Food Allergies & School

This information was reviewed and approved by Jennifer Moyer Darr, LCSW (8/1/2015).

The first day of school can be an anxious time for parents as well as their children. It is an especially anxious time for parents of food-allergic children. For many it is the first time that their food-allergic children are on their own, away from their parents, making independent decisions about food. That can be excruciating for parents.

"Navigating food allergies in a non-allergic world is a huge challenge, and the first-day of school is a major milestone,” said licensed clinical social worker Jennifer Moyer Darr. Ms. Darr works with families at National Jewish Health, helping them cope with the demands of parenting a food-allergic child. “With proper preparation, however, parents can let their children venture out on their own reassured that the school will provide a safe environment.

Tips for Sending Your Child to School

Our food allergy specialists offer advice for parents who are sending their food-allergic children to school for the first time, to a new school or just getting ready for a new school year.

Transcript

Alyssa Paschke: Hi everyone and welcome to our first Facebook live stream. My name is Alyssa Paschke and I'm here with Dr. BJ Lanser. He is the Director of the Pediatric Food Allergy Program here at National Jewish Health. We all know that back to school is a super busy time for parents and kids and there's some additional challenges for kids who have food allergies. So today were hoping to explore that topic a little bit more, answer some of your questions, and hopefully you'll be a little bit more prepared for back to school. If you do have a question, feel free to type it into the comment section and we'll answer as many as possible.

Alyssa Paschke: Dr. Lancer, would you mind telling us a little bit more about yourself and your experience with pediatric food allergies?

Dr. BJ Lanser: I wanted to become an allergist ever since I was in high school and went to get allergy shots with my mom. So that’s when I got interested in allergy and really came to become interested in food allergy as I was going through my pediatric residency training and seeing kids in the ER having had reactions and taking care of patients with food allergies. That then became my focus area in allergy and have been doing that ever since that time.

Alyssa Paschke: What should parents do as far as if a kid has a known food allergy? Who should they contact at their school and what should they tell them about the allergy?

Dr. BJ Lanser: I think it starts as so many things do in food allergy with wanting to just be prepared and that starts from the big picture of food allergy with having your epinephrine, having your emergency action plan, and having that ready to go to school. Once you’re then going to the school setting, start by talking to the administrators, the school nurses, your child’s teacher, and once that’s known for the year, then the kitchen and food services staff as well. That’s a really important part that for some parents, they don’t necessarily think about but getting a tour of the cafeteria, understanding the flow of the lunch day, really helps prepare the child but also can reassure the parents about what’s going on at school.

Alyssa Paschke: Yeah, absolutely! So if we do get into a situation where a kid comes into contact with or accidentally ingests something they’re allergic to, what should they do next?

Dr. BJ Lanser: We always talk with our kids about letting somebody know. Find an adult and let them know what’s happening. Either that you’re feeling something doesn’t seem right, you feel you’re having a reaction, or you think you ate something or you know you ate something, alert an adult right away and the schools have their practices and protocols in place to handle that safely and appropriately.

Alyssa Paschke: Yeah, that definitely makes sense. So, there might be kids out there that experience their very first allergic reaction to a food; can you talk about some of the symptoms that they might experience and when it might become serious?

Dr. BJ Lanser: Yeah, and that can certainly happen at school, or day care, another caregiver, or at home, so it could be anywhere, and it can be a lot of different things. Reactions to food can start out very mild. It can be things like hives, itching, redness of the skin, sometimes folks can feel throat itching or mouth tingling, swelling around the lips, so you can sometimes have some of those more superficial or mild kinds. Sometimes kids will vomit, or diarrhea can happen but that’s not as common or can occur later, not necessarily in the setting of the reaction. And what we worry about in the more serious reaction, which can happen early, or it can develop into a more serious reaction, or any time there’s respiratory involvement. So, if a child is coughing or having trouble breathing, feeling like their throat is closing, that’s when epinephrine is indicated and has to be given. What we want to prevent is that we don’t want that reaction to go so far and fortunately it doesn’t happen often in kids, but to what’s called anaphylactic shock, so essentially the full body reaction, the body really kind of fighting off that allergen with all of its available resources and that of course can be life-threatening.

