Coping with food allergies at school

As children head back to the classroom, it’s important for parents of kids with allergies to share their allergy action plan with the school. (AP Photo)

by Christopher C. Chang, M.D., Ph.D.

Editor’s note: Six million American kids have food allergies - and studies show that up to 18 percent of them have had a reaction to a food eaten at school. How can you keep your kid safe and stop worrying? Allergy expert Christopher C. Chang, M.D., Ph.D. of Nemours/Alfred I. duPont Hospital for Children has this advice.

Imagine your child bites into a French fry, only to feel that familiar upset stomach and itching sensation begin – a typical allergic reaction. You know she’s allergic to fish, but this is a potato! As it happens, the French fries had been cooked on the same equipment that was used to fry fish.

This is what living with a food allergy can be like.  It’s hard to anticipate every potentially harmful food.  Parents of children with food allergies know that fastidious label-reading and educating the child and others in the child’s life are key to preventing an allergic reaction. Even so, protecting an allergic child – from a nut that sneaked into a cookie, or those seemingly innocent French fries – can be challenging.

More than five million people in the United States (about two percent of the population) have food allergies. For them, certain foods cause a variety of unpleasant reactions, from rashes and nausea to severe respiratory distress. And it may only take one bite. The most common foods that cause allergic reactions in children are peanuts, wheat, soy, milk, eggs, tree nuts (walnuts, pecans, almonds, etc.), fish and shellfish. Allergies to fish and nuts tend to be lifelong, while allergies to soy, wheat, milk and eggs are often outgrown by school age.

Food Allergies at School

As children head back to the classroom, it’s important for parents of kids with allergies to share their allergy action plan with the school. We give every patient an action plan that specifies the allergic trigger(s), what to do in the event of exposure or ingestion, and what and how much medication to give the child.

Only a very small percentage of all allergies are severe enough that minimal exposure will cause the child to go into anaphylactic shock. Anaphylaxis is a sudden, severe allergic reaction that can include hives, swelling of the lips and face, difficulty breathing (due to swelling of the throat or an asthmatic reaction), vomiting and a fall in blood pressure,which can be fatal.

For those at risk for anaphylaxis, we recommend that epinephrine is on hand at all times to counteract the allergy symptoms. Children should carry two EpiPens with them,and each place where the child spends time – school, after-school care, grandparents, etc – should have them as well in case the child accidentally eats an offending food. There is no down side to administering epinephrine in a patient who one suspects is having an anaphylactic reaction.

Public awareness of food allergies has increased in recent years and many school classrooms have become “nut-free.” Often there is school-wide policy based on the presence of kids in the school with allergies. School nurses and nutrition staff are usually very involved, know who the children are and the types of food alternatives they require.

It is crucial that parents read labels, know the ingredients in any food their child eats, and make sure children understand that certain foods could make them sick. Family members, friends’ parents, teachers and school nurses should all be alerted to a child’s food allergy. Luckily, fatalities are rare, but when they occur, they are devastating to families because they are generally preventable. Successful management of food allergies requires the interactive involvement of everyone in the child’s life.

Christopher C. Chang, M.D., Ph.D., is division chief of the division of pediatric allergy/immunology at Nemours/Alfred I. duPont Hospital for Children, and clinical professor of pediatrics at Jefferson Medical College.