Readers who’ve been with me since the start of this blog may remember when it was still referred to in ancient journalistic terms as a column (back in the dark ages of 2006).

How fortunate I am as an allergic parent and journalist to have this cathartic outlet for my allergy angst, advice, experience and musings; and even more, to have such an amazing conduit to reach all of you.

Excuse me for waxing nostalgic, but ever since my kids’ beloved principal announced his retirement in early March, then took a leave for a hip replacement three weeks later, I’ve been plummeted backward in time, straight to the early years of my first-born son’s school life.

It seemed like Lucas was the first anaphylactic kid at his school, which gave me new trails to blaze back in 2005 when he was entering junior kindergarten. (Note: in Canada we start kindergarten a year earlier than in the U.S.).

I was a mess. His first teacher was assuring and accessible to begin with, but only willing to go so far in terms of food accommodation or flexibility in her classroom. At some point in our preliminary meetings, she actually suggested home schooling. That just about did me in.

But the principal at the time seemed to better grasp the need to keep Lucas safe from his allergens (peanuts, tree nuts, egg, shellfish, kiwi, poppy, mustard and other) at school.

She understood the brand new (and groundbreaking) Sabrina’s Law, but she up and quit the profession by end of November, leaving us with a series of retired principals to take her place for the remainder of the year. And leaving me to start over and over again.

But with each new acting principal that school year came new ideas, better solutions, greater sensitivity and an ease of communication. I was no longer scared to return to the principal’s office to revise a plan that didn’t seem to be working (like dealing with supply teachers and field trips).

And it wasn’t long before I realized that our Allergy Action Plan could include having me lead the school staff through bi-annual allergy sessions, having EpiPens getting placed throughout the school, the establishment of allergy-awareness policies and communication for the whole school (not just Lucas’ classroom), and so much more.

That was the good part. But Year One was also a treadmill of meetings as issues arose and new principals came in. It was emotionally draining, confusing and beyond time consuming.

Then it came. May 2006. The phone call that changed everything.

Next: A Principal with Anaphylaxis? Great! Er, I mean…

Angela Doody pulled open the front door of Priestman Street Elementary school two years ago, and strode across a shiny tiled floor on her way to the office to register her two children. Looking around, she was amazed at how clean and neat the kids’ new school was. “I thought, “We get to go here?” she recalls.

Aside from the friendliness of the staff, it was well organized and uncluttered. “It just seemed like a really good place to be educated.” Doody was not aware that day that Priestman Street has been a prototype: the first school to go through the New Brunswick Lung Association’s Healthy Schools program, the first in a province to vastly improve its indoor air.

Her 11-year old daughter, Katelyn, who has asthma, has been able to benefit from this program while in Grades 4 and 5 at the school. The previous school she attended was in an older, dusty  building, and that led to a “rough year for her,” says Doody.

While Katelyn did have some trouble with asthma control in her first year at pristine Priestman – “she picked up a lot of viruses,” says her mother – this past year was far better. “She didn’t miss many days of school last year because of her asthma,” says Doody.

Missing school is a big problem for students with asthma. Too often the school environment itself is a culprit, causing symptoms like wheezing or coughing that are exacerbated by the colds spread by classmates. Science is showing that air quality in schools can have a significant impact on health, and this becomes especially important when there are children attending with asthma or environmental allergies.

Back in the 1980s, asbestos in the schools became a focus (and is still a concern in some schools), but what our school systems have been slower to address are a huge number of allergen triggers and irritants. In classrooms and portables, mould can be a festering issue, antiquated ventilation systems can lead to stagnant air and recycled allergens, while old carpeting can harbour a double whammy of dust mites and mildew.

The janitor may inadvertently spark an asthma attack by using potent cleaning chemicals, so might rodents being shown for educational purposes, while a teacher’s fragrance can aggravate a child with a sensitivity to scent. Even tools as seemingly harmless as chalk and supplies for arts and crafts can be problematic.

Children are particularly susceptible to chemicals, dust and other allergens in the air; they are not simply mini-adults. Their skin absorbs toxins at a higher rate and they breathe more air per pound of body weight than adults do.

Students with asthma, in particular, benefit from an environment free of allergy triggers. Making improvements to a school’s air quality can at times be simple, such as switching to dustless chalk. Other changes, such as overhauling ventilation systems, are a lot more costly and may require lobbying at the school board level for funding.

However, in schools where air quality improvement plans have been made, the difference has been profound. At Priestman Street Elementary, change began with a simple walk through the school.

Donna Bliss, Priestman Street’s principal, worked with a team that surveyed the one-level school’s four wings, which contained classrooms, main offices, the gymnasium, and the music room. They worked from a checklist from the Lung Association’s Healthy Schools program, which includes a range of potential problems, such as cleanliness, pest control, moisture, ventilation, furnishings, parking zones and storage and use of art and science supplies.