Alyssa Paschke: Since you brought up epinephrine, I want to talk about that a little bit more that for people who are watching that may not know what it is and when it should be used.

Dr. BJ Lanser: Epinephrine is also known as adrenaline, so that kind of describes that adrenaline rush that we feel sometimes in a frightening situation. It’s a natural chemical that the body makes on its own and releases in certain situations and we can use that then to treat the reaction. So essentially, while it is a complex medicine and has a lot of different activities, essentially it blocks the mediators of the allergic response and helps stop that reaction and supports the body’s ability to protect itself rather than having a serious or life-threatening reaction. It should always be used if there’s any respiratory involvement in a reaction as we’ve talked about before, coughing, wheezing, feeling like your throat is closing, and, any time somebody has loss of consciousness or they’re not aware of what’s going on, certainly you want to give that as well.

The other rule of thumb that other folks will talk about in terms of epinephrine is if its two systems and sometimes it’s a little hard to get your head around but what that kind of means is when you’ve got skin symptoms, you’ve got redness and hives, and you’ve got something else going on, that that says you’ve got something else going on, then that says this is a more serious reaction. So anytime you know it’s more serious, or you’re worried about it progressing, or things aren’t getting better, it’s good to use epinephrine. One thing I teach my patients all the time, a question I ask is, if you think somebody’s reacting, but you happen to be wrong, but you think they’re having an allergic reaction and you think you need to give epinephrine, if you’re wrong, what’s the difference? What happens? The side effects of epinephrine are exactly the same. So it’s a safe medicine because it’s a natural thing our body makes, it’s a safe medicine, its very quick and short-acting so when we inject the epinephrine, it circulates in the body and its done its job very quickly. The side effects are really the same as when we have that adrenaline rush. So you feel your heart race, those kinds of things that are not dangerous. It’s a safe medicine, obviously, it’s a needle, we don’t want to give it unnecessarily, but if you think you’re having a reaction or you’re thinking about giving epinephrine, you really should give it.

Alyssa Paschke: So better safe than sorry, in that case. I just want to pause and see if we have any questions come in from the audience.

We have a question from Lindsay S. “Hi, my son has a severe dairy allergy, including contact allergy, and will be starting kindergarten. The cafeteria serves milk at lunchtime. I am super anxious about him being in there, any suggestions so he is not secluded?"

Dr. BJ Lanser: So, one of the things we talk about with kids, especially as they get older, and it has to be developmentally appropriate, but is ways to protect themselves at school and at the lunch table. We want to teach kids that their tray is their tray and they don’t touch anybody else’s tray and nobody else should touch their tray. If somebody does put something on their tray that wasn’t there before, that’s not theirs, tell somebody and let them know to protect them. Fortunately, in school, it’s not as much like day care where food tends to fly around the day care. Cafeterias are a little more controlled. Certainly, we see a lot of kids who will get splashed with milk and break out in hives. One of the reassuring things, or things to keep in mind, is that those kind of contact reactions don’t tend to be as serious because the skin normally does its job and is a great barrier to protect us from the outside environment. So if we come in contact with our allergen, we can see a local reaction, you know, redness, itching, hives, but that food especially if we wash it off quickly, there’s really very very little chance for any amount of absorption that would trigger a systemic reaction. What we want to prevent is from somebody licking their arm that’s been splashed with milk or touched peanut butter, if that’s what they’re allergic to, so wash the area off quickly, clean up any spills or messes, and that sort of thing. I think using that perimeter or the barrier of your tray and somebody else’s tray to separate them is a good starting point. We don’t want to isolate kids, absolutely, that’s something we want to avoid. We want them to be apart of their class and be with their friends and there are ways to do that safely.

Alyssa Paschke: We have another question from Sam R. She is wondering what a good age it is for kids to start administering their EpiPens?

Dr. BJ Lanser: Great question. It’s important to practice early and that can give you a good guide of practicing with the trainers that the devices should come with and so if you practice and they’re getting the hang of it, that’s great and that then varies, I’ll say. I have patients who are surprisingly young and are very competent and capable and they surprise you and then you have some older kids who just aren’t ready or comfortable to do it. So talk with your allergist and practice with your child. Another thing you can do is create scenarios and your allergist can help you with that if its kind of hard to come up with sometimes, of here’s what might be happening, how would you handle it? As they work through those scenarios and be comfortable, then you know they’re getting ready. So it varies from child to child.

