‘Everybody has to think – do I have any peanuts and nuts in my lunch?’ School nurses, collective adherence, and children's food allergies

Abstract

Developing robust explanations for patients' non-adherence to medical treatments is a pressing clinical concern. Social scientists have emphasised the importance of taking a 'patient-centred' approach to the study of illness management. Using data from a qualitative study of the management of children's food allergies, I found that school nurses created what I term collective adherence - the translation of individual medical recommendations into prescriptions to be followed by entire communities. School nurses secured collective adherence by aligning physicians, schools, and families around a particular interpretation of medical recommendations, setting guidelines of behaviour for the entire school community to follow, and balancing the diverging needs of illness sufferers and non-illness sufferers. This study contributes to the study of adherence by examining the medical recommendation as a dynamic prescription, extending adherence to the study of ancillary providers' interaction with medical recommendations, and examining the impact of illness on non-family ties. I conclude with a discussion of implications for the field of school nursing; and potential applications of the collective adherence framework to the management of health conditions and health risks.

Another Person’s Peril: Peanut Allergy, Risk Perceptions, and Responsible Sociality

“…Not only is this person unwilling to comply with a temporary and minor inconvenience to avert harm to another, but they are also vocal about their willingness to undercut any sense of mutual responsibility. These sorts of comments reveal the level of vitriol and antipathy that analogizes peanut-allergy risk as a punitive constraint on personal choice, something we see in corresponding debates over the past two decades around the introduction of restrictions or bans of peanuts and peanut butter in schools (Maldonado 2009; Muñoz 2018; Plicka 1999; Rous and Hunt 2004). These comments align with what their writers likely see as a pervasive societal devaluation of individual autonomy and self-determination; this viewpoint can elevate minor inconveniences into flashpoints of debate (O’Connor 2020).…”

“…Peanut allergy is a serious immunological condition that afflicts a small but growing percentage of people (1 to 2 percent in the United States, see Dyer et al 2015; Sicherer et al 2010). 2 Over the past two decades, it has been deemed a “new epidemic” and a “global health problem” by some medical experts (Fraser 2011; Smith 2015; Waggoner 2013), yet it remains poorly understood by the general public (Gupta et al 2009; Muñoz 2018; Page-Reeves 2015). Some food allergies can be outgrown, but this has rarely proved the case for peanuts (Sicherer and Malloy 2005), and immunological reactions to peanut proteins are often more severe than to other food allergens (Dyer et al 2015).…”

“…Afflicted individuals and their families often exist in a state of ever-present peril; if others do not believe the risk is real and critical, then the possibility of exposure is heightened. To be sure, skeptics reveal themselves in the comment sections of news articles, parenting blogs, and social media forums in response, for instance, to policy modifications made by schools and other institutions (Muñoz 2018; Rous and Hunt 2004). Some observers argue that social angst has outpaced peanut allergy’s empirical realities, noting fatalities are very few at the population level (Broussard 2009; Christakis 2008), but others suggest any easily preventable deaths are too many and thus there is dire need for new risk calculi, legally requisite accommodations, and augmented awareness of its dangers for the well-being of those afflicted (Beasley 2012; Rabin 2019; Severson 2008).…”

Anthropological and sociological perspectives on food allergy

“…Working class Latino parents, however, were unable to exert pressure to change school policies and they were not included in decisions about the allergy management of their children at school. 69 More research needs to be done on how socioeconomics and class impact allergy experience, management and care in a variety of institutions (e.g. schools, universities, companies and hospitals).…”

“…[30][31][32][33][34][35] There have also been some explorations of epidemiology, the hygiene hypothesis and the rise in allergy attributed to changes in food production, [36][37][38][39][40][41] as well as the potential protective role of food taboos on human health. 42 Since the early 2000s, research in socio-cultural anthropology and sociology on food allergy has primarily explored experiences of risk and stigma, 13,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] aspects of morality related to management, illness and parenting behaviour, 51,59,60,[63][64][65][66][67][68][69][70][71] explorations of gender, 38,65,…”