For most post-secondary students, grabbing a quick bite on campus would be considered a healthy snack. But for Andrea Mariano, that decision may have been deadly.
The 18-year-old student at Queen's University in Kingston, Ont., died at a nearby hospital on Sept. 18 after an anaphylactic reaction. Many details of her death are unknown, but Mariano was allergic to peanuts and dairy.
Fatalities from allergic reactions are increasingly rare as awareness and diagnosis of deadly allergies grows.
Still, when they do happen, "it's often teens and young adults," says Laurie Harada, the executive director of Food Allergy Canada, an advocacy and research organization.
Experts say teens and young adults have some traits that make them more vulnerable than children under their parents' watchful eyes or adults with years of extra life experience behind them.
Youth tend to lack experience negotiating food outside of home and school, seek to blend in with their friends and make riskier decisions, experts say.
"When you have a food allergy, you have to be on guard 24/7," Harada says.
1st time living away from home
For many kids who move away to study at college or university, it's their first time not living at home, she says. They move from a controlled food environment to "eating out every single day" for students on meal plans and frequenting more social situations with food — parties, residence events and frosh week.
That's "worrisome" for parents of kids with severe allergies, says Harada, whose 21-year-old son with multiple food allergies studies at the University of British Columbia.
That lifestyle demands a lot of responsibility. The student needs to work with food service providers to ensure they can accommodate their dietary needs, check food before consuming it and avoid products they're unsure about.
"They need to be able to advocate for themselves," she says.
Parents can help prepare their kids for this from a young age, says Harada.
Well before kids grow into teenagers, parents should encourage their children to speak for themselves and ask questions about meals served at restaurants, people's homes and other outings. Parents can guide these conversations, she says, but giving kids a voice provides them the confidence to address their needs when their parents aren't around.
As their teens prepare for university, Harada suggests parents help their kids contact campus administrators to learn how the school can accommodate their allergy and what emergency procedures are in place in campus residences.
But she cautions against parents doing all the legwork.
"Don't take over for your child," she says. "Do it with them."
Strong desire to blend in
The confidence to speak up about their allergies is something young adults need as they tend to want to blend in with their peers rather than be different, she says.
Giulia Cavaleri, a 22-year-old undergraduate student at Toronto's York University, has had a known peanut, nut, fish and shellfish allergy since she was four months old.
In elementary school, kids and some parents would pick on her because she was the person that prevented other students from enjoying certain foods at lunch or during recess.
Kids fear being bullied or teased, says Cavaleri, who now mentors youth with allergies through Food Allergy Canada's programs for young people. So they tend to be timid about revealing or openly discussing their dietary needs, she says.
Young people, whose brains are still developing and tend to make risker decisions, may also choose not to carry their medication.
Studies have shown that youth are sometimes negligent about carrying their prescribed EpiPen or Allerject injectors, which treat anaphylactic shock with epinephrine. They tend to leave their injectors behind when wearing tight clothes, playing sports or going to dances, Harada says.
This can be a deadly mistake if someone experiences anaphylaxis, a severe allergic reaction.
"When an allergic reaction happens it can happen very quickly and it can go from something seemingly mild to something life-threatening within minutes," she says.
It's more likely for older children to have fatal allergic reactions "because of their increasing independence and their reluctance to carry medication," reads a 2001 report on anaphylaxis by the Canadian School Boards Association, citing the experience of allergists.
Kids, and some adults, sometimes downplay their symptoms or seek privacy to avoid making a scene, Harada says.
Anaphylactic symptoms can include severe vomiting and/or diarrhea.
"Your natural inclination is [to] run to the nearest washroom," she says. But it's best to seek help and administer epinephrine in public.
Onus on schools, food services
While it's important for people with allergies to be vigilant around food and carry their medication, Harada says food services and schools must also play a role in safeguarding people.
Restaurants should train their staff to understand how serious allergic reactions can be, so they take extra care avoiding cross-contamination of food.
She recalls the 2003 death of Sabrina Shannon from anaphylaxis after her high school cafeteria served her fries using the same tongs that previously handled poutine. Shannon was allergic to dairy protein.
Her death resulted in every Ontario school board implementing an anaphylaxis policy under Sabrina's Law.
Post-secondary institutions should have emergency protocols in place to speedily respond to allergic reactions, she says.
Queen's University offers services to help students with allergies, said spokesman Chris Armes in a statement, like signage in the dining halls and meetings with the campus executive chef. The university "will review the many services we have in place to ensure they are consistent with best practices," he said.
Mariano's recent death is "awful," Harada says, but perhaps it provides "a good time to just look at what the protocols are."