Alyssa Paschke: On that note, with epinephrine, I recently read in the news there was a shortage of the EpiPen devices and I was just wondering if there are any updates on that and are there any alternatives to the EpiPen device?

Dr. BJ Lanser: So there are a couple of different epinephrine auto-injector products available on the market, so talk with your allergist about what might be appropriate or better, available. In terms of the medicine itself, they’re equivalent. It has all the same medicine, they’re just different devices so they have different ways to use them, so different functions so you need to learn of course how to use your device correctly. Figure out what prescription you have, what might be available. Certainly the shortage has continued in different parts of the country, we have seen different kind of varying rates of how hard it is to get that. Here in the Denver area, we haven’t had much trouble, our pharmacy certainly has the devices available. I’ve heard from some of my patients up in the mountains that they’ve had more trouble up there getting them, and different parts of the country have had more trouble than others unfortunately, so that shortage really does continue and can be an issue for some patients. If that’s the case, certainly talk with your allergist because may be a different brand or different product would be available. In terms of alternatives to epinephrine, there aren’t any. So that’s why we talked about before, epinephrine is the treatment of choice for anaphylaxis; the only medicine we have that’s effective and really needs to be used. You really do need to have epinephrine available and work with your allergist to figure out what to do if there is a shortage.

Alyssa Paschke: So definitely work on filling those prescriptions prior to starting school, so right now if your child is starting school in August.

Dr. BJ Lanser: It’s a good time to get those prescriptions refilled and also review your action plan. You want to make sure food allergy and anaphylaxis action plan is up to date and ready for the start of school.

Alyssa Paschke: Great. So we did talk a little bit about some kids might be feeling excluded from different school activities, and as we know in school, there’s birthdays, holidays, tons of different food-related events and things that go on, so what do you recommend other parents do or maybe even educators do to make kids that have allergies feel included?

Dr. BJ Lanser: Great question. There’s a couple different things, and one, some schools have started to say we’re just not going to have good at these parties, we can do pencils and other safe things, you can do crafts, it doesn’t necessarily need to be food. Some schools have moved that way and I think that certainly for some schools it is probably the right decision. Others want to keep that kind of treat situation going and that’s understandable, too. Food is a huge part of who we are and it’s a big cultural- you know, it’s culturally important for us, so you know some schools will say avoid certain allergens so if your child falls into that category of allergens, then you should be safe. Otherwise, I think its always a good idea regardless of either of those scenarios to have a box of snacks that you can send a box of snacks that you can send to school for your child that’s safe for your child that you know doesn’t have allergens that they regularly eat so that they can have something when everybody else is having something else, if that’s the case. A little bit of a case-by-case basis, you know craft projects or the other thing that’s an important thing to consider, is sometimes allergens will be used in different art projects and we want to avoid that as well, so that’s where its good to talk to the teacher early and think of those kinds of things. Whether that’s we’re not going to use egg cartons, or not going to use dairy-based products of whatever kind, or maybe we don’t use certain grains for some of the art. Certainly peanut butter pinecones with seeds are popular bird feeders in the past, and that probably isn’t the best thing we should be doing, so maybe let’s find a replacement for those. So sometimes thinking ahead and planning for those maybe more hidden or less commonly thought of allergens will help avoid a problem down the road.

Alyssa Paschke: That’s really good, I didn’t even think of art projects as something that could have allergens, so that totally makes sense. Along those same lines, you know some kids may have a little bit of anxiety or worry about starting school with their food allergies and what can parents do to help them feel a little bit more comfortable and confident for going to school?

