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Coping with food allergies Simple strategies to help you protect your students when even a whiff of peanuts could be lethal  October 22, 2003 Spencerport fourth-grade teacher Joanne Katz, left, discusses her son Andrew's health care plan with nurse Mary Kinsky. ALSO
ON THIS PAGE This Halloween, the scariest place could be the classroom party - and not just because of spooky costumes. With growing numbers of students reporting allergies to foods like peanuts, eggs and milk, consequences could be more than a simple stomachache. For some children, inhaling peanut dust is a matter of life and death. That has far-reaching implications for everyone involved in student safety and well-being: from school nurses and bus drivers to teachers, teaching assistants and cafeteria workers. "It's your right to know what the district plan is in the case of an emergency," said Wendy Hord, New York State United Teachers health and safety specialist. What do you need to know to keep highly allergic children safe? A constant concern Joanne Katz, a fourth-grade teacher in Spencerport and parent of a child with life-threatening food allergies, knows all too well how dangerous school can be year-round for someone with severe allergies. Throw in a couple of holiday parties and the danger multiplies. "You think it's just going to involve lunch, but it's not," said Katz, a member of the Spencerport Teachers Association. "A lot of times kids bring breakfast back to the classroom. If they eat it at their desks, each desk is a possible contamination site." Though some districts have been pressured to ban certain foods, activists like Katz believe communication and prevention are key to keeping students safe. Avalanche of allergies The American Academy of Allergy, Asthma & Immunology reports that nearly 7 percent of school-age children - almost 2 million - have food allergies. School nurse Susan Archer, a member of the New Rochelle Federation of United School Employees, monitors several students with food allergies. She, like many health professionals, has noticed a jump in the number of students dealing with allergies, including problems with peanuts. "For the most part, people are pretty savvy about peanut allergies since the rate is so alarming," Archer noted. "I'm seeing more children presenting with them." A student with food allergies may be eligible for accommodations under the federal Section 504 of the Rehabilitation Act of 1973, if the condition substantially limits one or more major life activities, including learning. The school district's 504 Team is responsible for developing an accommodation plan which would include the accommodations and/or services for students with life-threatening allergies. "A critical part of student learning is to keep them in an optimal environment," said nurse Anne Goldman, chairwoman of NYSUT's Health Care Professionals Council and a member of the United Federation of Teachers in New York City. That requires strategies that keep students safe without isolating them. Type and severity of food allergies vary. "An allergy could be someone reacting to chocolate and becoming hyper," Goldman said. "It goes the full gamut from just fidgeting to an actual medical emergency." While some students' symptoms are triggered only after eating a food that contains an allergen, others' allergies are so severe that any contact - merely inhaling peanut dust or touching a table where milk spilled - can set off a reaction. Emergency response Once a child has been exposed to an allergen, timing is crucial. Symptoms can occur in as little as five minutes and as much as four hours or more after being exposed. Symptoms can include hives, swelling, difficulty breathing and vomiting. When Katz's son, Andrew, began going to Spencerport schools, she and several other parents of food-allergic children made sure the school could accommodate their special needs. Andrew, now a ninth-grader at Spencerport High School, has allergies to peanuts, milk and eggs. Before school started this year, Katz met with the two nurses who would be providing Andrew's care: Patricia Brown, who had Andrew in elementary and middle school, and Mary Kinsky, nurse at the high school. At the high school, "there are 27 school staffers he's going to come in contact with throughout the day," Katz said. "Even though it gets easier as they get older, now he's also more of a risk taker." It's important everyone understands food allergies may be more than just a stomachache or runny nose, Brown said. "That's why we use the word anaphylactic. It's a little medical, but we need to get everybody's attention that it's not just a little discomfort." Anaphylaxis, a sudden, potentially fatal allergic reaction, involves various parts of the body including the skin, respiratory tract, gastrointestinal tract, and cardiovascular system. Epinephrine, usually in the form of a self-injectable EpiPen, is most commonly used to treat an anaphylactic reaction. Bus drivers' vigilance When Vivian Riveras hands out take-home Halloween treats on her bus this year, her highest priority is the well-being of the more than 50 students she transports to and from Newark Valley schools. "I send a note home to parents before I hand out treats on the holidays," Riveras said. "We don't know if kids are allergic to different foods or even which kids are diabetic. We're in the dark." Her local, the Newark Valley Cardinal Bus Drivers, led by Linda Tarbox, is advocating for more training for drivers - especially focusing on symptoms. "It has been a concern of our drivers," Tarbox said. "Our district is 240 square miles, so some of us are many miles from help." A team approach is the best defense in preventing a reaction. "It takes everybody's eyes to observe these kids, not just the teacher and the nurse," said Brown. Bus drivers often serve as a first line of defense when dealing with students with food allergies. Although most drivers, like Riveras, enforce a strict no-eating policy on the bus, they still need to be prepared if an incident occurs. The key for bus drivers is preparing for the worst-case scenario, said George Gould, president of the Spencerport Transportation Association. If an incident occurs on a Spencerport bus, drivers radio the garage where a call to 911 is placed. Drivers abandon their route and proceed to the nearest school or the child's home (whichever is closer), where they will be met by an ambulance. In the cafeteria, workers try hard to have students avoid reaction-causing foods. In Syracuse schools, a food-allergic students' allergies flash on the screen when they purchase their lunch. "This tells the cashier to really check the student's tray to make sure that there isn't anything he's allergic to," said Eileen Kitts, second vice president of the Syracuse Teachers Association's Unit 7, representing food service workers. The district's food director always makes sure there are plenty of options for students, Kitts said. While a student with a milk allergy might not be