Nut Allergies Pose Serious Problems

By Susan Coney

There is no longer such a thing as an innocent peanut butter and jelly sandwich sitting in the bottom of the lunch box; the reality is that peanuts are one of the most common food allergens to trigger an allergic reaction, and peanut allergies are among the most serious, potentially fatal of the food allergies.

A peanut allergy is caused when the body’s immune system mistakes the protein in the peanut as harmful and creates a defense system (antibodies) to fight it. An allergic reaction occurs when the antibodies are battling an “invading” food protein. Reactions can range from mild to moderate such as a rash, wheezing, tingling sensation, and diarrhea to a full blown anaphylaxis shock attack in which a person experiences life-threatening swelling of the throat, tongue, hives, and difficulty breathing.

Time is critical for any person experiencing this type of reaction and doctors prescribe the drug epinephrine as a life-saving treatment. Epipen Auto Injector, a portable one-time-use prefilled epinephrine syringe, is the commonly prescribed treatment for life-threatening allergies.

According to a nationwide study done in 2004 called the Impact of Food Allergies on School Nursing Practice, 60 percent of school nurses reported an increase over the past five years in elementary age children with food allergies. The study confirmed that food allergies are a growing health and safety concern in the classroom. Also in 2004 the American Medical Association mandated that schools begin to establish guidelines for managing food allergic children.

The Newtown Board of Education recognized the need as well for establishing effective management of potentially severe food allergies among school children and adopted a districtwide policy in June of 2004. The policy emphasizes the need for implementing a prevention plan involving parents, students, and school personnel. Through the food allergy policy the school district hopes to reduce the accidental exposure to food allergens but stresses that it can not fully assure the safety of food allergic students.

Sandy Hook school nurse Sally Cox, who has been a school nurse for 17 years, said that she has seen an increase of children with peanut and nut allergies in the last 12 years. Sandy Hook Elementary has the largest number of children with peanut or some type of combination food allergy. Out of the 665 students in the school, 15 children have severe food allergies requiring them to have an Epipen and an antihistamine such as Benadryl on hand at all times.

Ms Cox takes her job very seriously, saying that it is difficult to manage food allergies and that parents and students need to cooperate by following the recommended guidelines to create the safest environment for all students. In accordance with the districtwide policy, Sandy Hook has designated tables set aside at lunch time for students with peanut/nut allergies. Nonallergic children may eat at the tables with their friends as long as they have nut-free lunches.

The kindergarten through fourth grade school also has four nut-free classrooms. A letter is sent home with each child in those designated nut-free classrooms to inform families that their child has been placed in a peanut- and tree nut-free classroom. As part of the school’s ongoing effort to provide education for managing a nut-free environment, Ms Cox has complied a list of nut-free snack and lunch suggestions offering alternative options such as animal crackers, rice cakes, popcorn, pretzels, cheese, and raisins as well as many other acceptable foods. In the letter Ms Cox specifies that parents and students will need to read ingredient labels to check for the presence of any nuts, flavorings, or oils as ingredients can change frequently.

Children who have severe food allergies are required to eat only their own food from home. The parents of students with allergies are asked to provide prepackaged “safe” party snacks that the teacher can keep on hand for birthday or impromptu celebrations. Freezer space has been made available in the school kitchen for special treats such as ice pops to be stored.

All school personnel who come in contact with children who have severe food allergies are made aware of the medical condition. All teachers who have students with allergies are trained in the use of the Epipen. “Some teachers are reluctant to use the Epipen; however, I tell them that these students have life-threatening allergies and that the Epipen is a life-saving device. Once the Epipen is administered the adult in charge must call 911 for follow-up treatment. The Epipen is only good for 15 to 20 minutes; sometimes a second shot is needed,” Ms Cox said.

Ms Cox enters a large walk-in closet adjacent to the nurses’ office to reveal her meticulously organized array of emergency medical resources. Each child who has been identified as having a severe allergy has a large zipper bag containing disposable gloves, an Epipen, Benadryl, emergency contact information, doctors permission slip, and a photo of the child. She notes that all children with severe allergies have a written doctor’s prescription for the Epipen. “The practice of Dr Bell, Dr Miller, and Dr Lee in Danbury provide their own permission slip with an action plan so that nonmedical people can carry it out in an emergency. It is presented in a clear, concise manner that is easy to follow. It is very helpful,” Ms Cox said.

Ms Cox stated that while it is unclear why food allergies are on the rise, theories range from a reliance on processed food to pollution in the environment. She said that experts agree that it is an immune system problem. Ms Cox also said that many children with severe food allergies are also asthmatic and that while some families may have one or more members with severe food allergies others do not.