Bliss and the committee identified a number of issues. “We had plants in classrooms that had mould; we had to put air monitors in a couple of rooms because we thought the air was stagnant; we had to check piping because at one point they had been wrapped in asbestos,” she begins to list.

“Our service that gives us custodial supplies was just going through the transition to environmentally friendly products, and we still had some old products, so we had to dispose of them appropriately.” They also examined their outdoor grounds, which are beside a busy intersection in an area of Fredericton known as “Top of the Hill.” They found the yard lacked green space and that school bus drivers and parents were idling their vehicles on school grounds.

Next page: School Ventilation

An anaphylactic reaction includes more than one of the body’s systems, such as the respiratory tract, gastrointestinal tract, the skin and cardiovascular symptom. Symptoms of an allergic reaction include tingling in the mouth, swelling of the tongue and throat, itchy skin or hives, difficulty breathing, abdominal cramping and vomiting. In a severe anaphylactic reaction, a person may experience a drop of blood pressure, loss of consciousness and even cardiac arrest and death.

One of the issues in managing peanut allergy is that symptoms can vary. A person may have had minor symptoms, only to suffer anaphylaxis on a subsequent exposure.

Because peanut allergy reactions can be severe, it is important that a person with this allergy carry an epinephrine auto-injector (EpiPen or Twinject) with them at all times. Peanut allergy is often considered a lifelong allergy, but research has shown up to 20 per cent of children may outgrow it by the time they reach school-age.*

*Source: 2010 FA primer. JACI

Prevalence

In the United States, the rate of peanut allergy in children increased by 3.5 times from 1997 to 2008, to a rate of 1.4 per cent. In Canada, it is estimated that 1.68 per cent of children and 0.71 per cent of adults have peanut allergy.

More on Peanut Allergy Statistics

Next Page: Not a Nut!

As the mother of a dairy-allergic 8-year-old, I am often asked: “How can anyone be allergic to milk?” From an early age, we’re taught that milk is good for you. It’s hard for people to fathom living without it, and then you explain that the allergy is not just to cow’s milk, but to a protein in every dairy product. Whether milk, cheese or whey or casein ingredients in a packaged food – it’s all dangerous and to be avoided.

When we registered our daughter for Junior Kindergarten back in 2001, my husband and I heard all about anaphylaxis plans for peanuts and tree nuts. But school officials seemed to have a hard time grasping that milk could be just as deadly to a child allergic to dairy. The school had a monthly Pizza Day, and the allergist had recommended that  our daughter not go to school on those days, as the risk of a reaction from the melted cheese (which smears so easily) was high.

Since she missed many events, I asked the school to reconsider the importance of Pizza Day. To my great relief, the new principal was most understanding and promptly dropped the “day”. Not all parents have accepted this easily, but that’s OK. My primary job is to protect my child physically and psychologically; I want her formative years in academia to be positive. Four years into our journey with dairy allergy and the school, the awareness-building continues. Along the way, we have learned much that’s worth sharing.

Next Page: Keeping the Child Safe

She was indignant and didn’t know what she’d done wrong. “They can’t treat me this way,” she said.

Her mother wasn’t pleased to hear of a student disciplining another student, but she had a more immediate concern. Her severely peanut-allergic daughter had been alone while eating.

“Where was your EpiPen?” Cameron asked. The reply: “In my backpack.” And where was that? “In the classroom.”

“If she’d had a reaction in the hall, no one would have been there to help her,” says Cameron. The previous fall, Cameron first learned that adults weren’t supervising the lunch breaks at the Ottawa public school. Instead, pairs of Grade 5 or 6 students oversaw the younger children as they ate at their desks. In case of an emergency, these monitors would have to run and seek out an adult.

Thousands of miles west, in Victoria, B.C., Caroline Posynick can relate. She became a convert to allergy advocacy in 2006 over the issue of student lunch-monitoring.

She had been blissfully unaware that, in a school that ran from kindergarten through Grade 7, lunch for younger grade children was supervised by kids from the eldest grade. She also didn’t realize that the teacher had decided to keep her son Griffin safe by isolating the 7-year-old at the crafts table.

On Valentine’s Day in 2006, “my son was sitting at this special table. A kid who was really, really active got up and put some peanut butter on his finger and then put it on Griffin’s arm,” Posynick says. “He wanted to see what would happen. This occurred with kids watching kids, so they couldn’t stop it.”

There was panic in the room, Griffin froze, and the monitors hustled him off to the teachers’ staff room to get his arm washed.

When Posynick and her husband got to the school they found Griffin with a huge hive on his arm. Benadryl was enough to handle the contact reaction. But the boy’s sense of upset did not go away nearly as quickly.

