Re: Helping Families Manage Food Allergy in Schools

[Guest guest]

- thanks for posting for us. My son has a peanut allergy and it is

always amazing at how people try to minimize it because it doesn't affect

them or they don't understand it. It is not just about peanuts - it is about

all the foods that " may contain " or are " contaminated with peanuts " like

M & Ms.

Mostly what I did when he was small was to prepare all of his food - and to

give the teacher a stash of cupcakes in her closet (Hostess but read the

label, always read the label!) for her closet for parties. Plus I would

request that they omit any peanut projects like bird houses from his

classroom. He had a peanut free table at school which was voluntary - his

friends chose not to bring PB so they could sit near him. It was always easy

to just feed him really well before a party and to give him a cupcake

afterwards than try to educate other people about the " may contains " thing.

I truly sought to make it easy but keep it very safe and controlled.

I adopted the mindset that we eat a lot healthier because we cannot have

peanuts in our house. If you look at the list of what they are in - it is

really a lot of very calorie dense processed food. I cook a lot more stuff

from scratch and the birthday cake I developed is always a favorite and

highly requested by friends and family members.

Now he is off at camp at a university where they actually have a peanut

allergy cure and a peanut free cafeteria with a highly educated staff -

heaven for him! (Stanford taking a chemistry lab)

One thing that is highly enlightening is to read the peanut allergy forum -

they have a specific thread dedicated to the hundreds of people who have

died from the allergy. It seems it is always the accidental ingestion with

food prepared away from home that gets them. One person died from eating a

chicken sandwich which was not supposed to contain any peanuts.

<http://nutritioneducationstore.com>

Judy Doherty, PC II, Publisher and Chef

Food and Health Communications <http://foodandhealth.com>

EPicks Newsletter <http://clicks.skem1.com/signup/?c=CWUmV> | Cell:

| Email <judydoherty@...?subject=to%20Judy>

Facebook <http://facebook.com/foodandhealth> Linkedin

<http://linkedin.com/in/foodandhealth>

Salad Secrets iPad

<http://itunes.apple.com/us/app/salad-secrets-for-ipad/id431028101?mt=8#>

Salad Secrets iPhone

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> The Growing Problem of Food Allergy

>

> Food allergy is a growing epidemic in the United States. The Centers for

> Disease Control and Prevention estimate that nearly 3 million children

> younger than 18 years are affected by food allergy; over the past 10 years,

> the number of new cases of food allergy has increased 10-fold.[1] Food

> allergy can have a wide-ranging, negative effect on children and their

> families, affecting not only life at home but also work, education,

> vacation, and entertainment. Virtually no life activity remains unaffected

> by the presence of a potentially fatal allergy.[2] Recognizing that there

> is

> no known cure or proven treatment, the number of cases of food allergy is

> expected to increase. Studies have also suggested that many food allergies

> persist longer than was once previously assumed.[3] The chances are high

> that an individual parent or child will interact with a food-allergic

> person

> every day. Although much work has been accomplished in spreading the

> message

> that food allergens can potentially be life-threatening, a clear lack of

> understanding about this issue in many persons *without* food allergy

> remains.[4] The main management strategy for food allergy -- avoidance --

> is

> difficult to implement, a fact often underappreciated by unaffected

> individuals. Food allergy has become a global social issue, and protecting

> the health and self-esteem of affected children as well as the quality of

> life of the family, is a responsibility that must be shared by the entire

> community.

>

> Sending a food-allergic child to school, camp, or child care can be a

> daunting task for a parent and may be associated with much anxiety.

> Increasingly, allergists and nonallergists are being asked to help prepare

> students and their families to make a safe transition. This involvement

> consists of ensuring the following:

>

> - Each student has a self-injectable epinephrine device;

> - The family and child (if age-appropriate) know how and when to use the

> device;

> - The family can train others to use the device; and

> - The student has an emergency action plan for the facility to follow in

> case of a reaction.

