Allergy Injector Pilot Project Takes Aim at Food Courts

The recent anaphylaxis death of Canadian university student Andrea Mariano has horrified many people across the country and the tragedy was made all the more poignant by the fact that despite years of consistency, the 18-year-old had forgotten to take her EpiPen with her the day she consumed the smoothie that resulted in her death.

By contrast, in 2013, Maia Santarelli-Gallo died due to a severe allergic reaction at a mall in Burlington, Ontario, Canada. She had never been diagnosed with anaphylaxis and therefore did not carry an epinephrine auto-injector. She had eaten at the food court, was taken ill almost immediately and died before emergency responders could reach her. She was just 12 years old.

In an effort to ensure such a tragedy never happens again, the local Rotary Club, supported by Councillor Lloyd Ferguson of Ancaster, Ontario, partnered with McMaster University in Hamilton, Ontario, to create a pilot project that would provide epinephrine auto-injector (EAI) access to senior restaurant management staff in up to three mall settings in Hamilton.

This ambitious undertaking began in the summer of 2014 and was to run for one year. Unfortunately, only one mall, Jackson Square, has agreed to participate. Food Allergy Canada (formerly Anaphylaxis Canada) provided training in anaphylaxis awareness and proper use of an EAI to 24 security guards, four Tim Horton’s staff and one staff member from the Anchor Bar. Security guards have been carrying EAIs in their belts but have yet to need them. One incident of a severe allergic reaction has occurred during the study but the woman had her own EAI and did not require a second dose before EMS arrived.

In mid-August, Hamilton’s Board of Health voted to continue the pilot project for another year. Councillor Ferguson is hopeful the other two area malls will sign on soon. “This is about protecting the public and there’s no liability,” he said.

In Canada, most provinces have a “Good Samaritan Law”, ensuring that people who render aid in good faith are not liable for any unintentional injury they may cause, unless they are grossly negligent. Epinephrine is a form of adrenaline, a naturally occurring chemical in the body. Giving it when it is not needed will not harm a healthy person.

EAIs (EpiPen®, Allerject®) are the only effective treatment for a person suffering from an acute allergic reaction. No two reactions even for the same person are alike. Many people only carry one EAI but sometimes require several doses, either because their reaction is more severe than usual or because they are farther from emergency medical treatment than they are normally.

“This is not a dangerous drug, an addictive drug. Treat and ask questions later,” Dr. Susan Waserman, an allergist who is leading McMaster University’s participation in the program, said. “It’s OK to err on the side of injecting somebody — even if it turns out to be a false alarm.”

Many Canadian food service outlets will be watching with interest to see how the project fares in the long run. The hope is that eventually EAIs will be as prevalent and available as portable defibrillators. Tragically, the project can provide no support to the families of people like Andrea Mariano and Maia Santarelli-Gallo but perhaps it does offer hope to others who are similarly afflicted. Severe food allergies affect an estimated 7% of the population in Canada; therefore for every 1,000 customers served, there could be as many as 70 potential reactions. That is definitely food for thought.

About the Author

Lauren Solar is a freelance writer and editor who has multiple food allergies including anaphylaxis caused by shellfish and honey. She has been a writer and educator for various allergy and asthma patient education groups for more than 30 years.