Food allergies — Area schools on alert for life-threatening condition

By CRISTINA TRAPANI-SCOTT

When a child enters his or her first year of school it’s an emotional event for parents. For parents of a child with food allergies that beginning is emotional and frightening, as the possibility of their child being exposed to life-threatening allergens increases 100-fold. This is the scenario facing two families at Britton-Macon Area School and that is why the district, in preparation for the current school year, held a special staff inservice last Thursday.

Teachers, bus drivers, support staff and administration gathered to listen to Lenawee Intermediate School District nurse Janet Schuler, along with the students’ parents and allergy specialist Dr. Harvey Leo of Allergy and Immunology Associates of Ann Arbor on the campus of St. Joseph Mercy Hospital. The goal was to make staff aware of the emergency plan that Schuler has been working on with Elementary Coordinator Karen Scholl and to field questions and concerns staff might have, especially those working closest with the food allergic children.

Leo, who is the allergy specialist to the two students at Britton, works with childcare workers, administrators and parents to dispel myths associated with food allergies. He is not only an allergist, but he has dealt with food allergies personally with his own child. He’s worked on awareness at the local level with such districts as Ann Arbor Public Schools, and he’s working toward getting the information to a national audience as well through projects that are looking at food allergies in childcare centers. “Part of my obligation in taking care of food allergic children is helping the community understand these allergies,” Leo said.

According to him, there was a two- to three-fold increase in the number of cases of food allergies in the United States and worldwide throughout the 1990s. He said the trend has leveled-off a bit but food allergies now affect six percent of all children.

There are many reasons tossed around for the upsurge in cases of food allergies throughout the 1990s, but Leo said the three most popular theories include the increase of awareness, the fact that there is less exposure to allergens because of better hygiene practices, thus children’s immune systems are reacting to other foreign things such as food. Leo said the most controversial, and increasingly one of the most popular, theories has been that more and more people are deficient in vitamin D, which is made naturally in body when it is exposed to sunlight. He said that since the 1970s fewer children spend a sufficient amount of time outside to synthesize vitamin D and if they do they are wearing sun block, which not only blocks harmful rays but inhibits the synthesis of vitamin D.

Whatever the cause for the recent increases, the known fact is that there currently is no cure for food allergies and reactions very from breaking out in a hive or two, to sickness and even death. That’s why the district has worked so closely with Schuler and Leo in preparation for the 2008/2009 school year.

Leo and Schuler are encouraging district-wide awareness of nut allergies and implementing an emergency plant rather than prohibiting certain foods in the school. “As much as we talk of prevention, the bigger focus should be on the ability to react in an emergency situation,” Leo said. “The worst thing is when nobody knows what to do in a situation.”

Schuler said that designating a school nut-free often creates a false sense of security. The district already has determined that it will be a nut aware school, not nut free, but it will make the classroom the students are in during the day a “nut-free” classroom with signs clearly stating that it is nut free and notes going home to parents of children who will be in that classroom.

The students, who are allergic to all “tree-nuts” or nuts that grow on trees, not just peanuts, must stay away from foods made with any type of tree nuts and tree-nut oils.
Schuler outlined a plan that included responsibilities of the school and the parents of the children affected by food allergies. She said the school district should set up a simple plan that includes educating staff, understanding parent anxiety as well as staff anxiety, watching for bullying or teasing and being considerate to not single out the children with food allergies and to be aware of confidentiality. She advised the district to have signed medical release forms from the parents as well as emergency kits with items such as an EpiPen that administers a dose of epinephrine, the drug that counteracts severe allergic reactions, and that there be a plan developed for the transportation department that includes training the bus drivers as well as making substitutes aware of the food allergies. She said the families need to be actively involved in ensuring the district has up-to-date emergency information as well as medication and that the child is made aware that he or she can not eat food with unknown ingredients.

Leo walked through an emergency situation with the staff, telling the group that a reaction can move quickly and can easily escalate in a matter of four to six minutes. “What you want to do is try to prevent anaphylaxis,” he said. He described anaphylaxis as feeling like world’s worst allergy attack and it becomes life threatening because of a quickly constricting airway. He said at the first sign of reaction, the first responding staff member should give the child a dose of Benedryl. He said the reaction will either get better or progress. If it progresses, Leo said, that’s when the staff member should think about using the EpiPen. He advised that it’s always better to error on the side of caution and said an EpiPen will not harm a child. “We will thank you even if you give it an it is not needed,” said the father of one of the food allergic children who will be attend the school.

Leo called the teacher and bus driver who will work closest with the food allergic children during the school year up to demonstrate the proper way to use an EpiPen. He had each of them administer a dose to an orange.  Leo said reactions do vary, but he said that all allergic children have the potential to have a bad reaction.
Leo is keeping close contact with the school and urged staff to call his office any time if they have questions. “It’s very gracious of him to work with us like this,” said Scholl. “I’m told that doesn’t always happen.”