>

> Often, more detailed involvement is requested in guiding classroom and/or

> facility-wide policies, such as the establishment of section 504 plans or

> other individualized health plans that afford protection and services for

> food-allergic children at school. Understanding real vs perceived risks of

> a

> potential food-induced reaction at school or child care can be helpful in

> planning.

>

> Let's review the published evidence to gain a better understanding of this

> situation.

>

> How Common Are Reactions at School? What Are the Chances That a Reaction

> Will Occur at School or a Child Care Center?

>

> Reactions do occur at school and can be severe under certain circumstances;

> however, their overall occurrence is still rare. There are no exact data

> detailing how often reactions occur in school.[5] One study found that they

> occurred more frequently in younger children, particularly those in

> preschool and kindergarten.[6] The reasons for this are not entirely clear,

> although a contributing factor may be that food allergy commonly first

> presents at that age, and therefore some initial reactions may occur in the

> school or child care setting. Another potential contributor is that common

> allergenic foods (eg, peanut butter) may be used in class projects, which

> increases the potential for exposure. In addition, older children may be

> more experienced and better trained in knowing what they can and cannot

> eat,

> explaining the lower rate of reactions in the older age range.

>

> Sadly, there is a growing trend among some parents to “home-school” their

> food-allergic children out of fear that their child is at high risk for a

> reaction that will not receive adequate protection at school. This

> misperception diminishes quality of life for these families. There are no

> data to support the need for home-schooling to provide protection and

> decrease risk.[5] It is important to understand that the vast majority of

> even severely food-allergic children can and *do* attend school safely

> every

> day, and there seems to be little risk in attending school for food-

> allergic children.[5-7]

> What Route (eg, Oral, Contact, Inhalation) Is Most Likely to Cause a

> Reaction at School or Child Care?

>

> The highest risk for any food-induced reaction stems from direct ingestion

> of the food. Moreover, the risk for a severe allergic reaction from an

> unintended environmental exposure, such as contact with a contaminated

> surface or inhalation of air-borne particles, seems to be extremely low.

> Unfortunately, a common misperception held by many persons in the

> food-allergic community is that these are realistic risks. This belief

> causes unnecessary alarm and anxiety and may lead to requests for

> unwarranted precautions to be taken at school or child care, or may

> influence the decision to home-school.[8,9] However, the evidence to the

> contrary is quite clear.

>

> Peanut and tree nut particles are commonly believed to have the potential

> to

> provoke a reaction from air-borne inhalation.[5,6,10] In a study from s

> Hopkins, researchers failed to detect measurable quantities of peanut in

> air

> filters around the necks of volunteers who danced on peanut shells

> scattered

> on the floor of a poorly ventilated room.[8] Similarly, in a study from

> Mount Sinai, blinded participants inhaling from a jar of peanut butter at

> very close range did not experience significant allergic reactions from the

> exposure.[9] This same study also did not find detectable levels of peanut

> on surfaces first smeared with peanut butter then cleaned with commercial

> products. Detectable levels were also not found on hands coated with peanut

> butter and then washed with soap and water, nor after cleaning with liquid

> hand sanitizer.

>

> Skin contact as a route of exposure may be of particular concern in younger

> children who are more prone to touch contaminated items and not wash their

> hands before placing them in their -- or someone else's -- mouth. This is

> why a policy supporting strict handwashing after food contact in young

> children is important (to prevent both allergic reactions and infections).

> Nonetheless, these children still need to ingest the food to cause severe

> symptoms, although cases of contact urticaria can occur from certain foods

> in allergic children. Contact urticaria is generally self-limited to a

> cutaneous reaction that causes some mild discomfort without further

> generalization to other organ systems.[11] Wiping down the skin area of

> allergen contact often resolves the reaction. However, contact urticaria

> could be misinterpreted by a frightened observer unfamiliar with the

> child's

> reaction history as a sign of a more severe reaction.

