When Ashley Hickey's seven-year-old son went to school one day last month, she said he was one of the only kids who could not have macaroni and cheese at Spring Street Academy in Amherst, N.S.

The meal was served as part of a new provincial lunch program that started this fall in 28 schools. The program's website said its mac and cheese contains whole wheat pasta, which Hickey's son can't eat because he has celiac disease, an illness that affects one in every 100 to 200 people in North America.

Celiac disease is caused by an immune reaction to eating gluten, which can be found in wheat, rye and barley. It can trigger intense cramps, diarrhea, nausea gas and general pain.

While other meals in the program, such as the butter chicken and Lebanese rice, may technically be gluten-free given the ingredients listed on the website, Hickey is concerned that ingredients may change or get cross-contaminated.

"He brought home the agenda and he's like, 'There's this new program, there's pizza,'" she said.

"And I was like, 'You can't have it, Alex, I'm sorry."

The website for the program even has a disclaimer that "meals cannot be guaranteed to be 100 per cent allergen-free due to the risk of cross-contamination and possible substitutions" and "ingredient substitutions may occur without notice."

Examples of meals from the N.S. school lunch program. The menu includes macaroni and cheese. (Nova Scotia Government)

Hickey is not the only parent who has this issue.

Gunter Holthoff said his daughter, who has celiac disease, felt sad after seeing her friends having a warm meal while she had a gluten-free sandwich.

"There was a couple of other kids that didn't get any food, but that was because they didn't like their options. So she was the only one that didn't have a choice."

Accommodations 'challenging'

Krista Higdon, spokesperson for the Nova Scotia Department of Education, wrote in an email that families with children with food allergies should communicate with school administrators to ensure support.

Parents in Prince Edward Island, where a similar lunch program has been in place for four years, can order gluten-free meals, but the program still cautions that it cannot guarantee that the food is free from cross-contamination because many of the dishes are prepared by third parties.

"While inclusion is very important, I will say that accommodations are challenging for large-scale programs, that are not administered/produced at the school level, especially with the risk of cross-contamination, cost, and availability of the product," Katelyn MacLean, the executive director of the P.E.I School Food Program, said in an email.

Resources available online

Jennifer Gerdts, executive director of Food Allergy Canada, said her organization has heard complaints from Nova Scotian families about the lack of options for kids with allergies and food intolerance.

To her, the N.S. school lunch program could start by ensuring ingredients do not get changed last minute so that parents of kids who have alimentary restrictions can evaluate the menu meal by meal.

"We rely on access to accurate ingredient information and to know that the that what we're being served is what is in it," she said.

Ashley Hickey's son, Alex, wrote multiple reminders about the school lunch program in his agenda, but his mother says he can't have any of the meals served. (Submitted by Ashley Hickey )

Gerdts also said there are resources online for food service providers to teach their staff how to prevent cross-contamination.

As for Hickey and Holthoff, they said they will keep sending their kids to school with food from home, even if that comes at a higher cost to their famililes.