Nut allergies: Schools grapple with potentially life-threatening situations

May 2015 Posted in School, Your Health
Lunch is a favorite time for many kids, but for those with nut allergies it can pose real and dangerous challenges.

Lunch is a favorite time for many kids, but for those with nut allergies it can pose real and dangerous challenges.

By Brenna Wiegand

Teagen Cain hates to miss school.

“He’ll cry because he missed math or something,” his mom Lydia Cain said.

Missing school happens more often than they’d like.

A second grader at Eugene Field Elementary, Teagen has the severest, most sensitive nut allergy in the school district. More than once, classroom time has been interrupted by an acute, whole-body reaction – anaphylaxis. He’s been administered epinephrine injections via “EpiPen” and taken from school by ambulance.

“…and for every one of those there are dozens and dozens of times when I, my husband or my mom have had to come pick him up,” Cain said. “It can be airborne and send him into a life-threatening reaction.”

His condition has resulted in good friends who look out for him, alerting him to the presence of peanuts.

“The kids get it,” Cain said. “They have seen him when he can’t breathe and have an understanding and empathy well beyond their age.”

However, when nuts were banned at Eugene Field in 2011, several parents protested, questioning the limits put on more than 475 students for a single child.

The Cains aren’t the only family in the school district with a child severely allergic to nuts. Suellen Nida, a registered nurse with the district, said about 20 students districtwide have nut allergies, including seven at Silverton High School.

Silverton High School junior Gabi Frassenei had her first anaphylactic reaction at 10 months old. She had a recent attack the last weekend of April where she had to be taken to the hospital. She was the first child with nut allergies to enter Eugene Field, and though the school worked to eradicate nuts, it was an uphill battle.

“When we really got educated she was 5 or 6 years old,” her mother Gail Little-Frassenei said. “She started eating an oatmeal raisin cookie. Instantly she said her mouth felt spicy and her throat hurt. She started projectile vomiting and got a great big hive bubble all the way down her front. Just an infinitesimal amount can set her off.”

When she learned of Teagen’s situation, Gail reached out.

“Gail really helped pave the way for me and other kids,” Lydia said. “She’s been down that road and knew a mother wouldn’t want to go it alone.”

Though she hasn’t needed an injection since “the cookie incident,” Gabi’s symptoms began stepping up in January – about 3-5 days a week.

“I wasn’t really sure what was happening – my lips were swelling a lot more than usual and I was getting itchier and having to take my Benadryl,” she said. “One of my friends was going through the lunch line and saw they were making peanut butter and jelly sandwiches.” Once alerted, the school took peanut butter back off the menu.

Recently she handed a friend her notebook but he let it fall to the floor rather than touch it, remembering he’d had peanut butter that day. She, too, has good friends.

She’s also an accomplished dancer who practices 2-6 hours six days a week, is involved at church and takes Advanced Placement classes. She normally stays at school during reactions, removing herself from the situation and taking her antihistamine. This makes her drowsy; teachers know what’s going on if she falls asleep in class.

Gabi reads food labels and learns which restaurants are safe.

“Now I just kind of know what to do, but sometimes it catches me off guard,” she said. “In general, they’re not really scary except those kind where I start throwing up and my throat closes up.”

Gail feels bad for what Lydia has had to endure in keeping Teagen safe. She said it’s been an eye-opening journey.

“I understand why parents would get upset, but I don’t understand what seems like a lack of compassion from some people over a stupid peanut,” Gail said.

Though Gail said she was treated well when Gabi entered school, it was a learning curve for staff. The family resorted to driving rather than busing Gabi to school and took her out of the building the days PBJs were served.

“Nobody really realizes how horrible it can be,” Nida said. “(In the U.S.) every three minutes a food allergy sends a person to the emergency room; it happens all the time.”

Nida said Eugene Field attempts to cater to the needs of its current population though many institutions – Healthy Start, universities and school districts – have gone nut free.

