CAROLYN ABRAHAM
MEDICAL REPORTER Published on Monday, Feb. 20, 2006 12:00AM EST Last updated on Tuesday, Mar. 17, 2009 10:16AM EDT
The Toronto Maple Leafs were up two goals over the New Jersey Devils in the first period when Aly Young smelled it.
The thick, musty scent stung her throat. Her eyes watered. The 15-year-old scanned those sitting around her at the Air Canada Centre and there they were, on the laps of the couple seated directly behind her -- peanuts, cracked fresh from the shell.
Ms. Young popped four antihistamine tablets, but by the second period hives broke out. Then her throat tightened. She reached for the emergency epinephrine injection she carries to treat her severe peanut allergy, but it had expired. "I started to get freaked out." On-site paramedics administered oxygen, but by the third period, Ms. Young was struggling for air in an ambulance, fighting anaphylactic shock.
"I'm a huge Leafs fan," she said afterward. "I go to lots of games. I've just never had someone right behind me eating nuts before."
That frantic evening of Feb. 4 turned the Toronto high-school student into an activist. Ms. Young wants peanuts banned from sporting events. She's sent her plea to the Leafs' home arena -- the Air Canada Centre -- e-mailed her MP, Ontario's Community Safety Minister, Toronto Mayor David Miller and the news media.
Peanuts may be to sport events what popcorn is to movies, but Ms. Young believes her request is reasonable. The mysterious rise in lethal peanut allergies in Western countries has already led to efforts to create peanut-free classrooms, planes and food processing plants. Just this month, a week before Ms. Young's ordeal, Toronto City Council voted unanimously to bar the sale of peanuts and nut products in all municipal facilities, including vending machines.
"It just really struck me that they sell fresh peanuts at these sporting events -- they're not on planes, or in city arenas now," she said, "but usually it takes someone to die before they change the rules."
With restrictions spreading, the protein-rich legume now symbolizes one of society's sticky moral dilemmas. Should peanuts be banned from public places? Should majority rights tumble when the stakes are so high? Even trace amounts could be fatal for a growing number of people, many of them children.
"To impose the burden of abstinence raises questions," said Arthur Schafer, director of the University of Manitoba's Centre for Professional and Applied Ethics. "How great should the restriction on liberties be to accommodate the vulnerable?"
"If we agree that what [Ms. Young] wants is justifiable, then it would be appropriate to do it everywhere -- should we ban peanuts at cultural events, the ballet, rock concerts, movie theatres?"
Food has traditionally brought people together. But the sharp increase in food allergies, the reasons for which are largely unexplained, threatens to divide us. Nearly six in every 100 North American children now have food allergies, many to ingredients as common as eggs and milk. Peanut allergies, which have doubled in the past decade, affect roughly 1.5 per cent of Canadian children and are the most common. They are also the most likely to kill, usually after being ingested.
Last year, two peanut allergic Canadian teenagers died within a month of each other. In Edmonton, 13-year-old Chantelle Yambao died in December after eating a treat with traces of peanuts. In November, 15-year-old Christina Desforges of Saguenay, Que., died after kissing her boyfriend, who had eaten peanut butter nine hours earlier.
Food allergies have no cure and the only effective treatment to counter anaphylaxis, a life-threatening reaction that can strike multiple systems of the body within minutes, is a speedy injection of the hormone epinephrine, or adrenaline. Known generally by the brand names EpiPen and Twinject, the drug helps to open airways and improve blood pressure. Meanwhile, the only method known to prevent a reaction is strict avoidance in a world that can seem booby-trapped with hidden risks.
"The medical answer, the ideal approach is not to have any peanut protein in their environment . . . but then you are treading on other people's rights to have those foods,'' said Dr. Peter Vadas, director of Allergy and Clinical Immunology at St. Michael's Hospital in Toronto.
A survey done in 2000 and posted at http://www.canadianparents.ca polled 111 people and found that 34 per cent said "peanut-free zones are getting out of control," and agreed they aren't "fair for kids who like peanut products."
In response, Cindy Spowart Cook, the parent of an allergic four-year-old, wrote an article saying she was mystified that a parent might put a child's food preference above another child's life.
Ms. Young believes sports fans should be willing to forego peanuts to protect her from a life-threatening reaction. The couple at the Leafs game got rid of them as soon as she asked: "I don't think fans would mind not eating nuts."
But proprietors tend to be reluctant to halt sales of a popular and relatively healthy snack. Toronto's ban triggered immediate concerns from the city's lead vendor-machine supplier. At the same time, medical experts and advocates are concluding that blanket bans are not the answer.
