On April 25, the Tokyo Metropolitan Office of Education released a report that highlights the difficulties it faces in providing school lunches to increasing numbers of students suffering food allergies.

The Case Study Collection of At-School Food Allergy Countermeasure Near Misses and Hints reviews examples of food allergy incidents and recommends how they can be avoided in the future. The report is Tokyo’s response to the education ministry’s 2015 request in their School Lunch Food Allergy Countermeasure Guidelines for schools to provide feedback on incidents and determine how to avoid similar cases in the future.

Human error proved to be the biggest issue. In several cases children received the wrong dish when their teacher left the classroom or got distracted. Several other near misses resulted from mislabeling trays or losing labels. In a serious incident, a student who eats lunches prepared at home suffered from anaphylaxis. The student’s parents had mistakenly sent their child to school with bread containing milk.

Even dieticians working in school kitchens sometimes have trouble identifying all the allergens in meal ingredients. In one case, breadcrumbs were found to contain soybean flour, added to preserve freshness. The report also included the example of small shrimp mixed among seaweed.

Teachers also encountered students having first-time allergic reaction to foods such as kiwis. In some cases, the food had been consumed previously without any problem; in others, students had never eaten the food at home before.

A spokesperson for the Tokyo Community Education Support Division couldn’t provide the total number of allergy incidents. However, in 2015 Saitama Prefecture recorded 245 cases of students consuming foods to which they were allergic.

Education ministry figures show a recent rise in the number of students reporting food allergies. The 2012 death of a Tokyo elementary schoolgirl from anaphylaxis after eating her school lunch spurred a ministry survey. It found 4.5 percent of elementary school students, 4.8 percent of junior high and 4 percent of senior high school students had food allergies. In total, 454,000 public school students reported food allergies, an increase of 37.8 percent from 2004 data. Plus, 0.5 percent of students had a history of anaphylaxis, a figure 3.6 times higher than 2004.

More recent national data is unavailable, but in 2016 Saitama Prefecture reported 4.9 percent of elementary and 5.1 percent of junior high school students had food allergies. Out of the 28,203 Saitama students with food allergies, 10,480 required special measures when preparing school lunches, and 1,208 carried EpiPens.

A Tokyo Community Education Support Division spokesperson said results from the annual health questionnaire parents answer about their children gave the impression that the number of children with food allergies was increasing.

The problem is large enough that special allergy cooking rooms have become common in school lunch kitchens. For example, the Saitama city of Fujimino opened a renovated facility last year with a room for preparing meals that can’t contain eggs or milk.

Cooks preparing lunches in these special rooms risk becoming overwhelmed by parents claiming food allergies their children may not have. This increases the chance of a mistake occurring that harms a child with legitimate allergies. A 2011 survey of Okinawan schools found 3.55 percent of children received school lunch accommodations in schools that didn’t require a doctor’s diagnosis. In those requiring a doctor’s diagnosis the number dropped to 0.69 percent.

Currently in Japan, requests for school lunch allergy accommodations are supposed to be accompanied by an annual doctor’s note. However, not every diagnosis is made by an allergy specialist using blood or oral food challenge tests. Some doctors diagnose food allergies after a short interview.

Learning Curve covers issues related to education in Japan.

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