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Back to school
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Parents of children with severe allergies must manage their children’s environment and provide teachers with the necessary tools to help
By Laurie Harada
The first day back at school is a very exciting time for children — getting reacquainted with friends, starting a new grade, and joining school teams. For students with life-threatening allergies — as well as their parents — the back-to-school season can provoke much anxiety, especially if there is a perception that a safe environment has not been established.
Anaphylaxis (anna-fill-axis), a potentially life-threatening allergic reaction, is a growing health concern for Canadians. An estimated 600,000 (one to two per cent) live with the condition. Between two and eight per cent of Canadian children are anaphylactic, with the majority being allergic to certain foods. Others are allergic to medication, insect stings, or latex.
While public understanding and awareness of anaphylaxis have improved significantly over the past decade, gaps still remain. In Canada, it is estimated that 12 to 15 people die each year from food-induced allergic reactions. In schools, much can be done to close these gaps by reviewing risks, understanding signs and symptoms, and knowing how to respond in an emergency.
There is no cure for anaphylaxis and no method to safely determine one’s threshold for a given food. Avoiding the allergy-causing substance is the only way to prevent an allergic reaction.
Risks
Peanuts and tree nuts (such as almonds, walnuts, cashews, etc.) are the leading cause of food-induced anaphylaxis, and reactions to peanuts are often more severe than to other foods. While this is true in general, each child’s situation must be assessed. Children with a persistent milk, egg, fish, or other allergy may be at risk for equally severe reactions. A reaction can occur with exposure as small as 1/1,000th of a peanut. The risk of insect stings increases from May to November. Venom immunotherapy has been shown to have a high success rate in desensitizing insect allergic patients.
Signs and Symptoms
Anaphylaxis affects multiple body systems: skin, upper and lower respiratory, gastro-intestinal and cardiovascular. While symptoms tend to develop rapidly, they can be delayed or deceptively mild initially. The child may become uneasy, upset and red in the face. He may also develop a rapid heartbeat, prickling and itchiness in the skin, throbbing in the ears, sneezing, coughing, or difficulty breathing. Shock may follow in which blood vessels become leaky, blood pressure falls and the child becomes cold, clammy and faint. Without effective treatment, an anaphylactic reaction can be fatal.
Treatment
Despite best efforts, accidental exposure can occur. Epinephrine is the medication of choice. Students with a life-threatening allergy should always carry an EpiPen, a spring-activated auto-injector which carries enough epinephrine to slow down a reaction so a child can get to hospital. Given the rapidity with which symptoms can develop and progress, epinephrine must be available immediately. (Very young children might require a teacher to carry the EpiPen or have it available in the classroom.) While some allergic students know how to self-inject, they may not be able to do so during a reaction. Therefore, it’s important for staff to be trained in the proper administration technique.
What can schools do to minimize the risk?
The SAFE (Support Allergic Friends Everywhere) program, developed by Anaphylaxis Canada was designed for schools. Those who have been most successful in implementing a plan have made an appeal to the entire school community. These schools distribute a short written plan to families and staff, so that expectations are clear, recognizing that a plan does not provide a guarantee against accidental exposure, but does help to minimize the risk.
Food Labelling Issues
Many schools provide a list of “safe foods” to all families to help them comply with a no-nut request. This well-intended list can be a double-edged sword. It is impossible to stay on top of manufacturing changes which might affect the status of a product (e.g. “peanut-free”). Allergic students and their parents are urged to treat lists as a guideline and to always read food labels.
Are schools making the grade?
In Spring 2002, Anaphylaxis Canada completed a retrospective review of anaphylactic deaths in Ontario from 1986 to 2000. From 1986 to 1994, there were six deaths in a camp or school. From 1994 to 2000, not a single death in an Ontario school or camp was reported. Anaphylaxis awareness, especially at schools, is making a difference! It has also had a spillover effect in other areas. Congratulations to all who have made this a reality.
Lessons Learned from Parents Who’ve Been There
When you first make contact with the school, they might not know you. You also don’t know what prior experience they may have had with parents of anaphylactic children; it may not have been good. You need to gain their confidence that you will be reasonable, helpful, and address their needs. Be there to help them learn to manage anaphylaxis, don’t just look for them to help you. Provide them with all the resources if you can afford it (e.g. videos, posters for exterior doors, etc.).
•••
I remember vividly one day when I went to pick up my son from Junior Kindergarten. You could see the terror in his teacher’s eyes when she recounted how my son had said, “I think that boy had peanut butter for breakfast. I can smell it on his breath,” after passing an older boy in the hall. My son was not concerned, but this poor woman had spent the entire morning worried that he might have a severe reaction. She had been told by another parent that peanut-allergic kids could suffer a severe or fatal reaction from simply smelling peanut butter. It got me thinking — if people believe this, who would want to take care of my son?
Note: Researchers at Mount Sinai School of Medicine in New York recently studied the effects of casual exposure to peanut through skin contact and inhalation and found no systemic reactions. They did advise that schools should maintain practices which effectively reduce the risk of exposure.
Responsibilities of Students, Parents, and Staff
Students
•Always carry an EpiPen
•Wear MedicAlert identification
•Read food labels or ask an adult
•Only eat foods from home or those approved by your parents
•Place food on a clean napkin or plate
•Wash hands often
Parents
•Teach children to stick to key rules
•Provide ID sheet with child’s name, photo, details of allergy, signs and symptoms and emergency plan
•Help develop anaphylaxis management plan
•Get involved in awareness sessions
•Offer to help with school events
•Say thanks in a school bulletin or letter home through the teacher, reward your child’s classmates with a small token (stickers, etc.)
•Be realistic about what others will do to accommodate allergic students. Don’t expect others to read labels as vigilantly as parents.
Principal
•Develop a written anaphylaxis management plan with school council, staff, and families of allergic students
•Organize training and awareness sessions
•Purchase resource materials
•Ensure back-up EpiPens are readily available and not locked up
Teachers
•Attend annual and refresher training sessions
•Know the signs and symptoms of anaphylaxis
•Learn how to use the EpiPen and practise from time to time
•Ensure that allergic students are included, not isolated
•Keep information about allergic students in Day Book (for substitute teachers)
Friends
•Wash hands after eating
•Watch out for things that could make allergic friends sick
•Get help from an adult if worried about an allergic friend
•Don’t share food, straws, drinks or utensils with food allergic friends
•Don’t tease someone with allergies
Families
•Respect school guidelines when sending in food
•Teach children to respect others who have special needs
For more information about anaphylaxis:
•Anaphylaxis Canada is a national registered charity dedicated to improving awareness and understanding of life-threatening allergies. The organization provides information and supports research related to anaphylaxis. Go to www.anaphylaxis.ca or www.gosafe.ca or call 1-866-785-5660 for more resources.
•Anaphylaxis: A handbook for school boards at www.cdnsba.org
•Anaphylaxis in Schools and Other Child Care Settings at www.allergyfoundation.ca
• Association Québécoise des allergies alimentaires at www.aqaa.qc.ca
•Canadian MedicAlert® Foundation at www.medicalert.ca
•EpiPen at www.epipen.com
Laurie Harada, Executive Director, Anaphylaxis Canada, is the mother of a nine-year-old son with multiple food allergies.
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