>

> Inhalation reactions are frequently reported anecdotally, although again,

> evidence to support this as a reaction-inducing mechanism is

> limited.[6-9]What most likely occurs in these cases is that dust or

> particles are briefly

> released into the air but settle quickly, and unnoticed contact between the

> skin -- and subsequently the oral mucosa -- and the now-contaminated

> surface

> occurs, introducing unrecognized ingestion. (For example, a hand might

> touch

> a contaminated counter, and then is brought to the mouth.) Alternatively,

> anxiety in this situation may induce subjective symptoms like wheezing or

> shortness of breath attributable to paradoxic motion of the vocal cords,

> pharyngeal tightening, a globus sensation, itching, and even urticaria.

>

> To summarize a point that is often misperceived: The greatest risk for a

> reaction at school or child care in a food-allergic child is from direct

> ingestion of the allergen and not from other routes of exposure. This is

> essential to keep in mind when making any classroom or facility

> recommendations.

>

> rest can be found at www.medscape.com (free registration) Under Medscape

> Pediatrics

>

> let me know if you have problem finding it...

>

> --

> Ortiz, MS, RD

> *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

> Check out my blog: mixture of deals and nutrition

> Join me on Facebook <http://www.facebook.com/TheFrugalDietitian?ref=ts>

> Disney Lunch Tote + Free Shipping!

> $3<http://thefrugaldietitian.com/?p=24557>Save

> some school clothing money… <http://thefrugaldietitian.com/?p=24559>

> * " Nutrition

> is a Science, Not an Opinion Survey " *

>

>

>

[Guest guest]

Did you ever eat out? I can't imagine taking my child to eat out not

knowing what goes on in most restaurant kitchens (not always intentionally).

> - thanks for posting for us. My son has a peanut allergy and it is

> always amazing at how people try to minimize it because it doesn't affect

> them or they don't understand it. It is not just about peanuts - it is

> about

> all the foods that " may contain " or are " contaminated with peanuts " like

> M & Ms.

>

> Mostly what I did when he was small was to prepare all of his food - and to

> give the teacher a stash of cupcakes in her closet (Hostess but read the

> label, always read the label!) for her closet for parties. Plus I would

> request that they omit any peanut projects like bird houses from his

> classroom. He had a peanut free table at school which was voluntary - his

> friends chose not to bring PB so they could sit near him. It was always

> easy

> to just feed him really well before a party and to give him a cupcake

> afterwards than try to educate other people about the " may contains " thing.

> I truly sought to make it easy but keep it very safe and controlled.

>

> I adopted the mindset that we eat a lot healthier because we cannot have

> peanuts in our house. If you look at the list of what they are in - it is

> really a lot of very calorie dense processed food. I cook a lot more stuff

> from scratch and the birthday cake I developed is always a favorite and

> highly requested by friends and family members.

>

> Now he is off at camp at a university where they actually have a peanut

> allergy cure and a peanut free cafeteria with a highly educated staff -

> heaven for him! (Stanford taking a chemistry lab)

>

> One thing that is highly enlightening is to read the peanut allergy forum -

> they have a specific thread dedicated to the hundreds of people who have

> died from the allergy. It seems it is always the accidental ingestion with

> food prepared away from home that gets them. One person died from eating a

> chicken sandwich which was not supposed to contain any peanuts.

>

>

> <http://nutritioneducationstore.com>

> Judy Doherty, PC II, Publisher and Chef

> Food and Health Communications <http://foodandhealth.com>

>

> EPicks Newsletter <http://clicks.skem1.com/signup/?c=CWUmV> | Cell:

