Food Allergies Can Be Lethal By Melissa Tennen, HealthAtoZ writer Part one of a two-part series.
Jacqui Corba smelled peanut butter.
Then, something stirred. An instinct or maybe even a sixth sense told her she could die if she didn't get help right away.
And before that thought could finish, she raced to the nurse's office.
Corba, now 13, was in fifth grade when that happened. She has a life-threatening allergy to peanuts. Just the smell of peanuts can cause her airways to close in minutes.
The school nurse had an epinephrine shot (also known as adrenaline), which is the first line of treatment for anaphylaxis, or a systematic allergic reaction that occurs when a person is exposed to a protein or allergen. The symptoms can escalate quickly. And within minutes a child could die. So the injection as soon as possible can help save a child's life by buying time to get to the emergency room.
But some children with severe food allergies may not have the medication in their reach to save their lives. Possible allergens include peanuts, tree nuts (walnuts, pecans and more), fish, shellfish, eggs, milk, soy and wheat, and vary from child to child.
"Federal law mandates that all children attend school, however, for students with anaphylaxis, this mandate comes with great risk," says Nancy Sander, president of Allergy & Asthma Network Mothers of Asthmatics. "Most U.S. schools maintain drug-free zones, which unfortunately includes prescribed lifesaving medications for anaphylaxis and asthma."
Because of these laws and regulations, children in need of medications to save their lives may be unintended victims.
"Kids do die from anaphylaxis - at school bus stops, on field trips, in hallways, the classroom, the playing field and cafeteria," she says. "States and schools whose blanket policies prevent students from possessing and using prescribed lifesaving medications do not understand the life-threatening nature of these conditions or the consequences of violating the child's right to a safe educational environment."
During the workweek, children spend at least half their waking hours at school. Yet, the very medications that parents and kids might carry in everyday life usually aren't as close by as they should be.
"Doctors tell people that they have to carry with them at all times because they can have a reaction at any time and the parent isn't always around," says Anne Munoz-Furlong, founder and CEO of the Food Allergy & Anaphylaxis Network (FAAN). Yet the school unintentionally interferes with the doctor/patient relationship by saying the child cannot carry the medication at all times, she says.
State of the States
Only 30 states have legislation protecting students' rights to carry and self administer medication for asthma and of these, six states have laws allowing kids to carry and self-administer life-saving medication for food allergy reactions. At the time this article is written, states that protect a child's right to carry and self-administer for severe food allergy reactions are Georgia, Illinois, Louisiana, Massachusetts, New Jersey and Wisconsin. Most states leave it up to each school district to set its own policies.
Congress soon could be considering a bill called the National School Emergency Medicine Bill. Introduced by Rep. Clifford Stearns (R-Florida) and Rep. Patrick Kennedy (D-Rhode Island), the legislation supports the rights for children in all states to carry asthma inhalers and epinephrine shots while in school.
Food allergy is the leading cause of anaphylaxis outside the hospital setting, accounting for an estimated 30,000 emergency room visits and 2,000 hospitalizations each year.
In the Schools
"Some schools are afraid of kids abusing the medications or that the kids may let other kids play with it," Munoz-Furlong says. "But the reality is that very few kids are going to let it out of their sight and very few don't know how to use it. There is a much greater risk to a school if a child dies."
Teachers' unions tend to shy away from allowing teachers to administer medications for fear of liability, says Paul Young, principal of West Elementary in Lancaster, Ohio and president of the National Association of Elementary School Principals. But most schools make sure teachers know if a child has a severe food allergy and what to do in an emergency, he says.
Without regulations or state laws in place, many schools take each child with severe allergies on a case-by-case basis on whether or not that child can carry the shot, he says.
"It depends on the age of the child, the maturity of the child and how responsible the child is," he says.
Schools prefer to have someone like a school nurse with medical training to do the shots, Young notes. But if no nurse is available at those crucial moments, someone on staff, whether it's a principal or some other staff member, needs to know how to do it.
(Young's school requires school nurses or health assistants to go on field trips if a child with severe allergies is going.)
But Sue Drake, a nurse in a school district in Pennsylvania and a board member of the National Association of School Nurses, says there's a lot to be said for good old-fashioned prevention by educating teachers and staff.
"We plan with the mother, the doctor and the child," she says. "The key is to provide them with a safe school environment. When they are away from home, mothers can't control what comes into the environment as much. That's why it is so important to have planning."
Schools are encouraged to use the FAAN's Food Allergy Action Plan, which is an individualized written directive for what a teacher or other school staff member should do. What are the signs? What medication should be given? Who should be called first?
"We make sure the faculty recognizes the signs and symptoms," she says. "Teachers are told not to bring into the classroom any foods that do not have the ingredients listed. They are also cautioned about projects that include foods and empty food containers that are used to store classroom items."
Also, letters can be sent home to the families of the child's classmates about the dangers of packing foods and school items in containers with allergens such as peanuts in lunches and snacks, she says.
Some state statutes say only a school nurse can give a life-saving shot, she says.
But some schools have snipped nurses from their budgets, or one nurse serves several schools at once.
Prevention can only do so much. A study done by the American Academy of Asthma Allergy and Immunology (AAAAI) showed 28 percent of callers to a food allergy awareness organization had reactions to what they thought were safe foods and later learned these foods had unlabeled food allergens.
One way to give a shot of epinephrine is a shot called EpiPen