able to eat a cookie, another dessert choice might be diced fruit. Disaster averted For Halloween last year Joanne Katz thought she had covered all of her bases. "Even though I prepared and I knew ahead of time what parents were going to be bringing in food, you forget that everybody brings in something anyway." When parents showed up with more than 20 types of treats, Katz popped in a video to keep her second-graders occupied while she and the school nurse read every label before divvying up the treats. But food is not always the problem. Cross-contamination can be just as dangerous. "Teachers use many materials for manipulatives or we sometimes ask kids to bring in empty milk containers for crafts," Katz said. "Even the empty Twizzler's container could be a contaminant." Tips to avoid reactions Nurse Goldman said prevention - the first priority - "can only be accomplished through prior knowledge." That includes making sure parents are comfortable in sharing information with the staff. "Sometimes parents hesitate to share their child's medical information. They feel it may in some way impede our ability to educate the child," Goldman said. "We want to know and we want to be the first line of defense in assisting a student to deal with that issue if it should occur." - Clarisse Butler PEANUTS: FREQUENTLY ASKED QUESTIONS Here are a few frequently asked questions about food allergies. All information is provided by the Food Allergy & Anaphylaxis Network's School Food Allergy Program. What is a food allergy? Food allergies involve an interaction between the immune system and food particles. Once certain foods are broken down into proteins, in a food-allergic individual they may be recognized as foreign invaders by the immune system and cause the body to react. How much food does it take to cause an allergic reaction? Everyone reacts differently to reaction-triggering foods. It depends on how allergic the child is to the food, and in some cases, the amount of the food ingested. Some people react after smelling the allergenic food or physically coming into contact with it. Trace amounts of the offending food may be more than enough to cause a major reaction. Someone with a milk allergy may break out into hives after being splashed with a few drops of milk, while another person with a milk allergy may be unaffected. Some people with peanut allergies have reacted to muffins prepared on the same manufacturing line as those containing nuts. How can I recognize an allergic reaction? Allergic reactions are broken down into five categories: skin, intestinal, respiratory, heart and blood flow, and those affecting the nervous system. Skin symptoms usually appear as hives, swelling, an itchy red rash or an eczema flare. Cramps, nausea, vomiting, diarrhea and gas can all be indicators of an intestinal reaction. Respiratory reactions can include itchy, watery eyes, a runny or stuffy nose, coughing, sneezing, difficulty swallowing, shortness of breath or a swelling of the lips, tongue or throat. A person experiencing cardiovascular symptoms may exhibit increased blood pressure, and heart rate, or may go into shock. Neuro-biological symptoms are more difficult to recognize. The person may experience feelings of impending doom and weakness. Reactions can also include behavioral changes. Some children become hyperactive or exhibit aggressive behavior. All children may not exhibit the same symptoms. Speak with the child's parents to find out how the child has reacted in the past. Is there treatment for an allergic reaction? Many allergic reactions can be treated when recognized early enough. No cure or preventative medication exists for food allergies. A reaction can only be prevented by avoiding the offending food. Epinephrine is most commonly used to treat food-allergic reactions. It is available (EpiPen) by prescription only and administered through an auto-injecting syringe-type device. Other medications available to food-allergic individuals are antihistamines (Benadryl, Chlor-Trimeton, and Atarax) which can be administered in both liquid and tablet form, and inhalers for students with food allergies and asthma. What is an emergency action plan, and do we need one at my school? An emergency action plan is a predetermined set of steps to take in the case of an emergency. Don't waste time in an emergency trying to figure out what to do. An emergency action plan should explain what medication the food-allergic child needs, who is cleared to administer the medication, where the medication is stored, and all emergency contacts. Any school with children who have been diagnosed with food allergies HAS to have an emergency action plan in place. Under the law, food allergies are treated as any other disability, and it is the child's right to be treated. I drive a school bus, should I be told if there is a food-allergic child on my bus? Yes! All teachers, School-Related Professionals and administrators who come into contact with a food-allergic child should be aware of the child's allergies, and more importantly, should be trained in how to handle a reaction. A child may have a mild reaction to something ingested during the day and go untreated. By the time the child gets on the bus, the reaction could have heightened. A bus driver should be prepared to handle an emergency involving the child. How can I make sure the students with food allergies don't come into contact with any reaction-triggering foods? If the parents of the food-allergic child do not object, one suggestion is to send letters home to all parents informing them of a food-allergic child and what kinds of foods not to bring into the classroom. Parents of the food-allergic child may also be asked to bring in "safe snacks" for classroom parties or field trips. Everyone who may come into contact with the child should be informed of his/her food allergies. Depending on the extent of the child's food allergies, he may have to sit at a separate table in the cafeteria during lunch time. If the child's allergies are severe, he may have to eat in a separate room away from the other students, or near the teacher's desk. The most effective way of ensuring students do not come into contact with any offending foods is through education. Know the common and scientific names for all allergens. If you are unsure, do not use the food. Should I inform other students in my classroom about food allergies or the food-allergic child in particular? Each case is different and depends on the grade level and wishes of the child and his/her parents. It is usually a good idea to inform the children in your classroom about food allergies in general and the serious nature of them. Enforcing a "no trading" policy in regards to lunch and any snacks may be helpful. If students don't know what food allergies are they may unknowingly trade tainted food with the food-allergic student. Parents can visit the Food Allergy & Anaphylaxis Network online at www.foodallergy.org for parent's school safety tips. |
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