For the growing number of parents whose children have peanut or nut allergies, the back-to-school season can be a particularly stressful time.
Exposure to even tiny amounts of nut particles - residue on a desk, a book or a container - can cause a potentially life-threatening reaction.
The only way to prevent an allergic reaction is to avoid peanuts and nuts altogether, a task that is easier said than done when so many foods contain them. It takes education, relentless label reading, and communication with food manufacturers to ensure meals and snacks are safe to eat.
While all food allergies cause uncomfortable symptoms, peanut and nut allergies are especially troublesome because they often result in more severe reactions and can do so after exposure to only trace amounts.
They are also on the rise. According to the Allergy/Asthma Information Association, one out of every 150 school-aged children is allergic to peanuts or nuts. The incidence of peanut allergy has doubled in the past decade, and among those diagnosed with one, 80 per cent will have it for life.
Like other food allergies, peanut and nut allergies are caused by an overreaction of the immune system to otherwise harmless proteins. Symptoms can include hives, skin rash, runny nose, coughing, wheezing, sneezing, itchy and watery eyes, stomach pain, vomiting and diarrhea.
But peanut and nut allergies can also cause anaphylaxis, the most severe form of allergic reaction. Such reactions occur almost immediately after exposure and are characterized by swelling, difficulty breathing, abdominal cramps and vomiting. If not treated immediately they can be deadly.
The only way to prevent a reaction is to avoid peanuts and nuts completely, including all foods that contain them and their derivatives. (Individuals with peanut allergy are not necessarily allergic to other nuts and vice versa, but it's estimated that 25 to 35 per cent of people with peanut allergy are also sensitive to tree nuts.)
These allergies pose such a serious threat to children that, as of January, 2006, all publicly funded schools in Ontario are legally required to have polices in place to protect children at risk for anaphylaxis. Lawmakers in British Columbia are looking at similar legislation.
Many schools have already designated peanut- or nut-free zones or classrooms, and some have declared the entire building nut-free. Other schools, recognizing that it is impossible to guarantee a nut-free environment, call these areas "nut-aware."
If you're a parent who is new to packing lunches or snacks for a nut-free classroom, the learning curve can be steep.
What's more, peanuts, tree nuts and their derivatives are not always easy to spot on a food label. They can be disguised by other names on ingredient lists.
However, Canadian labelling laws are currently under review. Proposed changes would require manufacturers to list all common allergens, including peanuts and tree nuts, by their everyday, easily identified names. These laws would cover the identification of both ingredients and components of ingredients.
Already, some manufacturers appear to be listening. It's getting easier to find a variety of allergen-free foods in mainstream grocery and natural food stores across the country.
Dare Foods (Canada) has declared its manufacturing facilities nut- and peanut-free (products containing nuts are made outside the facility). As a result, you will see Dare's peanut-free logo on 29 products including cookies, crackers, candies and fruit snacks.
Quaker Chewy granola bars are also made in a peanut-free plant. (Chewy Dipps, Chewy Yogourt and Chewy Trail Mix are not peanut-free.)
Enjoy Life Foods offers allergen- and gluten-free cookies, granola, snack bars, bagels and trail mix. You'll also find Nonuttin' Foods granola bars and trail in natural food stores.
If you're looking for an alternative to peanut butter, NoNuts Golden Peabutter is available in grocery stores across Canada (it's made from golden brown peas).
Leslie Beck, a Toronto-based dietitian at the Medcan Clinic, is on CTV's Canada AM every Wednesday.
Ingredients to avoid
Label reading is key to sending safe, nut-free foods to school. Read ingredient lists carefully every time you shop.
Other names for peanuts
Goober nuts, goober peas
Other names for tree nuts
Calisson (a marzipan-like candy made from almonds)
Marzipan (almond paste)
Queensland nut (macadamia)
Source: Health Canada
Do not buy any food that doesn't have an ingredient list, such as bulk foods and bakery goods. Avoid imported chocolate bars, which may contain traces of peanuts or nuts.
Don't assume that all formats and sizes of a nut-free product are safe.
Some foods such as chocolate candies and sunflower seeds are often made on equipment that's also used to process peanuts and peanut-containing foods.
Read the ingredient list every time you shop since manufacturing and packaging practices can change without warning.
The statement "may contain traces of peanuts or nuts" means the product is risky and should be avoided.
While refined peanut oil should not contain any peanut protein and is unlikely to cause an allergic reaction, unrefined or cold-pressed peanut oil may have the proteins and could trigger a reaction.
If you're unsure whether a product contains peanuts or tree nuts, contact the manufacturer for ingredient information.