When Food Bites Back: Food Allergies Can Make a Twisted Trip Out of the Lunch Line at School
Posted on: Sunday, 2 September 2007, 09:02 CDT
By Karen Shade, Tulsa World, Okla.
Sep. 2--Taylor McKay doesn't sweat it when he catches sight of the orange candy wrapper in the vending machine he passes on his way to literature class.
He doesn't think about it much, but he knows that the contents of that small package could send him to the hospital or worse.
"I'm used to seeing it; I just know I have to stay away from it," said the Bishop Kelley High School sophomore.
The last time he had close contact with a Reese's peanut butter cup, McKay was rushed to an emergency room. He doesn't remember much of how he discovered his allergy to peanuts, but his mother, Joan Stewart, remembers everything.
During a visit with family in rural Missouri, McKay's aunt gave the then 3-year-old boy one of the candies. After he bit into it a few times, he began wheezing, coughing, and his nose was runny and eyes teared.
"Fortunately, my husband and I are both physicians, and we realized that he was getting sick fast," Stewart said.
McKay was experiencing anaphylaxis, a severe reaction to allergens that can lead to death. His parents quickly rushed him to the nearest hospital, where he was
treated and saved.
Controlling the home environment and a child's exposure to the foods he or she is allergic to is one thing, but school is a different (and potentially dangerous) world.
"I was just so scared when he started school. I just counted down the months -- 'Two more months, one more month,'" Stewart said.
Like McKay, children and teens with food allergies getting back into the school routine have more than homework and socializing on their minds.
For some, just being at the same lunch table with a food allergen can cause anaphylaxis.
According to a release from the Food Allergy and Anaphylaxis Network, allergies are the leading cause of anaphylaxis outside of hospitals in the U.S., resulting in more than 30,000 emergency room visits and up to 200 deaths every year.
The most common food allergies are to peanuts, tree nuts (pecans, walnuts, almonds, etc.) shellfish, milk, eggs, wheat, fish and soy. Some people have a combination of food allergies, states the FAAN Web site, www.tulsaworld.com/faan.
A food allergy is an immune system reaction. The body can mistake certain foods for harmful germs or bacteria and will make antibodies to protect the body against it. The next time that same food is eaten, the body reacts to it drastically, said Dr. Laudy Naimeh, an allergist/immunologist with the Allergy Clinic of Tulsa.
Symptoms of anaphylaxis can include swelling of the tongue and throat, hives, vomiting, difficulty breathing, a drop in blood pressure and loss of consciousness.
It is estimated that at least 12 million Americans have food allergies and that more than 3 million of them are children, according to the FAAN Web site.
Naimeh, who specializes in pediatrics, said instances in which food allergens are accidentally eaten almost always happen in the home, sometimes in day care.
The lunchroom
By the time many children reach school age, the family has usually discovered the food allergy. But sometimes food allergies suddenly develop later in childhood and even in adulthood.
Naimeh said she sees some cases in which a child first learns of an allergy because of exposure at school.
"But this is rare. This is not very common anymore because schools have been very aware of it now," she said.
A few years ago, Tulsa Public Schools stopped serving food containing peanuts or peanut-based products in its cafeterias. TPS also removed such foods from its vending machines, said Hossein Akhtarkhtavari, director of child nutrition of TPS.
Providing about 50,000 meals (breakfast, lunch, snacks) on an average school day to 42,000 students, TPS decided the risk of a reaction was too great.
Although the school enrolls students with other types of food allergies, only peanut-based foods have been eliminated from the menu, Akhtarkhtavari said, because allergies to nuts (along with shellfish) tend to be the most severe and most common.
"We can't restrict them all," Akhtarkhtavari said. "If we do that, we eliminate a lot of items that we serve our kids."
TPS continues to purchase and serve food that may be manufactured at the same factories where foods containing peanuts are also processed, he added.
Students also are not forbidden to bring peanuts or peanut butter to school.
"We encourage people not to, but we can't force parents to make those decisions," Akhtarkhtavari said.
Food allergies are on the rise, and doctors are not sure why, Naimeh said, but doctors have noticed that children often do not outgrow allergies to peanuts and shellfish, unlike many others types of allergies.
"If the school eliminates peanuts overall from its cafeteria, activities and snacks, you've pretty much eliminated the majority of your accidental ingestions," Naimeh said.
Naimeh said it's also important that students with food allergies remain engaged in activities and part of the social scene, instead of isolating them.
There is always one parent of another child who doesn't want to make adjustments to his or her routine, she said.
But "this is not a big deal," she said. "You cannot put another kid at risk because your kid doesn't eat anything else."
The plan
Students like McKay are used to the fact that they will probably have to carry an emergency kit -- epinephrine injector (like EpiPen or Twinject), Benadryl and oral steroids -- with them the rest of their lives.
In school, having an emergency plan in place is a good idea, particularly where field trips and school activities are concerned.