"It's a large problem because people take it to mean that with anaphylaxis, if you ban it, the problem goes away and it doesn't. . . . It lulls us into a false sense of security," said Dr. Susan Waserman, president of the Canadian Society of Allergy and Clinical Immunology and associate professor of medicine at McMaster University in Hamilton.
Bans make practical sense in places like nurseries or daycares, where it's impossible to stop young children from smearing peanut butter on toys or each other, doctors say. Efforts to ban peanut products from planes are also worthwhile, Dr. Vadas said, since anaphylaxis at 10,000 metres could pose insurmountable problems.
Even so, air carriers offer no guarantees. Air Canada stopped serving peanuts on all its flights in 1998. But Air Canada spokesman Peter Fitzpatrick says, "We just don't have a policy on food. It's just too difficult to police, and people have always brought on snacks, even back in the days when we served food.
"We do strive to be peanut-free, and although our suppliers have our specifications, we've always said that we cannot guarantee that our suppliers' items will be peanut-free."
Toronto lawyer Jamie Dunbar, an adviser to food manufacturers at law firm Fraser Milner Casgrain, pointed out, "There's a big difference between what is acceptable for an open-air stadium versus a sealed product." Enforcing peanut bans in public places could be problematic, Mr. Dunbar said.
"If someone goes through a door handled by someone who just had a peanut butter sandwich . . . it can't be strictly controlled."
Since no nut-free policy can be perfect, Dr. Waserman said people have to learn to safely co-exist in an ever more allergic society.
Laurie Harada, executive director of Anaphylaxis Canada, sympathized with Ms. Young's crusade.
"I'm sure she'll get a lot of support. There are a lot of people and parents who would like to ban the world. But where do you stop though? What about people with milk allergies, or sesame allergies?
"The truth is you can't control everything we do in life -- we go to shopping malls, to the food court, playgrounds," she said. "The emphasis has to be on education. . . . It's being ready to react when something bad happens."
Anaphylaxis Canada and four other allergy-related organizations are to release guidelines next week to instruct people with allergies, those who care for them and society how to cope with the condition.
The document stresses the need for everyone to recognize the symptoms of an allergic reaction and act fast, to know how to use an epinephrine injector and to follow that with an immediate call to 911.
But a striking feature of the guidelines is what's not there. The booklet contains no strident calls to eliminate peanuts wherever possible. In fact, Ms. Harada, a co-author, doesn't even like the term peanut-free. Instead, they use the word allergy-safe to stress that no one should ever lower their guard.
Similarly, Sabrina's Law, nicknamed for 13-year-old Sabrina Shannon who died from anaphylaxis in 2004 after eating French fries in her school cafeteria in Pembroke, Ont., does not issue sweeping bans on any particular allergen in the school system. The unprecedented Ontario law, which took effect in January, requires schools to craft and enforce policies to handle serious allergies and develop individual plans for each pupil at risk.
"It's much more than just restrictions that are going to make it safe," said Ms. Harada, whose 11-year-old son is allergic to several foods, including peanuts. "This has to be about coming to a middle ground to do what's practical in the community and protects the child."
Ms. Young developed her peanut allergy relatively late, at age 12. But only after her experience at the Leafs game did she learn that an epinephrine injection, not antihistamines, should be the first line of treatment. That night also taught her that it is critical to make sure her epinephrine injector is current and that waiting for symptoms to worsen could be a fatal mistake.
But none of this has reduced Ms. Young's desire to see an end to peanut sales at sporting events. Since even the smell of peanuts can trigger her allergic reaction, doctors who treated her at St. Michael's Hospital that night suggested that she take antihistamines before going to a stadium.
She has yet to hear from the politicians she e-mailed a week ago. But, as the daughter of Ontario's former attorney-general, David Young, she's grown up around politics and plans to start working the phones next week.
"If they could even stop selling fresh peanuts, that would be something," she said. Cracking peanuts from their shells releases a stronger odour and a greater possibility of airborne peanut particles. Arenas "don't let you bring food from the outside, so they could control it. . . . At least there could be a section, or they could take some kind of measure."
Maple Leaf Sports and Entertainment, which owns and operates the Air Canada Centre, did respond to Ms. Young, suggesting that fans with allergies could phone ahead and that special seating could perhaps be arranged. But the company stressed that the ACC is not a peanut-free facility
"Like any other place in the general public . . . fans with allergies must understand that they are entering the building at their own risk," it said.
ACC spokeswoman Rajani Kamath pointed out, however, that all of the arena's three restaurants are peanut-free: "Our executive chef," she said, "is allergic to peanuts."
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