House CallAug/Sept 2008 Issue

QA - Allergies and Food Sensitivities

Q. My 5-year-old daughter has a severe egg allergy and is starting kindergarten this year. Her school happens to be nut free but there’s been little accommodation for my daughter’s allergy. It seems like there’s reluctance from other parents to make changes. Is this normal?

A. Nut-free schools are more prevalent now but there are many children entering schools with other food allergies that are just as serious—and adjustments must be made accordingly. It isn’t always easy, as you’ve discovered. I’ve seen parents of peanut-allergic kids, for example, resist school-wide accommodation for a child with another type of food allergy. The biggest conflicts I’ve witnessed, however, are when families of food-allergic children clash with families of non-food allergic children over how their school decides to handle this issue. Parents can be very vocal and emotions can run high.

As a medical professional who’s worked with school officials and families in these situations, I often appeal to higher values. We want our kids to grow up to be good citizens, to learn to accept different races, religions, backgrounds — and health conditions. The food allergy issue is the perfect way to help kids (and their parents) do this.

We want to work together to find common ground. In my experience, parents become upset when they feel they’ve had no input into a decision that affects their school community. Open dialogue among parents and school officials can help mediate these types of conflicts. In addition, I encourage schools to work with local medical experts to develop standardized plans within each school district to address parental concerns and to ensure safety for all students.

Q. My little boy has anaphylactic food allergies. I’m already worried about sending him off to public school next year. When’s the best time to approach the school?

A. Research I’ve conducted for the University of Michigan Center for Managing Chronic Disease and my own experience confirm that the earlier a parent interacts with the local school (i.e., teacher, school nurse and principal) about a child’s medical condition, the easier the transition is for everyone and the better the chances the school can ensure a safe environment.

April or May before enrollment is not too soon to contact the school to introduce yourself as the parent of a child with a severe food allergy. Ask for an appointment with the principal and the school nurse to discuss the upcoming year and the steps that can be taken to make the school safe for your child. Come to the meeting armed with information about your son’s allergy and anaphylaxis. The school can help you draft an individual health care plan, which should include signs of a reaction and what to do, instructions for using an EpiPen and emergency contacts. Then right before the school year begins, the principal or nurse can send out a letter on school stationery to the parents of your child’s classmates to alert them to your child’s allergy.

Overall, the school should undertake basic strategies, such as training staff in anaphylaxis response, educating about food safety and promoting school-wide awareness about allergy issues, including signs and symptoms of a reaction and the food products that can trigger it. Then the problem is addressed logistically – limit snacks to fresh fruit and veggies, have allergic kids eat separately with someone observing, etc.
For more information, contact the Food Allergy and Anaphylaxis Network (www.foodallergy.org) or the Food Allergy Initiative (www.foodallergyinitiative.org).

Q. How many EpiPens should I have available for my 2-year-old son in preschool?

A.  I usually recommend that kids have at least two EpiPens or Twinjects at school. If there’s an error or malfunction in one, there’s still another dose available. If a child travels to different places during the school day or if he or she is at camp or playing sports and isn’t staying in one location, parents should make sure there’s medication available at each location or that it travels with the child.
 
I often remind parents that epinephrine is a controlled substance and that schools are not permitted to use another kid’s EpiPen to treat their child. Parents should make certain their child has his or her own medication, that it is up to date (not expired) and that it’s readily accessible in the event it’s ever needed.
 
Parents should complete and sign the required medical forms that grant the school permission to administer medication in their absence. Emergency contact information should be accurate and readily available. As an added precaution, kids should wear a medical alert bracelet to notify emergency personnel of their condition. For more information, go to www.medicalert.org or www.laurenshope.com.

Q. My son is allergic to bees. We watch him carefully during the summer but I feel like we’re off the hook in the fall after school starts. Am I correct?

A.  Don’t let your guard down yet. Stinging insects are still prevalent during late summer and early fall. The two common culprits—yellow jackets and honeybees – are very active this time of year. In fact, this is the season when most kids get stung.

Yellow jackets are attracted to sweet drinks and foods. Many children and adults have been stung in the mouth after sipping from a soda can, not realizing there was an insect inside. Keep alert to that possibility and also make certain your son wears shoes when playing outdoors. Yellow jackets build their nests in the ground so barefoot kids are particularly vulnerable. LW

Harvey L. Leo, M.D. is a pediatric allergist with Allergy and Immunology Associates in Ann Arbor, Michigan. He also holds an academic position at the University of Michigan School of Public Health.

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