Preparing children
with food allergies for school
Although only about 4 percent of Americans are affected, food
allergies seem more prevalent today than 10 years ago, partly
because the only treatment for food allergies is complete avoidance
of that particular food. Research to solve these allergies, both
in clinical and lab settings, is ongoing at Children's Hospital
Boston.
Many children have food intolerances, which result in conditions
such as minor skin rashes or gastrointestinal symptoms, but food
allergies, which trigger the immune system and can cause anaphylaxis,
are less common and much more serious. Anaphylaxis can be fatal
within minutes, either through swelling that shuts off airways
or through a dramatic drop in blood pressure. Ninety percent of
food allergy reactions are caused by a very few foods: eggs, peanuts,
tree nuts (walnuts, pecans), milk, shellfish or fish and soy.
Fortunately, anaphylaxis can be stopped with an injection of
Epinephrine (the EpiPen), which acts quickly to constrict the
blood vessels, relax airway and lung muscles, reverse swelling
and stimulate the heartbeat. Children who have had positive skin
tests or blood tests (ImmunoCap RAST tests) to a particular food
should always be prescribed an EpiPen or EpiPen Jr. and instructed
to keep it near them at all times, even if they have never had
a reaction.
The biggest problem, according to Karol Timmons, RN,
MS, CPNP, of the Allergy/Immunology Department at Children's,
is the fear of using the EpiPen. "Parents or caregivers should
not be afraid to use them," she says. "The side effects of the
EpiPen include increased heart rate and anxiety, but that's a
small price to pay to stop the reaction. For the most part, it's
safe for everyone to use."
Many people are inclined to give Benadryl to stop an allergic
reaction, but it can take 30 to 40 minutes to be processed by
the body. An allergic reaction from a food allergy can often get
very bad very quickly, so using an EpiPen is strongly recommended.
While administering the EpiPen can quickly reverse the effects
of anaphylaxis, the severity and suddenness of an allergic reaction
often makes parents extremely nervous when it's time for their
child who has a food allergy to enter school.
"One of the most difficult things for parents is to hand their
child off to a school," says Jane Romano, RN, MSN,
of the Allergy/Immunology Department at Children's. "But there
are many things they can do to make it easier for themselves and
their child."
Partnering with the school
"Parents need to form a partnership with the school and let the
school know they will help them make sure their child is safe,"
says Romano, a former public school nurse. "Teachers may be scared
about the possibility of a reaction, so they will most likely
sit up and listen when told what a child needs to avoid and why."
Physicians and healthcare providers can help ease this time by
recommending to parents the following ways to work with the school:
- Before the child enters school, meet with the school nurse,
teacher, principal and cafeteria monitors so they know the child's
situation.
- Bring educational materials into the classroom if it seems
that the severity of the child's allergy is not fully understood
by the school. « Make suggestions, such as a peanut-free table
in the cafeteria, but keep in mind what is reasonable to ask
of the school.
- Find out who is responsible for the child's action plan and
administration of the EpiPen when the school nurse isn't there,
or is caring for another child, or if a field-trip is planned.
- Make sure before- and after-school programs are aware of the
child's EpiPen and action plan. Even if they are at the same
location as the school, they may not be affiliated.
- Give the child's doctor or healthcare providers permission
to share medical information with the school. Without parental
permission, they cannot.
-
Decide, with input from the child's physician
and the school nurse, where the EpiPen should be stored: in
the classroom, in the nurse's office, or on the child at all
times.
- Ask school bus officials if drivers are trained in First Aid,
if they have 911 access and if they can be trained to give the
EpiPen.
