Food Allergies Are on the Rise. Are Schools Prepared?
Many severe reactions occur in school setting
When Abbe Large's daughter was a toddler, she was diagnosed with a peanut allergy so severe that the skin on her cheek reacted to a kiss from her father hours after he'd eaten peanuts.
With two daughters with multiple food allergies, Large worked with an allergy consultant to figure out how to eat, how to store food, and how to control her children's exposure to the allergens that could send them into anaphylaxis.
Large was anxious when it was time to send them to their Connecticut elementary school. Peanut protein is difficult to clean from skin and surfaces, which would leave her younger daughter, now 10, vulnerable to a reaction even if peanut-eating classmates didn't have the nuts at school.
"I would put her to bed at night and really fear for her life," Large said.
School-based health providers and education leaders say they've seen a major uptick in allergies to peanuts and other foods, sometimes creating logistical challenges for teachers, food service workers, and school nurses.
"I've been a school nurse for 24 years, and the number of students presenting with risk of anaphylaxis related to food has grown exponentially," said Laurie Combe, the president-elect of the National Association of School Nurses. "When I started, I had one student with an EpiPen, and now I will go into schools and they will have 20 to 30."
And new research backs up the assertion that the number of children with food allergies is growing.
Peanut allergies in children have increased 21 percent since 2010, and nearly 2.5 percent of U.S. children may have an allergy to peanuts, according to preliminary research presented by Ruchi Gupta, a professor of pediatric medicine at Northwestern University.
Gupta presented her findings, derived from a survey of 58,000 U.S. households, at the American College of Allergy, Asthma and Immunology's annual scientific meeting in Boston last month. Her findings also showed rising rates of child allergies to tree nuts, shellfish, fin fish, and sesame during the same time period.
Scientists have suggested that a lack of early exposure to allergens may have contributed to an increase in children with allergies.
Growing rates of food allergies should concern schools, advocates say, because many children who have not been diagnosed with an allergy have their first allergic reactions in a school setting.
Between 20 and 25 percent of epinephrine injections administered to counter severe allergic reactions at school are given to students who've not yet been diagnosed with an allergy, according to Food Allergy Research & Education, an advocacy group for people with allergies.
FARE advocates for policies that allow schools to carry epinephrine injectors that aren't prescribed for use by a specific student so that they can react quickly in the event of an allergic reaction.
States have responded to growing allergy concerns in recent years. Every state but Hawaii has a policy that allows or requires schools to stock epinephrine, according to a FARE legislation tracker. And most states require training for teachers and administrators in how to use the devices.
Those state policies come after a 2013 federal law that prioritizes some federal grants to states that stock epinephrine injectors in schools. Mylan, a leading distributor of epinephrine injectors, pushed for the federal law. Some policymakers have said requiring schools to stock the injectors, rather than merely allowing them to do so, creates a financial burden because of the cost of training staff and maintaining drug supplies.
Groups like the National Association of School Nurses have also pressed for a nurse in every school, noting that relatively common diagnoses like allergies can quickly become serious health risks.
Parents like Large say that, as more schools adopt clear policies related to things like food in the classroom and allowing for broader use of epinephrine injectors, they are more comfortable sending their children to school.
Schools Need Broad Policies
FARE pushes for parents of children with allergies to secure "504 plans" that outline how their schools will limit exposure to allergens and respond if they have reactions, said Jennifer Jobrack, the organization's national advocacy director.
But schools shouldn't address allergies as merely issues for individual students, Jobrack said. Rather, they should implement broader policies that reduce allergen exposure for all students, even those who have not yet been diagnosed.
"Food-free classrooms," where teachers avoid using things like M&M candies for counting exercises and egg cartons for craft products would be one example, Jobrack said.
Schools should also limit use of products like peanut butter in cafeterias, provide special tables for highly allergic students in the lunchroom, and require classroom snacks that include listed ingredients so parents can screen for allergens, she said.
Such policies, applied across an entire school, can help reduce the stigma for individual children with severe allergies.
"You never want to single out a child and make other children feel that because of Johnny's allergy, we can't have M&M's in our classroom," Jobrack said.
Only 16 states require their schools to have food-allergy policies. But many schools in states without such mandates have adopted them on their own, using guidelines like those from the National Association of School Nurses and the National School Boards Association.
Such policies can help schools reassure parents that their child will be safe, said Combe, of the nurses association.
"When a parent is bringing a child with food allergy to school for the first time, they are terrified," she said. "They've lived in this protective environment of their home, and now they're sending them off to school to people they don't know."
Combe told the story of an elementary student whose mother wanted her to carry an epinephrine injector with her everywhere. While most allergy-affected children stored their injectors in the nurse's office, administrators allowed the girl to carry hers in a "fairy purse" on her shoulder until her mother grew more confident in the school's preparedness.
"You have to meet parents where their level of anxiety is, and then you can build trust," Combe said.
Large, the Connecticut mother, channeled her concern into a mission to boost the level of allergy education in her children's schools. She went school-by-school to meet with principals, parent-teacher association members, and parents of affected children to put policies in place related to food and allergen exposure.
She convinced schools to switch from peanut butter to sunflower butter in cafeteria foods, and she developed informational features about allergies that could be included in parent newsletters.
"At the end of the day, nobody wants to put a child in harm's way," Large said. "Nobody does it intentionally. It's all about education."
Vol. 37, Issue 13, Page 7Published in Print: November 15, 2017, as Rising Food Allergies a Challenge for Schools