Incidents with lunch supervision are not hard to find among the parents of food-allergic children. They illustrate that, for all of the advances such as Sabrina’s Law in Ontario (an act to protect anaphylactic pupils) or B.C.’s ministerial framework on anaphylaxis, and for all the allergic community’s advocacy on risk reduction and readiness for emergencies, gaps remain in the protection of food-allergic children.

Within Canada’s public elementary schools, there’s a patchwork of student monitors and adult lunch supervisors, but even with the latter, the person in sight line of the child may not be trained on giving an epinephrine auto-injector. Who’s watching the kids depends on a school board’s policy and then, in turn, on how an individual principal handles (and applies budget to) lunch supervision at his or her school.

For instance, in Vancouver, the norm today is paid lunch assistants, but a ferry ride away in Victoria, students not old enough to babysit frequently patrol lunch in the class.

In 2005, Anaphylaxis Canada did a survey of its online registry about allergy policies in Canadian schools. Of the 678 parents who responded about their child’s public elementary school, 28 per cent said the school relied on student lunch monitors, 43 per cent said school staff supervised (sometimes in combination with students) and 33 per cent had paid lunch supervisors. At some schools, there were also a small percentage of parent volunteers assisting.

Most public elementary students (73 per cent) ate lunch in their class as schools often lacked the space for lunchrooms. “You do have to consider what the principals are dealing with,” notes Laurie Harada, executive director of Anaphylaxis Canada. “They’ve had cutbacks, the best that many principals can do is to have someone to wander the halls and poke their head in and monitor the kids.” That said, she adds: “too much of this is ad hoc, and schools need to think through this.”

U.S. ‘All Over the Map’

In the United States, student lunch volunteers are less the issue, but again – despite a growing number of anaphylaxis laws among the states, there are gaps. Lunch is usually eaten in a cafeteria or lunchroom, making it possible for fewer adult eyes to survey a larger group of kids.

Yet anaphylaxis prevention practices and auto-injector training can vary from district to district, and cafeteria to cafeteria.

Lunch supervision “is an all over the map situation in the U.S.,” says Deb Scherrer, vice president of education for the Virginia-based Food Allergy & Anaphylaxis Network. “Sometimes it’s a teacher, sometimes it’s a food service worker, sometimes it’s a parent – it may be paid staff or volunteer.”

*Name changed by request.

UNITED STATES

FAAN’s Back-to-School Tool Kit
FAAN’s Food Allergy Action Plan
Food Allergy Initiative’s Authorization of Emergency Treatment Form
FAAN/FAI e-learning resource, comprehensive tool for teachers. www.allergyready.com
Federal 504 Plan
AAFA on the Americans with Disabilities Act (ADA)
National Assn of School Nurses’ Anaphylaxis Provision of Care documents

CANADA

Comprehensive resource - Allergy Safe Communities site.

• Allergy Safe Communities’ Emergency Plan for EpiPen
• Allergy Safe Communities’ Emergency Plan for Twinject
• Sample letter from principal
• Sample letter from teacher
• Steps for school anaphylaxis plan
  

Also: Canadian School Boards Association publication:
Anaphylaxis: A Handbook for School Boards (New Edition)

Asthma Action Plans

• Alberta’s Asthma Action Plan (Canada)
  
• The Lung Association’s Action Plan (Canada)
• AAFA’s Student Asthma Action Card (USA)
• American Academy of Family Physicians Asthma Action Plan (USA)

Allergic Living‘s School Articles

• Food in the Classroom – click here
• Allergic Living’s award-winning article – Sabrina’s Law
• Hear Sabrina – Her moving CBC radio documentary – A Nutty Tale
• FAAMA: Inside the U.S. Food Allergy Law here
• Laurie Harada: Talking to School Officials here
  
• Laurie Harada: Off to Kindergarten - here
• Laurie Harada: If Your Child is Bullied - here
• Food Allergy and the Risky Teenage Years - here
• Sabrina’s Law: The Girl Who Inspired Change - here
• Who’s Watching Lunch at School? New excerpt here
  
• Off to College with Allergies - here
• Teens Talk: Life with Allergies - here
• Samantha Yaffe: Grade 1 and Letting Go – click here
• Kids, Anxiety and Anaphylaxis - here
• Backlash Against School Accommodations - here
• Air Quality at School - here
• The September Asthma Spike - here
• Sara Shannon’s Journey with Sabrina’s Law - here
• Reader’s Story: Sabrina’s Law Success - here
• Sabrina’s Law in Context – For a Kid, Dairy Allergy is a Life Changer

State and Provincial anaphylaxis laws, policies and guidelines, click here.

The amount of food the average child comes in contact with at the modern school is several times what his 30- or 40-something parent encountered as a pupil. Today’s staples include the pizza-at-school fundraisers, rich and fatty cafeteria food, and school vending machines brimming with oversized beverages and chocolate bars.

