The New Rules for Food Allergies

Nut-free schools. Treatless birthday bashes. Restaurant menus with asterisks. As food-allergy rates have soared, the way we feed all kids looks a lot different than it did even a few years ago.
kids' hands with allergy bracelets on

Meiko Takechi Arquillos

The call came into Jenness Stock's office from the kindergarten room downstairs: A student couldn't stop coughing -- could the nurse take a look at her? Stock, who at the time oversaw 650 students at two Waukegan, Illinois, public schools, found the little girl coughing noisily between sips of water. In her classroom, the other kids were eating African and Asian dishes as part of a cultural-studies unit.

"My tongue feels too big for my mouth," the girl said. Her face was red around her lips, and Stock's heart skipped a beat. "Food allergy," the nurse instantly thought.

Stock raced back to her office and saw the child had no allergy paperwork on file, much less a prescribed EpiPen, the injectable form of epinephrine, widely used to halt a severe allergic reaction. Luckily, Stock had two spare EpiPens in her office -- and a standing order to use one in this very sort of instance. She grabbed one and sprinted back to the classroom, where the girl had begun to develop hives across her face. "Hold my hand, honey, this is going to hurt," said Stock, and she jammed the tip of the injector into the girl's thigh through her cotton pants. The child yelped, but within minutes her coughing subsided and the red patches started to fade. An ambulance soon arrived to take her to the hospital for observation. Later, an allergist confirmed that she had a previously unknown allergy to the peanuts used in one of the foods served at school that day.

The kindergartner was potentially saved not just by Stock's swift thinking on that October 2011 day but also by an Illinois state law, passed just weeks earlier, requiring school nurses to have spare EpiPens on hand. According to the Asthma and Allergy Foundation of America, Illinois is one of 38 states that have passed laws requiring or allowing schools to keep epinephrine auto-injectors at the ready and to use one when a student seems to be experiencing a life-threatening allergic reaction, whether the child has a known allergy or not. Many states were prompted by an incident in 2012, when a Virginia first-grader, Amarria Johnson, ate a peanut that a friend offered her on the playground and quickly developed hives and breathing problems. She had a known nut allergy but no prescription pen at school, and the state's policy at the time discouraged educators from giving a child medication prescribed for someone else. Amarria stopped breathing before an ambulance arrived and then died at the hospital.

To nudge holdouts into action, Congress passed the School Access to Emergency Epinephrine Act, which gives financial incentives to states with epinephrine-stocking laws. When President Obama signed it last November, he used the occasion to comment publicly for the first time that his daughter Malia has a peanut allergy. He added that regardless of one's personal experience with food allergies, "making sure that EpiPens are available in case of emergency in schools is something that every parent can understand."

The law is a leap forward for allergy awareness. And yet, the law and the tragic stories that inspired it speak to a sobering truth about food allergies in 2014: We still need to do more to protect kids from potentially life-threatening reactions. "This is a condition that's managed not so much medically but by a community of supportive adults who help prevent allergic reactions by label-reading, hand-washing, and enforcing no food sharing and who are trained to assist in an emergency," says Lynda Mitchell, vice president of Kids With Food Allergies, a division of the Asthma and Allergy Foundation of America.

One in 13 kids is now affected by a food allergy -- a 100 percent jump from just 15 years ago -- meaning that one or two of the kids in any given setting is allergic. While some have only had mild reactions, such as an itchy mouth, hives, or upset stomach, 40 percent of allergic kids have had a severe reaction, including life-threatening anaphylaxis, which usually involves symptoms such as a rash, hives, swelling of the lips or tongue, vomiting, abnormal heartbeat, and trouble breathing. And all children are vulnerable. One-quarter of reactions at school occur in kids who have never been diagnosed with an allergy. "Any person who's had a mild allergic reaction has the potential to have a major reaction in the future," says pediatrician Hugh Sampson, M.D., director of the Jaffe Food Allergy Institute at Mount Sinai Medical Center, in New York City, and a Parents advisor. "But we still have no good way of predicting who will have such reactions or when they will occur."

As a result, more schools are developing policies to prevent allergic reactions and to train staff to handle emergencies. There are now national model guidelines for school food-allergy management available from the Centers for Disease Control and Prevention. Some parents are pushing for a total ban of peanuts, the most common and deadly allergen, in schools. (Other problem foods include milk, shellfish, and tree nuts.) They argue that nut-free cafeteria tables, which are more customary than a school-wide nut ban, are socially isolating and tough to police. There are also calls for food-free classroom celebrations and more organized plans for emergencies beyond the cafeteria.

Dr. Sampson's colleagues found in a 2013 study that one in three allergic kids are bullied about their allergy. As a result, many advocates are pushing for sensitivity training in schools and a little more parent-to-parent understanding. Because let's face it: Denying your own child a PB&J or cupcake is hard enough; asking other parents to do the same for their child can be cringe-worthy. Indeed, a new survey of teachers from the National PTA found that 28 percent are frustrated with parents for not being more sympathetic to the needs of their child's allergic classmates, and 71 percent have had to buy a safe snack for a child who was unable to eat a treat served in the classroom.

And yet, to a parent like me, who hasn't sat in an allergist's office, rules about what's allergy-friendly and what's not can be mind-boggling. Thanks to a flurry of research about what may cause allergies, messages to new moms about how they should feed themselves and their kids seem to change constantly. (Suffice it to say I had three babies in the past eight years and a different relationship to Reese's Peanut Butter Cups each time.)

All parents need to understand, and be understanding about, food allergies. Reactions can start at any age, and even if your child doesn't develop an allergy, one of his friends likely will. What's more, researchers are now homing in on ways to reduce the risk of reactions before they even occur. With the help of top docs and in-the-know parents, these facts can help all kids thrive in an allergic world.

Food Allergies: Keeping Medication in Schools is Crucial
Food Allergies: Keeping Medication in Schools is Crucial

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