The Slowcook at Spydog Farm The Slowcook at Spydog Farm

Food Allergies In School

September 4th, 2009 · 2 Comments · Posted in kids

EpiPen: Emergency medicine for allergic reactions

EpiPen: Emergency medicine for allergic reactions

What do teachers do to prepare for the new school year? At the private elementary school where I teach my food food appreciation classes, one of the things we do is hold an assembly with the school nurse and study the health problems of every kid in the school who has one.

These can range from grand mal seizures to irritable bowel syndrome, peanut allergies to facial tics. The allergies are nothing to take lightly. Some children have seasonal issues with tree or grass pollens. Others are allergic to bee stings and can be deathly sensitive to certain foods, not just peanuts. I am always shocked at the number of kids who suffer from asthma and a wide variety of food allergies. These include not just the obvious ones like peanuts and shellfish. Would you believe peach skins? How about lentils? We have many kids who are allergic to milk and other dairy products. (This is an allergy, not lactose intolerance.) Many are allergic to tree nuts (peanuts are a legume, not a true nut), some to stone fruits or even tomatoes. A few have enzyme issues that can trigger a reaction to fava beans, and several are intolerant to gluten.

Some children are allergic to eggs, which means they also will not tolerate certain vaccines that have been incubated in egg.  For instance, the new H1N1 (swine flu) vaccine has been manufactured with egg. The Centers for Disease Control says anyone whose children have an egg allergy should consult their physician before being vaccinated for swine flu. Otherwise, young children are at the top of the list for swine flu vaccination.

This school does not ban food allergens such as peanuts on the theory that kids need to learn how to cope in a great, big world full of trouble. But kids are prohibited from sharing food. At lunch time, those who have foods that may cause allergic reactions are placed at special tables. So you may have a nut table, for instance, or a dairy table, or, conceivably, a seafood table. This way the kids with allergies get to eat with the rest of their class. They aren’t singled out and stigmatized.

Every year, kids die from food allergies. According to our school nurse, most of these deaths take place in school and usually because emergency treatment was not initiated quickly enough. An allergic reaction of this type is a histamine reaction gone horribly awry, the body producing an overblown response to what may be only minute amounts of, say, peanut protein that can be transmitted from a handshake, a tabletop, or even a kiss. In severe cases, anaphylaxis ensues, which can lead to respiratory failure and a collapse of the cardio-vascular system.

It all happens very quickly, within minutes. If you see a kid with redness or swelling around the mouth, tingling or swelling of the tongue, you know you’ve got a problem. Don’t wait. According to our nurse, it’s always better to err on the side of caution and administer a dose of emergency medicine. But also call 911 immediately.

Most of the children with severe food allergies have a prescription for epinephrine, a substance that is produced naturally by the body as adrenline, but has been synthesized specifically to counter severe hystamine reactions. It usually comes in a syringe with a spring-loaded needle under the brand name EpiPen. As part of our first-aid instruction, we are shown how to remove the cap from the EpiPen and jab it into the thigh of a student. The needle is thick and powerful. It will penetrate almost any type of clothing. It’s also very painful. We are told to hold students down on the ground if necessary to administer it as it may save the child’s life.

The EpiPen is not a remedy. It merely holds the anaphylactic reaction in check until a rescue team can arrive to administer other drugs. It only lasts 15 minutes. If your rescue team doesn’t get there within that time, you may have to administer a second dose. For this reason most of the kids who have EpiPens usually have more than one.

Fun, huh?

The school nurse not only keeps track of all of the kids with issues, she also stores their EpiPens and asthma inhalers in special lockers in her office, along with medical information indicating what kind of medicine the parents have consented to be administered to their children in an emergency. (There are different EpiPens with different doses of epinephrine depending on the weight of the child involved. There are also parents who do not provide their children with medicine, which raises some interesting issues.) The nurse also tracks when medicines expire and need to be refilled. For field trips, all of these medicines and paperwork must go on the bus with the children in a special backpack and then be unpacked and stored again at the end of the trip.

In most cases, the nurse has had in-depth conversations with parents about the children with special risks. Many of them she has treated herself. But actual use of EpiPens is fairly rare. Thankfully, kids with severe allergies learn how to avoid exposure to dangerous foods.

I now have a whole new level of respect for our school nurse. How’s yours?

Read more about how we are taking back our food system at Fight Back Fridays.

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  • evalundsager

    Thank you, Ed, for helping to educate people about food allergies! Having seen our son stop breathing because he ate a bite of muffin with walnut in it (we were told it was nut free) it can be very discouraging to have people treat you like your a crazy person because you’re cautious about the food your child eats. My kids can eat at your house anytime!

  • megwolff

    Yes, Ed, thanks for a most informative post. I didn’t realize that it was such big problem.