> | Email <judydoherty@...?subject=to%20Judy>

> Facebook <http://facebook.com/foodandhealth> Linkedin

> <http://linkedin.com/in/foodandhealth>

> Salad Secrets iPad

> <http://itunes.apple.com/us/app/salad-secrets-for-ipad/id431028101?mt=8#>

> Salad Secrets iPhone

> <http://itunes.apple.com/us/app/salad-secrets/id386087367?mt=8#>

>

>

>

>

>

>

> > The Growing Problem of Food Allergy

> >

> > Food allergy is a growing epidemic in the United States. The Centers for

> > Disease Control and Prevention estimate that nearly 3 million children

> > younger than 18 years are affected by food allergy; over the past 10

> years,

> > the number of new cases of food allergy has increased 10-fold.[1] Food

> > allergy can have a wide-ranging, negative effect on children and their

> > families, affecting not only life at home but also work, education,

> > vacation, and entertainment. Virtually no life activity remains

> unaffected

> > by the presence of a potentially fatal allergy.[2] Recognizing that there

> > is

> > no known cure or proven treatment, the number of cases of food allergy is

> > expected to increase. Studies have also suggested that many food

> allergies

> > persist longer than was once previously assumed.[3] The chances are high

> > that an individual parent or child will interact with a food-allergic

> > person

> > every day. Although much work has been accomplished in spreading the

> > message

> > that food allergens can potentially be life-threatening, a clear lack of

> > understanding about this issue in many persons *without* food allergy

> > remains.[4] The main management strategy for food allergy -- avoidance --

> > is

> > difficult to implement, a fact often underappreciated by unaffected

> > individuals. Food allergy has become a global social issue, and

> protecting

> > the health and self-esteem of affected children as well as the quality of

> > life of the family, is a responsibility that must be shared by the entire

> > community.

> >

> > Sending a food-allergic child to school, camp, or child care can be a

> > daunting task for a parent and may be associated with much anxiety.

> > Increasingly, allergists and nonallergists are being asked to help

> prepare

> > students and their families to make a safe transition. This involvement

> > consists of ensuring the following:

> >

> > - Each student has a self-injectable epinephrine device;

> > - The family and child (if age-appropriate) know how and when to use

> the

> > device;

> > - The family can train others to use the device; and

> > - The student has an emergency action plan for the facility to follow

> in

> > case of a reaction.

> >

> > Often, more detailed involvement is requested in guiding classroom and/or

> > facility-wide policies, such as the establishment of section 504 plans or

> > other individualized health plans that afford protection and services for

> > food-allergic children at school. Understanding real vs perceived risks

> of

> > a

> > potential food-induced reaction at school or child care can be helpful in

> > planning.

> >

> > Let's review the published evidence to gain a better understanding of

> this

> > situation.

> >

> > How Common Are Reactions at School? What Are the Chances That a Reaction

> > Will Occur at School or a Child Care Center?

> >

> > Reactions do occur at school and can be severe under certain

> circumstances;

> > however, their overall occurrence is still rare. There are no exact data

> > detailing how often reactions occur in school.[5] One study found that

> they

> > occurred more frequently in younger children, particularly those in

> > preschool and kindergarten.[6] The reasons for this are not entirely

> clear,

> > although a contributing factor may be that food allergy commonly first

> > presents at that age, and therefore some initial reactions may occur in

> the

> > school or child care setting. Another potential contributor is that

> common

> > allergenic foods (eg, peanut butter) may be used in class projects, which

> > increases the potential for exposure. In addition, older children may be

> > more experienced and better trained in knowing what they can and cannot

> > eat,

> > explaining the lower rate of reactions in the older age range.

> >

> > Sadly, there is a growing trend among some parents to “home-school” their

> > food-allergic children out of fear that their child is at high risk for a

> > reaction that will not receive adequate protection at school. This

> > misperception diminishes quality of life for these families. There are no

> > data to support the need for home-schooling to provide protection and

> > decrease risk.[5] It is important to understand that the vast majority of

> > even severely food-allergic children can and *do* attend school safely

> > every

> > day, and there seems to be little risk in attending school for food-

> > allergic children.[5-7]

> > What Route (eg, Oral, Contact, Inhalation) Is Most Likely to Cause a

> > Reaction at School or Child Care?

> >

> > The highest risk for any food-induced reaction stems from direct

> ingestion

> > of the food. Moreover, the risk for a severe allergic reaction from an

> > unintended environmental exposure, such as contact with a contaminated

> > surface or inhalation of air-borne particles, seems to be extremely low.