Communication between families, teachers and physicians is crucial, said Pam Butler, director of health services for TPS.
"It has to be in order to make it as successful for the child as possible," she said.
Butler said when enrolling at TPS, parents and students must complete a health information form asking for details such as known allergies. The form and other school health information is available at www.tulsaworld.com/tpshealth.
Parents need to keep the student's information as current as possible, she added.
All TPS elementary schools have a resident health assistant, and nurses rotate at the sites. Middle schools and high schools have permanent registered nurses on the premises.
Both health assistants and nurses are required to renew first aid/CPR certification every year. Part of that training is how to recognize and handle anaphylaxis. Schools also have resources such as emergency medicine and fact sheets on hand, Butler said.
Depending on the severity of the allergy, students also may keep emergency medicine in classrooms with teachers.
Butler said it is difficult to say exactly how many students at TPS have food allergies, but "once a person becomes identified . . . then we can support the school by giving them that information."
Kids often support each other, too, or at least that is McKay's experience.
McKay said he continues the solitary pursuit of playing piano, but is also trying out for the soccer team this year. He eats in the lunch room with friends, who are careful to avoid bringing peanut butter cookies to his table.
"It may mean having to tell your friends about it and explaining it to them, but that doesn't mean you can't hang out with them or anything," McKay said. "They're cool about it and they understand. It's not like I'm missing out on a lot of things."
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Karen Shade 581-8334 karen.shade@tulsaworld.com
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Pollen in the air can affect food's effects on the body
Nearly every authority on nutrition (including mom) recommends adding more fresh fruits and veggies to your diet, but when you have seasonal allergies, the choices may not always be so clear.
That's because eating certain bounties-of-the-earth can further aggravate allergy symptoms when eaten by people with allergies.
Also known as pollen-food syndrome, oral allergy syndrome can cause the same itchy, watery eyes and runny nose that allergy sufferers experience when the ragweed count soars.
The proteins of certain fruits and vegetables are molecularly similar to the pollen proteins of common environmental allergens, said Dr. Laudy Naimeh, an allergist/immunologist with the Allergy Clinic of Tulsa.
"When the molecule of that protein is similar to the ragweed, the body mistakes it" and reacts in a similar way, Naimeh said.
Oral allergy syndrome is not the same as a full-blown food allergy, which, when triggered, can cause a severe, sometimes fatal, reaction. Instead, OAS patients are more likely to experience more local itchiness, tingling and/or swelling of the mouth, tongue and throat, particularly at this time of year when ragweed and the like are in full bloom.
Ragweed sufferers seem to experience these symptoms most with bananas, cucumber, watermelons, cantaloupe, zucchini, sunflower seeds, chamomile tea and echinacea.
People with an allergy to birch tree pollen are more likely to have a reaction to peaches, apples, pears, cherries, carrots, hazelnuts, kiwis and almonds, states a release from the American Academy of Allergy, Asthma and Immunology (AAAAI).
Eating these fruits can actually make seasonal allergy symptoms worse, although some people will continue to eat these foods because the symptoms are minimal, she said. OAS is more common in adults.
Naimeh added that treating environmental allergies often will alleviate any symptoms of OAS.
"It's nothing new," she said, and it's as old as hay fever.
OAS does not affect all allergy suffers, perhaps only a third of those individuals with seasonal allergies. Cooking the foods often reduces the chance of having a reaction to it, but the AAAAI encourages those with symptoms and high allergy sensitivity to see an allergist/ immunologist to determine if certain foods should be avoided altogether.
For more about the AAAAI, go to
on the Internet.
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Keeping kids safe
Communication is the key to keeping students with food allergies safe during school hours and school activities. The Food Allergy and Anaphylaxis Network suggests several actions families, schools, physicians and, of course, students, can take to make it all work. Here are a few:
1. Parents should inform schools about a student's known allergies when they enroll at a new school, provide written medical documentation and keep health information current as new allergies are discovered. They also should provide emergency contact information and appropriate medications.
2. Parents also need to educate the child about the food allergy (which foods are safe and unsafe, what are the symptoms of a reaction, etc.)
3. A team of school staff should work with parents and physicians to create a plan to prevent a student's exposure to a known food allergen and a plan for emergencies at school, on a bus, during field trips and during other school events.
4. Schools should review the student's health records (provided by parents and physicians) and be knowledgeable about applicable federal and state laws (Americans With Disabilities Act, Individuals With Disabilities Education Act, etc.) and follow them.
5. Schools should not exclude students from school activities because of food allergies.
6. Educate school staff who directly interact with the student about food allergies, and ensure that a staff member trained to properly administer medications is available at the school.
7. Students with food allergies should not swap food with other students or eat anything with unknown ingredients.
8. Students also need to have an active part in managing food allergies as is appropriate to their age and development.
To learn more about the Food Allergy and Anaphylaxis Network and all its recommendations, go to www. tulsaworld.com/faan.
Source: Food Allergy and Anaphylaxis Network
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