Peanut Allergy
Part Two
Management of Food Allergy in Schools

by Peter R. Smith, MD
Allergy and Asthma Associates of Fredericksburg

We do not know why the prevalence of food allergy in children is on the increase, but it is. In a recent survey of 400 elementary school nurses the challenge of managing food allergy was felt to be similar to that of managing diabetes. It seems like food is everywhere and in everything at school. How can complete avoidance be achieved? This was the comment and question that a concerned parent made in our office recently. Her child has life-threatening food sensitivity. Should we remove peanuts from the school? It makes sense. Peanut is the most common cause of fatal food reactions. Unfortunately, the risk of accidental exposure for this child through peanut avoidance at school will not decrease the risk at all. She is allergic to milk, not peanut! I know, in this series of articles, we are focusing on peanut allergy and how the parent, child and school system deal with this potential life-threatening problem. However, it is very important to realize that any avoidance policy must encompass the principles of avoidance and treatment that can be applied to all food-allergic children regardless of the allergen involved. Allergen, by the way, is the protein that causes the allergy. Peanut, milk and essentially all food proteins contain several allergens that can cause allergic reactions.

Sending a food-allergic child to school can be a very terrifying experience for a parent. Your child's life is in the hands of others. Accidental exposure can occur on the bus, in the classroom, hallway, cafeteria, on the school playground or on field trips. How can this be prevented or at least the risk of exposure be significantly reduced? If it is peanut allergy we are dealing with, it would appear that avoidance should be quite easy. Let's make the school peanut free. We have made our home peanut-free, Grammie's house is peanut-free, so why not the school? This is an approach that is being tried in some school systems in varying degrees throughout the world. The verdict is still out as to the effectiveness in reducing accidental exposure. It is known that a significant number of food allergic reactions will still occur in the "allergen-free" home.

Before getting into the "nuts and bolts" of avoidance, we would like you to be aware of a couple of well-conducted studies by highly recognized food allergy research centers. The studies address the issue of food allergen casual contact and the subsequent risk of a serious reaction. After all, this is the kind of exposure -- inhalation or skin contact -- that most likely would occur in a school environment. In one study, children with a severe peanut allergy were exposed to peanut inhalation and skin exposure. Fortunately, no systemic or respiratory symptoms were observed. Of the thirty children studied, ten did experience minor skin reactions at the site of exposure. Another study measured peanut allergen in the air at a lunch table where PB&J sandwiches were being eaten and where peanuts were not only eaten but crushed and walked upon on the floor. No peanut allergen was found in the air. What about the case reports that airborne peanut allergen exposure in aircraft cause allergic reactions? In the very limited number of cases reported, the level of exposure may have been higher due to recirculated air or, more than likely, inadvertent oral exposure occurred.

Studies such as these are reassuring. Casual exposure is not likely to be life-threatening, however, a school food allergy management policy must be structured to protect the most sensitive child, especially from oral exposure -- hand-to-mouth. And remember, peanut is not the only food allergen that has the potential of causing life-threatening reactions in the sensitive child.

Future articles will outline a parental checklist for a school food allergy management plan, legal issues relevant to food allergy and a more detailed discussion of school peanut bans.

Dr. Peter Smith is a father, grandfather, and board certified Pediatric and Adult Allergy and Clinical Immunologist at 511 Park Hill Dr., Fredericksburg, and 12 PGA Drive, Stafford. (540)371-5660.

Ask the Allergist!

Allergy Partners, P.A. of Fredericksburg in association with Fredericksburg Parent will help answer our readers' questions concerning immunology or allergies. Every few months, they will share valuable information in a new column: Ask the Allergist. Based on "over 27 years of specialty care for the allergic child and adult," the professionals at Allergy Partners will answer concerns submitted by our readers. Please send your questions to cdenton@allergypartners.com.