> > Unfortunately, a common misperception held by many persons in the

> > food-allergic community is that these are realistic risks. This belief

> > causes unnecessary alarm and anxiety and may lead to requests for

> > unwarranted precautions to be taken at school or child care, or may

> > influence the decision to home-school.[8,9] However, the evidence to the

> > contrary is quite clear.

> >

> > Peanut and tree nut particles are commonly believed to have the potential

> > to

> > provoke a reaction from air-borne inhalation.[5,6,10] In a study from

> s

> > Hopkins, researchers failed to detect measurable quantities of peanut in

> > air

> > filters around the necks of volunteers who danced on peanut shells

> > scattered

> > on the floor of a poorly ventilated room.[8] Similarly, in a study from

> > Mount Sinai, blinded participants inhaling from a jar of peanut butter at

> > very close range did not experience significant allergic reactions from

> the

> > exposure.[9] This same study also did not find detectable levels of

> peanut

> > on surfaces first smeared with peanut butter then cleaned with commercial

> > products. Detectable levels were also not found on hands coated with

> peanut

> > butter and then washed with soap and water, nor after cleaning with

> liquid

> > hand sanitizer.

> >

> > Skin contact as a route of exposure may be of particular concern in

> younger

> > children who are more prone to touch contaminated items and not wash

> their

> > hands before placing them in their -- or someone else's -- mouth. This is

> > why a policy supporting strict handwashing after food contact in young

> > children is important (to prevent both allergic reactions and

> infections).

> > Nonetheless, these children still need to ingest the food to cause severe

> > symptoms, although cases of contact urticaria can occur from certain

> foods

> > in allergic children. Contact urticaria is generally self-limited to a

> > cutaneous reaction that causes some mild discomfort without further

> > generalization to other organ systems.[11] Wiping down the skin area of

> > allergen contact often resolves the reaction. However, contact urticaria

> > could be misinterpreted by a frightened observer unfamiliar with the

> > child's

> > reaction history as a sign of a more severe reaction.

> >

> > Inhalation reactions are frequently reported anecdotally, although again,

> > evidence to support this as a reaction-inducing mechanism is

> > limited.[6-9]What most likely occurs in these cases is that dust or

> > particles are briefly

> > released into the air but settle quickly, and unnoticed contact between

> the

> > skin -- and subsequently the oral mucosa -- and the now-contaminated

> > surface

> > occurs, introducing unrecognized ingestion. (For example, a hand might

> > touch

> > a contaminated counter, and then is brought to the mouth.) Alternatively,

> > anxiety in this situation may induce subjective symptoms like wheezing or

> > shortness of breath attributable to paradoxic motion of the vocal cords,

> > pharyngeal tightening, a globus sensation, itching, and even urticaria.

> >

> > To summarize a point that is often misperceived: The greatest risk for a

> > reaction at school or child care in a food-allergic child is from direct

> > ingestion of the allergen and not from other routes of exposure. This is

> > essential to keep in mind when making any classroom or facility

> > recommendations.

> >

> > rest can be found at www.medscape.com (free registration) Under Medscape

> > Pediatrics

> >

> > let me know if you have problem finding it...

> >

> > --

> > Ortiz, MS, RD

> > *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

> > Check out my blog: mixture of deals and nutrition

> > Join me on Facebook <http://www.facebook.com/TheFrugalDietitian?ref=ts>

> > Disney Lunch Tote + Free Shipping!

> > $3<http://thefrugaldietitian.com/?p=24557>Save

> > some school clothing money… <http://thefrugaldietitian.com/?p=24559>

> > * " Nutrition

> > is a Science, Not an Opinion Survey " *

> >

> >

> >

[Guest guest]

Aha - yes - we found restaurants like Italian or healthy fresh Mex types of

places that do not have peanuts on the menu. I do allow him a Mc's

indulgence, too, because that is pretty safe and standardized in my opinion.

