen-free zone at school harms the child’s willingness to behave carefully in other places, where the allergen will certainly be found (friends, restaurants and various recreation spots and the like).”

Creating separate tables for allergic children is certainly not recommended, since it will alienate the allergic child from his friends, the specialists continued. 

“In light of the understanding that these assumptions were misguided, in recent years, the international allergy associations (American, European, and Australian) have published position papers in a similar spirit, recommending not to prohibit the introduction of allergenic foods into kindergartens and schools except for infants and small children or children with developmental delays. These recommendations are implemented in Europe, the US, and in Australia.” 

Instead, the IAACI stated that it recommends starting to implement these recommendations in a gradual manner while adapting them to the Israeli education system and depending on the type of food and the maturity of the child: 

• Ensure regular follow-up by a doctor specializing in allergies/ Bring to school a letter detailing the child’s allergies, as well as an action plan for treatment in case of an allergic reaction to food. 
• Instruct the school staff on food allergy and treatment of allergic reactions. 
• Recently, an Israeli law was passed stating that schools must be equipped with Epipen syringes. The association calls on school principals to ensure that they have these syringes in their possession and in good condition. At the same time, the association calls on the parents of allergic children to make sure that they are always equipped with a valid personal Epipen syringe in their schoolbags. 

Hershko stressed that all over the world, there are more allergies, not only food allergies but also asthma, allergic rhinitis, and atopic dermatitis of the skin. “Many parents bring their children to me, claiming they are allergic to a certain food. I hear the details and tell them they have no allergy. There is a huge overdiagnosis by non-specialists. Only an allergologist can diagnose such things – and there are only six dozen of us in the whole country. It can take months to a year to get an appointment with one. There are parents who come to parking lots of hospital emergency rooms with their child to give them milk or other foods for the first time and see in a safe environment if they are allergic! Some children who are allergic to celery or other uncommon food allergens are not entitled to helpers according to the current directives.”

The problem, said Hershko in frustration, is that “we need a wide coalition of the two ministries, family physicians, and parents on the issue. All must agree, but they don’t. The kindergarten personnel and teachers don’t want to have the responsibility. They may be afraid of being sued if a child is hurt. They don’t want to use Epipens. Some parents’ groups are angry at us for suggesting changes; they were used to what was, and now we cast doubt on the rules. That’s why we need a strong coalition. Privately, Education Ministry officials who are familiar with the problem agree with us, but they don’t want to say anything out loud.” 

The Education Ministry assigns a helper to sit with a very-young child who has an allergy. She is told to watch carefully to prevent him or her from eating such food. But this covers only pre-kindergarten, kindergarten, and the first grade for all the time in class and second grade for just a few hours. 

“There are Epipens in every school, but who is responsible for using them? The helper should know how to use it and call MDA. But from third grade, who is responsible for giving the shot and calling Magen David Adom emergency services? Nobody! So the easiest thing for them is to bar allergenic foods.” 

Research has shown that as a child grows older, fewer youngsters have food allergies, but in those that still do, the risk of a strong reaction is greater, said Hershko. 

“Helpers are very problematic, because if they are on sick leave or vacation, nobody fills in for them. There are no nurses in Israeli schools. And who watches allergic kids in the optional afternoon sessions? There are no helpers then. And children can buy all kinds of allergenic (junk) food in vending machines on school premises or at nearby kiosks that the Health and Education ministries have not barred.”

The ministries don’t report how many cases of Epipen use have occurred in schools. The IAACI believes that most cases occur at home or in restaurants, based on reports from Israel and worldwide. There was a tragic case of a 22-year-old woman allergic to milk products. She went to a kosher meat restaurant and ate dessert. It turned out that it nevertheless contained milk products. She didn’t come with an Epipen – and she died. 

WHAT IS responsible for the growth in food allergies? The Hadassah specialist suggests that lifestyle changes are to blame. It’s better for a young child to be raised on a farm or with a dog or cat because this strengthens their immune system. Children are also given too many antibiotics needlessly, and they eat too much highly processed food.

The Post asked the Education Ministry for permission to interview an expert who has been dealing with the issue. After some time passed, Ilanit Zvili of the spokesman’s office refused to allow an interview and only said: “We will act in accordance with instructions from the Health Ministry. Without them, there isn’t much we can do.”

When this reporter asked Health Ministry spokeswoman Shira Solomon for permission to interview ministry pediatrician Dr. Deena Zimmerman, who has been closely involved in talks with the IAACI and the Education Ministry on the issue, Solomon refused; interviewing an expert has for years been a policy of the ministries, which prefer to send a few sentences as a response. 

Although the position paper was sent three weeks ago, Solomon wrote: “The Health Ministry received the Association’s position paper. The professionals are discussing the issue together with the Education Ministry, the IAACI, parents’ groups and other organizations. Naturally, maintaining the children’s health is at the top of our priorities.” 

Both ministries are clearly passing the buck.