Dr. BJ Lanser: I think we can all remember back to the days when we were nervous about starting with a new teacher, and a new school, and a new classroom, and new friends and so there’s a lot certainly to think about just to go back to school, let alone worry about food allergies so that’s where again, I say it many times and I say it every day, preparation is really important and so you can kind of start that conversation early in the year, early in the summer, as you start to talk about going back. Talk with your allergies for kids who have pretty significant anxiety or more worried, there are ways we can help them and work with behavioral health specialists, therapists that can really be helpful, just as a sounding board, and somebody to talk to you and help them learn some coping skills and tools that they can use to help work on that anxiety. For some kids talking through scenarios is helpful to say “let’s pretend this is what happens at the lunch table, what do you do?” And just having that idea of, now I know, I’ve thought this through, I have an idea of what to do, can be really helpful to reduce those fears. Getting into the school early can be helpful too, so if they can see the cafeteria and classroom, talk with their teacher, that’s helpful. A lot of times I think there’s a misconception or a thought or fear that folks will know nothing about food allergies and in today’s world that’s just not true. Everybody might have a little bit different knowledge and a little bit different approach for management, but that’s okay, as long as you have those conversations early and talk about it, I think that would be helpful.

Alyssa Paschke: Great! Any other questions?

All right, so I think we’re going to wrap it up for today. Thanks to Dr. Lanser and everyone who joined our broadcast this afternoon. Like our National Jewish Health Facebook page so that you can see future broadcasts where we’ll talk about other trending health topics. If you would like more information from National Jewish Health, please go to www.njhealth.org and sign up for our monthly health newsletter. Thanks and have a great afternoon.

Meet with School Officials Early

Don’t wait until just before school begins to alert school staff about your child’s food allergies. If possible, meet with the principal, teachers, nurse, and cafeteria staff, in the spring or summer before your child starts a new school.

Parents can inform school officials about their child’s allergies and special precautions that need to be taken. They can also learn from staff about the various measures and precautions schools already have in place for food-allergic children. Below are some questions and talking points for discussions with school officials:

Inform them about your child’s allergies, symptoms and needs.
Ask how the school staff generally manage food allergies.
Ask about EpiPens. Where does the school keep them, who has access to them, and how would my child receive an EpiPen injection if he or she needed one?

Written Plan

If possible, develop with school staff a written plan for your child that outlines necessary information and actions to prevent exposures, recognize reactions and respond to accidental exposures. Download the National Jewish Health Food Allergy Action Plan (pdf). The Food Allergy Research & Education and the American Academy of Allergy, Asthma & Immunology are also rich sources of all sorts of information about food allergies.

Lunch Seating

Many schools now have a separate table in the cafeteria for food-allergic children. Although many schools and parents feel safer with separate seating, most school-age food-allergic children can be safe sitting with their classmates at lunch.

“Eating is a social activity that takes on more importance as children grow older,” said Ms. Darr. “Parents and children need to weigh the issues of safety, anxiety and healthy social interactions when making a decision about where to eat.”

Studies have shown that common cleaning agents effectively remove peanut butter from cafeteria tables. Research has also shown that skin contact with allergenic foods causes a much milder reaction than eating the food.

“The vast majority of moderate to severe allergic reactions to foods are the result of accidentally eating the food,” said BJ Lanser, MD, professor of pediatrics at National Jewish Health. “Touching the food may cause local contact reactions, but almost never leads to a severe reaction, unless the food gets into the mouth or eyes.”

Children who understand their allergies, are aware of the importance of avoiding potentially allergenic foods and can be counted on to make safe choices should be able to sit at the table of their choice.

Some young children may be prone to taking food off another child’s plate or accepting foods given to them by other children. Those children require more supervision and distance from their peers. Sometimes a fully separate table is not necessary. A separate desk at the end of the cafeteria table allows for both increased safety and social inclusion. Although it may not be necessary to sit at a food-allergy table, a child’s comfort level and preference should also be considered.

Tour the Cafeteria

Although many parents pack lunches for their children, others may want to have the school cafeteria as a possible alternative. Talk to food-service staff to learn if they do anything special for food-allergic children, where the food comes from and precautions they take against cross-contamination to learn what might be safe for a child to eat.

Show and Tell

If your child is comfortable, it can be valuable to have him or her tell the class about food allergies, such as what they are allergic to, foods that contain the allergens, what happens when they have a reaction and what students should do if they see the child having a reaction.

Pictures

In the classroom, pictures of a child with a label about his/her food allergy can help alert anyone who enters the room. You can place one on the classroom wall and a smaller one on the child’s desk, which can serve as a secondary reminder when snacks are served.

Safe Snacks

Give the teacher a small supply of safe snacks for your child in case someone brings in an allergenic snack for the class.