There is a neat healthy burger place here that does not have peanuts on the

menu. And another Mediterranean place where the owner himself is peanut

allergic and there are no peanuts anywhere, there. And if we get a bagel we

have them put it in the bag and do not go near it with a knife. We avoid

places like Asian restaurants where there are a lot of peanuts in dishes and

sauces.

It is nerve wracking - particularly since I spent so many years in

foodservice - a real kitchen is an absolute madhouse at best with underpaid,

overworked staff that really is not that educated and haphazards are

everywhere.

He loves to cook - really we are happy at home.

<http://nutritioneducationstore.com>

Judy Doherty, PC II, Publisher and Chef

Food and Health Communications <http://foodandhealth.com>

EPicks Newsletter <http://clicks.skem1.com/signup/?c=CWUmV> | Cell:

| Email <judydoherty@...?subject=to%20Judy>

Facebook <http://facebook.com/foodandhealth> Linkedin

<http://linkedin.com/in/foodandhealth>

Salad Secrets iPad

<http://itunes.apple.com/us/app/salad-secrets-for-ipad/id431028101?mt=8#>

Salad Secrets iPhone

<http://itunes.apple.com/us/app/salad-secrets/id386087367?mt=8#>

> Did you ever eat out? I can't imagine taking my child to eat out not

> knowing what goes on in most restaurant kitchens (not always

> intentionally).

>

>

>

> > - thanks for posting for us. My son has a peanut allergy and it is

> > always amazing at how people try to minimize it because it doesn't affect

> > them or they don't understand it. It is not just about peanuts - it is

> > about

> > all the foods that " may contain " or are " contaminated with peanuts " like

> > M & Ms.

> >

> > Mostly what I did when he was small was to prepare all of his food - and

> to

> > give the teacher a stash of cupcakes in her closet (Hostess but read the

> > label, always read the label!) for her closet for parties. Plus I would

> > request that they omit any peanut projects like bird houses from his

> > classroom. He had a peanut free table at school which was voluntary - his

> > friends chose not to bring PB so they could sit near him. It was always

> > easy

> > to just feed him really well before a party and to give him a cupcake

> > afterwards than try to educate other people about the " may contains "

> thing.

> > I truly sought to make it easy but keep it very safe and controlled.

> >

> > I adopted the mindset that we eat a lot healthier because we cannot have

> > peanuts in our house. If you look at the list of what they are in - it is

> > really a lot of very calorie dense processed food. I cook a lot more

> stuff

> > from scratch and the birthday cake I developed is always a favorite and

> > highly requested by friends and family members.

> >

> > Now he is off at camp at a university where they actually have a peanut

> > allergy cure and a peanut free cafeteria with a highly educated staff -

> > heaven for him! (Stanford taking a chemistry lab)

> >

> > One thing that is highly enlightening is to read the peanut allergy forum

> -

> > they have a specific thread dedicated to the hundreds of people who have

> > died from the allergy. It seems it is always the accidental ingestion

> with

> > food prepared away from home that gets them. One person died from eating

> a

> > chicken sandwich which was not supposed to contain any peanuts.

> >

> >

> > <http://nutritioneducationstore.com>

> > Judy Doherty, PC II, Publisher and Chef

> > Food and Health Communications <http://foodandhealth.com>

> >

> > EPicks Newsletter <http://clicks.skem1.com/signup/?c=CWUmV> | Cell:

