Food Allergies in Lake Travis Schools: Is your child prepared?

by Dr. Jessica Morgan, MD

Last week Dr. Van and I met with the Lake Travis ISD school nurses to talk about food allergies, an area of concern for the school district.  We were surprised to learn that many students with a history of a life-threatening anaphylactic food allergy do not carry an EpiPen, or other type of epinephrine auto-injector, and fail to provide one to the school in case of an emergency.  We wonder ‘Why?’

Food allergies affect 1 in 13 children in the U.S. or about 1 or 2 in every classroom.  Recent studies indicate that 16-18% of school age children who have food allergies have had a reaction in school. In approximately 25% of the reactions that occurred at school, the student had not yet been diagnosed with a food allergy.   Food allergies account for 35-50% of all cases of anaphylaxis in emergency care settings.  Peanut and tree nut allergies are responsible for most cases of fatal or near-fatal reactions in the United States. Peanuts and tree nuts make up two of the 8 food groups that cause 90% of serious allergic reactions. The other six groups are soy, eggs, milk, wheat, shellfish, and fish.   Children may outgrow some of these allergies.  The American Academy of Pediatrics estimates that 80-90% of egg, milk, wheat, and soy allergies resolve by age 5 years.  However, only 1 in 5 children will outgrow a peanut allergy and fewer will outgrow allergies to other nuts or seafood.  In other words, children are less likely to outgrow allergies to the most dangerous allergens.

Not only are food allergies becoming a growing public health concern for Lake Travis schools and our country, but severe reactions like anaphylaxis (multi-system, whole-body reactions) can be fatal when treatment with epinephrine is delayed or not given.  Those at most risk for experiencing fatal or severe reactions are teenagers and young adults, people with a history of asthma, and those with a history of a food allergy.  So when the school nurses informed us that these are the students- teenagers, those with a history of food allergy, those most at risk for a fatal reaction-that do not have access to a life-saving medication we were more than surprised.

The school district, like most others in central Texas, uses individualized doctor-prescribed Food Allergy Action Plans for students with a medically diagnosed food allergy.  This plan serves as orders for the school nurses and staff in case of an emergency.  If a student’s action plan orders an epinephrine injection for symptoms of anaphylaxis, the nurse will administer the medication or sometimes older students are allowed to self-administer.  It is important to know that school clinics do not stock epinephrine.  School nurses can only administer medications if they are prescribed to a student by a physician and if the medication is provided to the school by the parent or guardian appropriately labeled.  A school nurse is not authorized to give another student’s medication to someone else, even in emergency situations.

The school district works hard to help prevent exposure to food allergens. Some schools have food-free zones. All encourage good hand-washing before and after meal times and emphasize that students not share food or utensils to help prevent cross contamination. Teaching students to read food labels also helps with prevention, but even that isn’t a 100% guarantee. The federal Food Allergen Labeling and Consumer Protection Act mandates that when a top 8 allergen is an ingredient in a food product, it must be listed using its common names as an ingredient.  The Act does not address advisory warnings such as ‘may contain {allergen}’ or ‘processed in a facility with {allergen}.’ These kinds of warnings are not currently mandated, but are purely voluntary.

Again, our question is ‘Why?’  Why take the risk of your child experiencing a severe, or even fatal reaction?  Why are schools not being provided with a potentially life-saving prescription?  If your child has a history of a food allergy or anaphylactic reaction, please talk to your pediatrician or allergist and your school nurse regarding the use of epinephrine.

 

For more information on Lake Travis ISD’s Food Allergy Management Plan, visit http://www.ltisdschools.org/Page/349.

To learn more about food allergy and how to recognize the symptoms of anaphylaxis, visit www.allergyready.com.

To review the US DHHS Voluntary Guideline for Managing Food Allergies in Schools and Early Care and Education Programs, visit www.cdc.gov.

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