School is in the air. The leaves haven’t changed yet but they have lost their vivid green hue. New shoes, backpacks, fresh notebooks await that first day of school. For over 5 million US food-allergic students, preparing for school also means dealing with a host of challenging situations: recess; lunch time; birthday parties; cooking projects; special treats; school outings. How will these be dealt with safely?
I recently had a discussion with another food allergic parent about school allergy management issues. How much should schools be doing? What is the parents’ responsibility? Are there any laws (such as ADA) or federal guidelines that might apply to food allergic children?
Sadly, most schools aren’t sufficiently prepared to meet the needs of food-allergic children. A joint study between the Food Allergy and Anaphylaxis Nextwork (FAAN) and The Jaffe Food Allergy Institute revealed the nature and frequency of food allergen ingestion during school. Offending allergens were most often ingested at birthday parties, holiday celebrations, craft and science projects, field trips and bus rides. Alarmingly, only 1 in every 3 food-allergic students had a treatment plan in place. The study found that treatment delays were due to: delayed recognition of a reaction; calling parents first; not following emergency protocols and not being able to administer Epinephrine properly. Bottom line, most schools are simply not managing the needs of their food-allergic students effectively.
The study is sobering but needn’t be depressing. There is much that can be done proactively and reactively to help food-allergic children. Thanks to the passage of FAAMA (The Food Allergy and Anaphylaxis Management Act) there are now national food allergy guidelines for schools. In addition to these comprehensive guidelines, schools can consult their local and state food allergy management guidelines.
While proactive strategies are essential in minimizing allergic reactions, accidents happen. Let’s focus on reactive plans, how to respond to allergic emergencies. Swift assessment of the situation and prompt treatment are key. Signs and symptoms vary from person to person and even within the same person. Some reactions progress slowly while others can strike with lightning speed. Be on the lookout for signs like hives, abdominal discomfort, vomiting, runny nose, itchiness, funny taste in the mouth, tongue tingling, throat closing up, and lethargy. The first responder will have to make a quick judgement call and determine treatment. When in doubt, never hesitate to administer epinephrine.
Delays in administering epinephrine can be fatal. While auto-injectors can seem intimidating, they are very easy to use and save lives. All school personnel should be familiar with epinephrine administration. A reaction can occur on school trip or even in the Art Room. Everyone should be prepared to respond if necessary. Once epinephrine is administered, the child should be brought to the closest Emergency Room for monitoring. Rebound reactions, a recurrence of life-threatening symptoms after initial treatment, can occur.
Another point that must be addressed in school food allergy management is bullying. According to a study published in Annals of Allergy, Asthma & Immunology, more that 30% of food allergic children reported being harassed because of their food allergies. Schools must have a zero-tolerance policy when it comes to bullying to protect all of their students, especially medically vulnerable ones.
Schools have an enormous responsibility in the management of food allergies and they can only live up to this task if they partner with students and their parents. For the parent of a food-allergic child, there is no such thing as “outsourcing” their child’s allergy care to the school. They must understand that having their child in the school is harder for faculty. Approaching the faculty with honey rather than vinegar goes along way. Parents must remain vigilant and actively communicate with school’s administration and faculty to keep their child safe.
Parental responsibilities include:
1. Preparing and updating their child’s food allergy emergency action plan that includes: a student’s allergies and medications; signs and symptoms of child’s reaction; contact numbers (parents, healthcare providers) and informed consent (as well as insurance info).
2. Creating a 504 plan if appropriate (only certain food-allergic conditions are considered disabling and qualify for American’s with Disabilities Act Protection).
3. Providing school with medications and auto-injectors (must be easily accessible).