> > | Email <judydoherty@...?subject=to%20Judy>

> > Facebook <http://facebook.com/foodandhealth> Linkedin

> > <http://linkedin.com/in/foodandhealth>

> > Salad Secrets iPad

> > <http://itunes.apple.com/us/app/salad-secrets-for-ipad/id431028101?mt=8#

> >

> > Salad Secrets iPhone

> > <http://itunes.apple.com/us/app/salad-secrets/id386087367?mt=8#>

> >

> >

> >

> >

> >

> >

> > > The Growing Problem of Food Allergy

> > >

> > > Food allergy is a growing epidemic in the United States. The Centers

> for

> > > Disease Control and Prevention estimate that nearly 3 million children

> > > younger than 18 years are affected by food allergy; over the past 10

> > years,

> > > the number of new cases of food allergy has increased 10-fold.[1] Food

> > > allergy can have a wide-ranging, negative effect on children and their

> > > families, affecting not only life at home but also work, education,

> > > vacation, and entertainment. Virtually no life activity remains

> > unaffected

> > > by the presence of a potentially fatal allergy.[2] Recognizing that

> there

> > > is

> > > no known cure or proven treatment, the number of cases of food allergy

> is

> > > expected to increase. Studies have also suggested that many food

> > allergies

> > > persist longer than was once previously assumed.[3] The chances are

> high

> > > that an individual parent or child will interact with a food-allergic

> > > person

> > > every day. Although much work has been accomplished in spreading the

> > > message

> > > that food allergens can potentially be life-threatening, a clear lack

> of

> > > understanding about this issue in many persons *without* food allergy

> > > remains.[4] The main management strategy for food allergy -- avoidance

> --

> > > is

> > > difficult to implement, a fact often underappreciated by unaffected

> > > individuals. Food allergy has become a global social issue, and

> > protecting

> > > the health and self-esteem of affected children as well as the quality

> of

> > > life of the family, is a responsibility that must be shared by the

> entire

> > > community.

> > >

> > > Sending a food-allergic child to school, camp, or child care can be a

> > > daunting task for a parent and may be associated with much anxiety.

> > > Increasingly, allergists and nonallergists are being asked to help

> > prepare

> > > students and their families to make a safe transition. This involvement

> > > consists of ensuring the following:

> > >

> > > - Each student has a self-injectable epinephrine device;

> > > - The family and child (if age-appropriate) know how and when to use

> > the

> > > device;

> > > - The family can train others to use the device; and

> > > - The student has an emergency action plan for the facility to follow

> > in

> > > case of a reaction.

> > >

> > > Often, more detailed involvement is requested in guiding classroom

> and/or

> > > facility-wide policies, such as the establishment of section 504 plans

> or

> > > other individualized health plans that afford protection and services

> for

> > > food-allergic children at school. Understanding real vs perceived risks

> > of

> > > a

> > > potential food-induced reaction at school or child care can be helpful

> in

> > > planning.

> > >

> > > Let's review the published evidence to gain a better understanding of

> > this

> > > situation.

> > >

> > > How Common Are Reactions at School? What Are the Chances That a

> Reaction

> > > Will Occur at School or a Child Care Center?

> > >

> > > Reactions do occur at school and can be severe under certain

> > circumstances;

> > > however, their overall occurrence is still rare. There are no exact

> data

> > > detailing how often reactions occur in school.[5] One study found that

> > they

> > > occurred more frequently in younger children, particularly those in

> > > preschool and kindergarten.[6] The reasons for this are not entirely

> > clear,

> > > although a contributing factor may be that food allergy commonly first

> > > presents at that age, and therefore some initial reactions may occur in

> > the

> > > school or child care setting. Another potential contributor is that

> > common

> > > allergenic foods (eg, peanut butter) may be used in class projects,

> which

> > > increases the potential for exposure. In addition, older children may

> be

> > > more experienced and better trained in knowing what they can and cannot

> > > eat,

> > > explaining the lower rate of reactions in the older age range.

> > >

> > > Sadly, there is a growing trend among some parents to “home-school”

> their

> > > food-allergic children out of fear that their child is at high risk for

> a

> > > reaction that will not receive adequate protection at school. This

> > > misperception diminishes quality of life for these families. There are

> no

> > > data to support the need for home-schooling to provide protection and

> > > decrease risk.[5] It is important to understand that the vast majority

> of

> > > even severely food-allergic children can and *do* attend school safely

> > > every

> > > day, and there seems to be little risk in attending school for food-

> > > allergic children.[5-7]

> > > What Route (eg, Oral, Contact, Inhalation) Is Most Likely to Cause a

> > > Reaction at School or Child Care?