Add to the mix the modern child’s obsession with computers, the hours of instant and text messaging time, and results are a shocker: kids across Canada and the United States are more overweight now than at any other time in history.

Between 1978 and 2004, government statistics show that the proportion of overweight Canadian kids aged 6 to 11 doubled to 26 per cent, while the rate of teenagers who were too heavy also doubled – to a whopping 29 per cent. The rate of obese teens tripled to 9 per cent.

Due to weight issues, the federal government stated that, for the first time, this generation of children might not live as long as their parents. In the United States, over the past three decades there has been a doubling of obesity rates for preschoolers and teens, and a tripling for the 6-to-11-year-old group.

“Kids are drinking more sugary drinks, and you have exercise being designed out of their lives,” says Dr. Brian McCrindle, a cardiologist at The Hospital for Sick Children in Toronto, professor of pediatrics and author of Get a Healthy Weight for Your Child. “Because of safety concerns, they don’t play outside, and you see a proliferation of sedentary pursuits, video and computer.”

As children have grown ever heavier, the concurrent trend, of course, is the skyrocketing of food allergy. A study from Mount Sinai’s School of Medicine in New York, published in 2004, confirmed what allergists knew anecdotally; the incidence of food allergy in the U.S. had doubled, and those statistics are mirrored in Canada. Six to 8 per cent of Canadian school children now have food allergies, which can cause dangerous, even life-threatening reactions. Provinces and states are considering and, in a few cases, passing anaphylaxis-readiness laws in the schools.

But as those bring restrictions on what is appropriate for the lunchbox, simultaneously, the weight issue has grabbed the attention of educators and the media. The result: the pendulum is beginning to swing toward better nutrition in some schools. This means a new focus on fruits and vegetables, which happens to dovetail neatly with concerns about allergens in the class, since those foods are not the top allergenic sources, and they won’t lead to accidental exposures.

The Institute of Medicine, a scientific advisory group based in Washington, produced a report in April, 2007 calling for a dramatic new approach to food in the classroom: no food as rewards; no food for celebrations. Then it ranked foods into tiers. Tier 1 is acceptable: fruits, vegetables, real juice, low-fat dairy, and nothing with trans fat.

These are the only snack foods to be allowed for elementary school children and fundraising efforts, while higher-fat and sugary Tier 2 food could be available for after-school activity for teens. No snack, though, should be more than 200 calories.

Next: Banning the cafeteria fryer

In Lexington, Kentucky, a girl in the eighth grade was arrested on felony charges in April after she put peanut butter cookie crumbs in an allergic classmate’s lunch box. (The allergic student did not eat the contaminated lunch, and did not suffer a reaction.) While clearly not the first time an allergic person has been threatened with their allergen, cases usually don’t escalate to this level, says Anne Muñoz-Furlong, the founder and CEO of the Food Allergy & Anaphylaxis Network.

Following the arrest, media outlets such as the Wall Street Journal, The Globe and Mail, and various radio stations ran reports about allergy bullying. In fact, the website Wordspy.com, which tracks “newly coined” phrases, added “food allergy bullying” to its lexicon at the end of April.

Laura Bantock, who leads an anaphylaxis support group in Kamloops, B.C., knows that bullying is something many allergic kids have experienced. “I do hear of kids being taunted. To an allergic child, being threatened with the thing that they’re most afraid of, whether it’s peanut or milk, to them the perception is a very serious threat.”

Muñoz-Furlong says that food allergy bullying arises because some people aren’t aware that a speck of food could kill. “It just doesn’t seem normal that you say, ‘I could die from having a little bit of milk, or having a peanut butter sandwich.’ And because so much attention gets given to that child, so many plans and restrictions are in place, sometimes that makes the person a target for kids who don’t understand or perhaps resent the attention, or are skeptical that this is a real issue.”

Education does seem to work to help curtail bullying. Bantock’s 14-year-old daughter, Tess, an aspiring singer-songwriter who is at risk of anaphylaxis to peanuts, nuts and soy, was taunted earlier this year by some boys in her grade. “They threatened me with peanut butter. I don’t know if they had any, but they said they did,” she says. She told her teacher who, with the help of her parents and the school, explained to the boys the seriousness of food allergies. Tess believes they just hadn’t realized how threatened she felt. “They’re nice to me now. They asked me some questions about my allergies, because they were curious,” she says.

As someone who has experienced bullying, she is happy that the authorities in the case in Kentucky are taking it seriously. That teenage bully was charged with felony wanton endangerment, and will face her charges in juvenile court. “Sometimes you wonder, ‘does the government care?’” Tess says. “I don’t think prison is what you want to do – but education, or perhaps community [service] hours to help people to understand.”

First published in Allergic Living magazine, Summer 2008
(c) Copyright AGW Publishing Inc.

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