Nearly six million American children have life-threatening food allergies. If that stat wasn’t on your radar before, the tragic death of Amarria Johnson, the first grader who died from ingesting peanuts at her Chesterfield County school in early January, has significantly raised awareness.
Allergies can lead to death when exposure causes anaphylaxis, the term for the immune system’s overreaction to a food protein. Anaphylaxis can affect the entire body. The most dangerous reactions involve the respiratory and cardiovascular systems. Death may occur when airways swell shut or from an extreme drop in blood pressure. Any report of allergic symptoms must be taken seriously. What looks like a mild reaction can quickly become deadly. Symptom expression is unpredictable, even in the same person. This means that a reaction might result in puffy lips in one instance, but the next exposure may result in a closed airway or shock. How can parents feel safe sending their child with a Life-threatening food allergy into the world?
“Making sure your child has immediate access to epinephrine is the most important defense a parent can take,” says allergist Ananth Thyagarajan, MD. “The second major safeguard is that parents maintain an up-to-date food allergy action plan at school and everywhere their child spends significant time.” Parents must be pro-active and make sure all paperwork is completed. Dr. Thyagarajan, who lives in Henrico County with his wife and kids and practices in Henrico and Chesterfield, stresses that open-communication between parents and school is key. For the sake of their children, parents should be nonconfrontational to help teachers understand how best to make their classrooms safe.
The Food Allergy and Anaphylaxis Network (FAAN) is an impressive resource to educate yourself, your child, her teachers, and other significant people in your child’s life. Originally founded by a mother in 1991, when information on food allergy was difficult to find, it has become the frontline for food allergy education.
As a parent, you have a responsibility to educate your child to speak up for herself to warn others of her food allergy. Yael Beckman, whose daughter Julie has a life-threatening peanut allergy, vividly remembers a Halloween when 3-year-old Julie “knocked on doors in her witch costume and said, ‘trick-or-treat, I’m allergic to peanuts.’ We let her participate in the same activities as her older sister, but she learned to be careful.”
For a child with a life-threatening allergy, school events including birthday parties, holiday celebrations, and field trips can be risky. “You realize how often events in Our culture are linked to food,” says Susie MacLeod, a mom of twins with severe food allergies. “Packing my children’s peanut-free lunch was easy, but what if a best friend offered to share a sugar cookie made with a peanut product?” For these families, every week brings landmines to navigate: cupcakes to celebrate a birthday; math problems solved by counting with M&Ms; well-meaning parents with post-game brownies. “You can’t monitor every minute,” says MacLeod. “We made it a family rule not to eat anything that didn’t come from home. Even when parents were aware of our children’s allergy, peanut-laden goodies still got into the classroom. It helps To have back-up treats like Starbursts and Skittles.”
Strict avoidance of the allergen is the only way to prevent a reaction. “That’s why a first line of defense is the child,” says Marguerite Pennoyer, MD, a Columbiaeducated allergist. “The child needs to be an active participant in the allergy plan and not eat anything given by anyone except a trusted adult who knows about the food allergy. Anaphylaxis occurs only with actual ingestion.”
Still, it’s scary to consider that a food can look peanut-free, but still be made with nut by-products or in a factory that uses peanuts in other products. Cross-contamination is common. To decrease risk, many schools are peanut-free or offer peanutfree tables, but this action is controversial.MacLeod is against peanut-free zones because she believes they provide a false sense of security that is more dangerous.In her experience, it is impossible to keep peanuts out of school because traces are in so many non-obvious foods.
“Another issue,” says Dr. Thyagarajan, “is a child may feel ostracized. It’s hard enough to be a kid without being labeled as different. There is a much greater risk of a child being bullied because of food allergy segregation than of a child having a severe allergic reaction from sitting at a foodintegrated lunch table. Plus, where do you draw the line? There are more children with severe allergies to milk and eggs than there are to peanuts; do we then make milk- and egg-free zones?”
Even with an allergy action plan, kids are kids, and cookies are tempting. Also, teachers who are aware of the plan get sick,And substitutes become the trusted adult in the classroom. That’s why all schools need to have a plan in place to identify children with food allergies, their care plan, and what to do if exposure occurs.
If the allergen is accidentally ingested, symptoms typically begin as hives, a tingling sensation of the tongue, and/or mild swelling of the lips. These may progress to vomiting, respiratory distress, severe swelling, and finally shock. The first signs of a reaction may be described in vague terms by a child. Think possible allergic reaction when a child with a food allergy describes anything unusual about her mouth, tongue, throat, or stomach. Not recognizing the early signs wastes valuable response time.
The treatment of choice for anaphylaxis is epinephrine, most commonly prescribed as an easy-to-administer EpiPen. Epinephrine counteracts the dangerous overreaction by opening airways and increasing blood pressure. If the child is showing mild symptoms such as an itchy mouth, a few hives, or nausea, use an antihistamine like Benadryl to suppress the histamine reaction. Continue to observe the child, as a mild reaction can turn dangerous in minutes. If symptoms progress, epinephrine should be injected immediately and 911 called. Make sure affected children go to the emergency room, as life-threatening symptoms reoccur in 20 percent of cases.
“Do not hesitate to give epinephrine,” says Dr. Pennoyer. “A saying I use to educate my patients is: Benadryl is for HIVES, EpiPens save LIVES. There is no reason not to administer epinephrine during an anaphylactic emergency; the risk of dying by withholding epinephrine is much greater.”
EpiPens are injections made for easy administration by self or others. The needle is designed to go through clothing and the medication will self-inject into the muscle. Grandparents, teachers, field trip chaperones, anyone responsible for the child should be trained in how to administer an EpiPen. “Two doses of epinephrine should be carried, as a severe reaction may require a second dose,” stresses Dr. Pennoyer. “Most co-pays will cover prescriptions for four EpiPens if they are written for two double packs, one for home and one for school.”
Children should be taught how to self-administer EpiPens as soon as their maturity levels allow. “I tell my patients to practice with expired EpiPens on watermelons,” suggests Dr. Thyagarajan. Directions are on the side on every pen and demonstration videos are easy to access at EpiPen.com.
One-in-four anaphylactic reactions occur in school settings. Schools must be prepared to treat allergic reactions in the event a student’s personal epinephrine auto-injector isn’t available or the student is having a reaction for the first time. This is why the School Access to Emergency Epinephrine Act, also called the Durbin-Kirk Bill, is being examined in Congress. The bill encourages states to ensure that epinephrine is available in schools and that school personnel are trained to administer it.
According to local newspapers, Amarria’s EpiPen wasn’t at school when she had her reaction, nor was there a school nurse.Having back-up epinephrine available would probably have saved her life. As well-stated by Dr. Thyagarajan, “Amarria’s death is beyond unfortunate, but it should serve to underscore the basics, not create reactionary panic. As long as a child has immediate access to her EpiPen and a plan of care is in place, parents should feel safe dropping their child off at school.”