School leaders prepare for potential problems as food allergies rise
February 14, 2012
By Tom Corrigan
There is absolutely no doubt that instances of food allergies have increased, said physician and allergist Marlene Peng, of Minor and James Medical in Seattle.
“No one knows quite why,” added Peng, though she did say there are several theories.
The issue of food allergies hit home in the Issaquah School District last month when an Issaquah High School student suffered what was described as a severe reaction to kiwi. From the school’s point of view, that specific issue is moot, as the student withdrew from local schools Jan. 26. Withdrawal forms do not require a reason for leaving the school and no reason was given in this instance, Sara Niegowski, district executive director of communications, said in response to a public records request.
In the past, officials have said the district had a personalized health plan in place to deal with the student’s allergy. Creation of a unique health plan is one of several standardized steps the district takes when notified of any student health issue, including allergies, said Jan Stromgren, a registered nurse serving Pine Lake Middle School, who is also the nursing team leader for the district.
Schools’ allergy game plan is in place
The system kicks into gear when the schools receive formal notification from a physician that a student has a specific allergy. And that notification must come from a physician, not just be the opinion of a parent or student, said Marilyn Holm, district director of special services.
The schools naturally attract a large cross section of the general population, Holm added. That means the district sees all types of allergies, including problems with certain foods, latex or bee stings, Stromgren said. When the schools are alerted to a potential problem, several steps occur automatically, including the creation of a unique health plan for that student.
“The nurses have very close connections with the families,” Holm said.
Building nurses keep a file on any students with allergies. That file includes information on what type of medication needs to be on hand in case of emergency. Allergy medication most often means an Epinephrine pen, Stromgren said.
School staff that might be around a child with an allergy are informed of the potential problem and told what type of medication should be given to the student if needed. Staff members can be trained about how and when to administer an EpiPen. Some pens are kept in the nurse’s office; some are carried or stored by the student. The school can’t use one student’s pen to treat a different student, Holm noted.
On the Web
There are numerous sites on the Web providing information about allergies and food allergies specifically. Go to www.minorandjames.com/services and click on “Allergy & Immunology.” Also try the Mayo Clinic website at www.mayoclinic.com/health/ food-allergy/DS00082.
Issaquah schools have never banned a food from any building, officials said. Even younger students are expected to know what allergies they have and take responsibility to stay away from that food or allergen.
“The goal is always to get the youngster to self-manage,” Holm said.
If needed, students with food allergies can sit at special tables in school lunchrooms. For example, a table can be declared a peanut-free zone. Sitting at the table is not supposed to be perceived as a punishment, Holm added, so students are allowed to have friends sit with them. In that same vein, no student is ever required to sit at a restricted table.
Students and parents are usually very good about keeping an eye out for potential problems, both Holm and Stromgren said. There are few instances where, for example, a young child with a peanut allergy deliberately reaches for a candy bar with nuts. Few students who ever have suffered through an allergy attack are going to knowingly subject themselves to another of those attacks, Holm said.
“The kids are really pretty good about it,” she continued, saying friends of students with allergies usually are supportive.
In some cases, district officials do go to extreme lengths to ensure children have access to education, as required by law. For example, in the case of one medically fragile student, that student only visits a specific, isolated area of her school, Holm said. The area is washed down every day.
How often do students have allergic problems at the school serious enough to warrant use of medication, as was reportedly the case with the Issaquah High girl? Two EpiPens were used during the last school year, Stromgren said. Whenever the pens are used, staffers are instructed to call 911 for medical help. Officials even keep track of how long it should take for an ambulance to arrive. The district is purposefully very conservative and careful in how it deals with allergies, Holm said.
A doctor’s view of allergies
There are several categories of allergic reactions, Peng said. Skin reactions can include hives or swelling. Gastrointestinal problems, such as vomiting or diarrhea, can occur. In serious instances, a victim may wheeze or have difficulty breathing. Blood pressure may drop.
Once you take your problem to a doctor, the most common allergy tests are skin tests or blood tests. With skin tests, you are exposed to minute amounts of a possible allergen while the doctor monitors the results. Once an allergy is isolated, Peng said she, like the schools, takes a number of steps.
“There’s lots of education needed,” she said, adding that parents and children alike have to understand the situation, what could happen and how to deal with problems. In some cases, she recommends patients wear a bracelet announcing an allergy.
What do you do if someone you are with begins having an allergic reaction? The seriousness of that reaction should dictate the response, Peng said. If the person has an EpiPen, use it and call 911. At the same time, Peng said that breaking out in hives is usually not a reason to call for emergency medical help.
In controlling allergies, teenagers might represent the biggest challenge to doctors, parents and others, Peng said. Young teens might be out on their own for the first time in their lives. And all teens are more prone to risk-taking than other age groups.
Why are allergies on the rise?
Like Peng, both Holm and Stromgren said there is no doubt food and other allergies are becoming more common. For the current school year, the number of personalized student health plans grew by more than 100 from last year. The number of EpiPens kept at schools has increased from 490 to 620. Hygiene may be one reason for the increase in the problem.
People are constantly told to wash their hands, use antibacterial soap and take numerous other measures to protect themselves from germs or bacteria. But a trade-off may be that children are not exposed to certain germs and bacteria and never build up any immunity to those particular strains. As a result, allergies and other problems may develop, Peng said. But she emphasized the idea is just one theory used to explain the rise in allergies. Another potential source of the problem might be not introducing foodstuffs at an early enough age.
There are no cures for allergies. Pills and medications may treat or eliminate the symptoms, but the underlying allergy is still there.
“The only thing you can do is practice avoidance,” Peng said. “That is easier said than done in a lot of cases.”