Students With Allergies

Newtown parent Ann Sadlon has two children; Elana, a fifth grader at Reed, has mild allergies, while her brother Richie, a third grader at Sandy Hook, has numerous severe allergies as well as asthma. Ms Sadlon said that Richie was first diagnosed at the age of 15 months when he came in contact with a small amount of peanut butter and had a frightening reaction.

“I was scared when Richie first went to school,” Ms Sadlon said. “I was nervous that he would pick up traces of nut products off of desks, tables, doors, and even the playground monkey bars. When he goes on field trips, I go on the bus and wipe down the seat and surrounding area to make certain that there is no trace of a peanut product. He can’t go to parties and eat; we have to bring his food. We don’t go out to eat a lot because it is too difficult to assure that something doesn’t contain trace amounts of nut products or were not cross contaminated in preparation, where a knife, spoon or cutting board had previously been used to prepare something containing nuts.

“The school has been very cooperative in making his environment safe. The food service staff has to prepare food for over 700 kids. If one knife has a trace of a nut product on it, it could cause a child with a food allergy to have a serious allergy attack. Many people just don’t realize the severity of the problem,” she said. Ms Sadlon emphasized that it is up to the parents to educate and teach their child about the dangers and insist that they follow the recommended safety guidelines provided in the school policy.

“You can’t eliminate food. The kids have to learn to live with it. It’s not up to the school, it’s really up to the parents to be the advocate,” Ms Sadlon said.

“It becomes more difficult as he gets older because now he is socializing much more and I can’t always be there. What boy wants his mom around all the time when he is with his friends? How can I control whose sitting next to him eating a Snickers bar at a movie theater. He has an extremely serious allergy but he is a real trooper about it,” she said.

A long, sought-after dream for Richie is to be able to ride the bus to school everyday. Children are not allowed to eat on the bus and, in preparation, the driver has been made aware of the serious nature of the student’s allergy. Richie anticipates taking his very first bus ride to school by the end of October.

Jake Tolson, a sixth grader at Reed Intermediate School, shares Richie’s dilemma. Although Jake is not sensitive to peanuts he is highly allergic to every other type of nut. He also has allergies to more than a dozen types of trees, pollen, ragweed, strawberries, as well as numerous other fruits and animal hair.

Jake had his first and only reaction when he ate a cashew truffle at a Passover celebration when he was about 7 years old. He had to be rushed to the hospital for breathing problems and his parents promptly took him in for a battery of allergy tests. Now Jake goes to the allergist twice a week for allergy shots. He also has a prepared kit at the nurses office at school and carries an Epipen with him.

Jake admitted that he sometimes feels that it is unfair that he has to have such severe allergies but acquiesced that he would have to live with it.

“When I was younger I didn’t know to be careful. I knew eating certain things were dangerous but I depended on my parents to guide me. Now I pretty much know what I can and can’t eat. I have a lot of friends and they don’t treat me any differently,” Jake said.

Jake’s teacher, Gael Lynch, said “I don’t take it lightly. We are very vigilant at this school. It is not a problem for me to have a nut-free classroom. I would want someone to do that for my child. Our job is to be advocates for the kids and keep them safe. I don’t think the public is always aware just how serious this is,” she said.

Reed nurse Pat Phillips said that there are two nut-free student clusters at the school. “It is a lot of work for the teachers to police this. The kids in the 5/6 school are at a good age. They really are responsible and they are their own best advocate,” Ms Phillips said.

In speaking with other nurses throughout the Newtown district all were in agreement that the school system does its utmost to provide a safe learning environment for all students. Middle school nurse Barb Reilly stated that all the schools have standing orders of what to do in the event of an allergic reaction emergency. “We update the procedure every year,” she said.

In addition Ms Reilly stated that the school offers training to all staff members in the event of an emergency and that training is also offered to parents, siblings, and even to friends of the student who has severe allergies so that they are educated about how to react in an emergency.

Jill Patterson, registered dietician for Chartwells, the food service provider for Newtown Schools, said that her company has provided all cafeteria staff with training. She stated that while peanut butter and jelly sandwiches are available in all the schools, they are self-contained in plastic wrap and there are safety steps in place to prevent cross contamination in the kitchen when preparing food. She also said that there are no nut products available at the salad bars and that granola has been eliminated from the menu because it is often difficult to ascertain whether nut products are found in the granola mix.

Ms Patterson emphasized that the new point of service (POS), which is the new computerized system for paying, helps by tracking students who have severe allergies. When a student purchases a lunch, if they have a serious allergy the cashier is alerted of the condition in a discrete manner. At this time only Reed, Newtown Middle School, and the high school have the POS system in place; however it will be made available in all schools shortly.