Peanut Allergy
Part Three
The Food Allergic Child Goes To School -- A checklist

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

Ask the Allergist!

In our two previous articles, we have focused on the increasing prevalence of food allergy in school children and the necessity of effective management. The essentials of management are primarily those of avoidance and appropriate treatment of the reaction should it occur. Any parent who has a child with this potentially life-threatening condition knows the difficulties of dealing with the allergic condition in the home. Management issues are magnified many times when their child is out of the home, especially in their "home away from home" - day care or school.

We would like to provide a checklist of questions with some suggestions that a parent or caregiver should consider in regard to food allergy management. Answers to these questions may vary depending upon the specific allergen, extent of sensitivity, age of the child and the day care or school system involved. Most importantly a direct line of communication must be established and maintained with all school staff that supervise your child.

Is everyone involved in the process?

• Am I prepared at home to avoid the offending food and treat the reaction if accidental exposure occurs? As a parent of an allergic child you will need to be a teacher. You need to be educated and prepared.
• How prepared is the school staff to avoid exposure to the offending food and to rapidly manage an allergic reaction should it occur? Supervisory staff will include the school nurse, teachers (full time and substitute), coaches, administrators, transportation drivers, cafeteria workers and even volunteers.
• Will the school personnel be able to recognize the symptoms of an allergic reaction and respond appropriately? A one-on-one meeting with any and all school staff personnel involved in your child's school activities is advised. It is essential that all supervisory staff realize that they may be the first person to be in a position to recognize, assess and even treat a life-threatening allergic reaction.
• Are you, as a parent, and is the school staff competent to administer basic life support - the ABCs and the Heimlich maneuver?

Is the cafeteria food allergy "safe"?

• What are the cafeteria procedures in place to ensure that food served to food allergic students do not contain the offending food allergen?
• Are appropriate nonallergic food substitutes available?
• Are "may contain" foods and snacks available, and are records kept of these products?
• Is there an "allergen safe" area in the cafeteria for those students who feel, and/or whose parents feel need such an area? If so, are those areas cleaned with the appropriate material and monitored?
• Is there a "no food trading policy"?

Is the classroom food allergy "safe"?

• Is food allowed in the classroom? Can the food to which your child is allergic be kept out of the classroom? If food is allowed, recommend that only labeled food be permitted, and that "may contain" products be prohibited.
• Recommend that the use of food as part of the teaching curriculum be eliminated. For example, use marbles rather than "M&Ms" for counting. Noncaloric awards will help towards curbing obesity as well as help prevent food allergic reactions.
• Is there an "allergen clean" environment in the classroom? Hand washing entering the classroom as well as before and after eating will reduce the allergen exposure risk as well as decrease the spread of infectious disease. Consider use of cleaning wipes to clean desk areas and the backs of chairs.
• Is an emergency action plan available in the classroom for a substitute teacher? How are substitute teachers made aware of children with health issues - food allergy, asthma, diabetes, seizures?
• How quickly can they administer Epinephrine if a severe reaction occurs in the home room, another classroom, any location on the school grounds or school bus? Recommend that the school consider conducting an anaphylaxis drill just as they practice a fire drill.
• Is the epinephrine easily accessible, and does all responsible staff know where it is? A severely allergic child may carry Epinephrine on his person, or a dose may be in the teacher's desk or carried by the teacher on the playground and on field trips. Epinephrine should never be under lock and key.
• Are avoidance and emergency plans reviewed prior to field trips?

Is everyone involved in the process?

• What efforts are made to educate students about food allergies? It may be a student who is the first to observe the manifestations of an allergic reaction and alert the staff to begin emergency treatment. Under no circumstances should a food allergic student be teased about the fact that they are food allergic.
• Teaching material is readily available through the Food Allergy and Anaphylaxis Network - www.foodallergy.org.

Preventing accidental food allergen exposure and lifesaving treatment of an allergic reaction in the school or day care setting can only occur if a partnership exists between parent, child and the school/day care staff. Everyone must be informed and work together within the limits of the realities of potential food allergen exposure. It is unwise to assume that any environment, home or school, can be made allergen free 100% of the time. Minute amounts of the offending food can come from many occult sources. We can, however, through education and working as a team, create a "food allergen safe environment" that is ready and able to treat an allergic reaction should it occur.

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.