“Food allergies can be very misunderstood and it can ruffle some feathers,” Nida said. “If a parent accidentally sends a child to school with a peanut butter sandwich we don’t treat them horribly; we just let them know about it and they usually feel really bad.”

Nut oil stubbornly clings to skin. Using hand sanitizer doesn’t work, although a good hand washing with soap and warm water goes a long way toward removing the oil. Classrooms at Eugene Field are not equipped with sinks.

Frustrated in her attempts to educate the families of 475 students, Nida recently posted pictures of kids having allergic reactions in the school halls.

“I think people took to that more than all the other information we sent out,” she said.

Designated staff members are trained to administer epinephrine and then call 911. Each school is required to have two of both adult and pediatric-sized EpiPens that run $150-200 each, usually donated. Kids with allergies also supply their own.

“There are so many people who have nut allergies now; we call it ‘nut aware’ because there’s always a time we may let our guard down,” Nida said. “A child somewhere in the cafeteria can have peanut butter and if an allergic child ends up touching the same basketball at recess he can go into a life-threatening reaction. I want everyone to take ownership of their own community member.”

A classified employee at Eugene Field, Cain would entrust any of her fellow staff members with Teagen in the event of an allergic reaction.

“…but as a mom I’m like ‘Please let us get through the day,’” she said. “He’ll always be on my mind.”

Some students with severe allergies fall under federal statute Section 504, part of the Rehabilitation Act of 1973 requiring schools to meet the needs of students with disabilities as adequately as they do other students.

“These families have wonderful teams behind them but they are to the point where they need the community to join the effort,” Cain said.

Eugene Field Principal Jennifer Hannan said the alarm factor is around nuts because some children don’t have to ingest them to have a medical emergency.

“We can keep kids from ingesting things fairly easily, but if a student has nut oil on his hands and transfers it to a community surface, that’s a safety issue,” Hannan said.

Lesser allergies are generally handled on a case-by-case basis between student, office, teacher, cafeteria crew and the nurse.

“Perception from some of our community is that this is something we’ve done for one allergy for one student, but in my 17 years in the district I have worked on a latex ban, perfume ban, evergreen ban and a light-up shoe ban – they can trigger seizures,” Hannan said. “For whatever reason the nut ban has gotten a lot more push-back from parents. That may be because it’s a staple of small children and leaves families unsure of what to do; the personalities involved and the unfortunate timing of the federal Healthy Kids program putting other food restrictions in place at school.

“Some parents have said ‘enough is enough’ with being told what they can and can’t do,” Hannan said. “This is why the No. 1 thing I want parents to understand is that this is a health and safety issue, not a political issue.”

Teagen loves to learn, is athletic, plays the violin and always carries his meds and medical history. They call hotels months in advance so they can prepare a room; same for Disneyland, where Teagen was given a pass to the front of ride lines and the chef came out to personally to assure them his meal was produced in a nut-free environment.

“He is learning to maintain a full, functioning life with the allergies,” Lydia said. “As horrible as this is, he’s been given a personality and a heart that will allow him to roll with it.”

Allergy and anaphylaxis

Each year, 150-200 Americans die from food allergies; about 60 percent brought on by peanuts.

Food allergies affect 1 in 13 kids under the age of 18 – roughly two per classroom – and have resulted in more than 300,000 ambulatory care visits. In the U.S. about 1 in 90 people have a tree nut and/or peanut allergy with reactions ranging from mild to the potentially deadly state of anaphylaxis.

Food allergy symptoms develop within a few minutes to two hours and may include, often in this order, itching of the lips, tongue and palate; swelling of the lips, tongue and throat; swollen, itchy, watery eyes; generalized itching, flushing, swelling of the skin and hives; increased heart rate, abdominal cramps, nausea, vomiting, diarrhea; difficulty breathing, wheezing and asthma; a sense of impending doom; weakness, faintness, collapse and loss of consciousness.

Anaphylaxis requires an injection of epinephrine and an immediate trip to the emergency room.

– National Institute of Allergy and Infectious Disease; Asthma and Allergy Foundation of America; Centers for Disease Control

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