> > >

> > > The highest risk for any food-induced reaction stems from direct

> > ingestion

> > > of the food. Moreover, the risk for a severe allergic reaction from an

> > > unintended environmental exposure, such as contact with a contaminated

> > > surface or inhalation of air-borne particles, seems to be extremely

> low.

> > > Unfortunately, a common misperception held by many persons in the

> > > food-allergic community is that these are realistic risks. This belief

> > > causes unnecessary alarm and anxiety and may lead to requests for

> > > unwarranted precautions to be taken at school or child care, or may

> > > influence the decision to home-school.[8,9] However, the evidence to

> the

> > > contrary is quite clear.

> > >

> > > Peanut and tree nut particles are commonly believed to have the

> potential

> > > to

> > > provoke a reaction from air-borne inhalation.[5,6,10] In a study from

> > s

> > > Hopkins, researchers failed to detect measurable quantities of peanut

> in

> > > air

> > > filters around the necks of volunteers who danced on peanut shells

> > > scattered

> > > on the floor of a poorly ventilated room.[8] Similarly, in a study from

> > > Mount Sinai, blinded participants inhaling from a jar of peanut butter

> at

> > > very close range did not experience significant allergic reactions from

> > the

> > > exposure.[9] This same study also did not find detectable levels of

> > peanut

> > > on surfaces first smeared with peanut butter then cleaned with

> commercial

> > > products. Detectable levels were also not found on hands coated with

> > peanut

> > > butter and then washed with soap and water, nor after cleaning with

> > liquid

> > > hand sanitizer.

> > >

> > > Skin contact as a route of exposure may be of particular concern in

> > younger

> > > children who are more prone to touch contaminated items and not wash

> > their

> > > hands before placing them in their -- or someone else's -- mouth. This

> is

> > > why a policy supporting strict handwashing after food contact in young

> > > children is important (to prevent both allergic reactions and

> > infections).

> > > Nonetheless, these children still need to ingest the food to cause

> severe

> > > symptoms, although cases of contact urticaria can occur from certain

> > foods

> > > in allergic children. Contact urticaria is generally self-limited to a

> > > cutaneous reaction that causes some mild discomfort without further

> > > generalization to other organ systems.[11] Wiping down the skin area of

> > > allergen contact often resolves the reaction. However, contact

> urticaria

> > > could be misinterpreted by a frightened observer unfamiliar with the

> > > child's

> > > reaction history as a sign of a more severe reaction.

> > >

> > > Inhalation reactions are frequently reported anecdotally, although

> again,

> > > evidence to support this as a reaction-inducing mechanism is

> > > limited.[6-9]What most likely occurs in these cases is that dust or

> > > particles are briefly

> > > released into the air but settle quickly, and unnoticed contact between

> > the

> > > skin -- and subsequently the oral mucosa -- and the now-contaminated

> > > surface

> > > occurs, introducing unrecognized ingestion. (For example, a hand might

> > > touch

> > > a contaminated counter, and then is brought to the mouth.)

> Alternatively,

> > > anxiety in this situation may induce subjective symptoms like wheezing

> or

> > > shortness of breath attributable to paradoxic motion of the vocal

> cords,

> > > pharyngeal tightening, a globus sensation, itching, and even urticaria.

> > >

> > > To summarize a point that is often misperceived: The greatest risk for

> a

> > > reaction at school or child care in a food-allergic child is from

> direct

> > > ingestion of the allergen and not from other routes of exposure. This

> is

> > > essential to keep in mind when making any classroom or facility

> > > recommendations.

> > >

> > > rest can be found at www.medscape.com (free registration) Under

> Medscape

> > > Pediatrics

> > >

> > > let me know if you have problem finding it...

> > >

> > > --

> > > Ortiz, MS, RD

> > > *The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

> > > Check out my blog: mixture of deals and nutrition

> > > Join me on Facebook <http://www.facebook.com/TheFrugalDietitian?ref=ts

> >

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> > >

> > >

> > >