Allergy Shmallergy

Simplifying life for families with food allergies.

COVID Life: Food (Allergies) in the Classroom this Fall? July 2, 2020

 

The American Academy of Pediatrics (AAP) came out with a statement in favor of in-person schooling for children wherever schools can do so safely.  In it, they cite the importance of school on child and adolescent mental health and academic engagement as well as the lower rate of transmission and contraction of the coronavirus. [Read the AAP’s full statement here.]. The AAP’s statement also offers guidance to schools about how they might resume in-person education while protecting students as much as possible.

 

In May 2020, the Center for Disease Control (CDC) also published guidance about schooling during the COVID-19 pandemic.  At that time, AllergyStrong co-signed a letter urging the CDC to balance their guidance with the concerns of life-threatening health conditions facing students including food allergies – which they did.  [Read the CDC’s updated guidance here.}

 

Both the AAP and CDC recommended that students eat meals in the classroom rather than the cafeteria in order to promote social distancing and limit contact between classes (cohorts) and grades.  And, both AAP and CDC mention the need to be cognizant of food allergies in that scenario.

 

 

How do you bring food into the classroom safely?

The AAP and CDC guidance leaves many parents wondering how can teachers, staff and administrators help protect their students from food allergic reactions while following this guidance?

1. Enforce a “No Sharing” food policy.  

This must be strict and plainly stated to protect classmates from food allergic reaction which can be serious.

2.  Wash hands.  

This is doubly important in the age of COVID.  But unlike a virus, food allergens are not eliminated by hand sanitizer.  Hand washing with good-old soap and water is what is recommended to prevent cross-contamination and cross-contact with food protein that can cause a severe reaction.

3.  Cleaning shared surfaces.

It is critical to clean common surfaces (again doubly so with the coronavirus at play) to prevent accidental cross-contact and protect students with food allergies.  Cleaning with soap and water is best.

4.  Review symptoms of an allergic reaction.

It is imperative for teachers and classroom staff to re-familiarize themselves with the signs and symptoms of an allergic reaction as well as how a child might describe those symptoms [Read, The Language of a Food Allergic Reaction for more information.].

5.  Know how to respond to an emergency.

Minutes matter during a food allergic reaction.  Severe reactions, called anaphylaxis send patients to the hospital and can be fatal.  Review a student’s 504 plan and any Emergency Action Plans available.  Know where epinephrine auto-injectors are stored, how to use them and WHEN to use them.

6.  Take advantage of the stock epinephrine program.

Under the School Access to Epinephrine Emergency Act, also referred to as the Stock or Unassigned Epinephrine Act, schools are allowed to keep on-hand epinephrine auto-injectors that are not prescribed to a particular patient for use in emergencies.  This program is available in 49 states and is used to save the life of any student, teacher or staff member having an allergic reaction regardless of whether they have epinephrine on file.  Up to 25% of stock epinephrine use in schools is with people who have no history of diagnosed food allergies.

 

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What can parents do to protect their children?

1. Establish/Review the student’s 504 plan.

Section 504 of the Americans with Disabilities Act protects a student’s access to equal education and academic success while preserving safety.  Provisions in a 504 plan for a student with food allergies might include class-wide hand washing, a voluntary refrain from bringing allergens into the classroom, communication with parents about allergens, or approval for a student to carry his/her own epinephrine auto-injectors. Now is the perfect time to work with your school to establish a written 504 plan for your food allergic child should you feel they need it.  [Read Kids With Food Allergies Sample Section 504 Plans for Managing Food Allergies for more information.]

2. Practice how to respond to situations with food with your child.

Because eating may be done in the classroom, a child’s peers may have questions or comments about his/her food allergy.  Practice answering these questions with your child so they feel comfortable and confident to handle anything that comes their way. [Read Armed with Words:  Teens and Food Allergies to get your conversation started.]

3. Review symptoms of an allergic reactions with your child.

It is critical that everyone with food allergies know the signs and symptoms of an allergic reaction.  Teach these symptoms in an age-appropriate way so as not to scare younger children.  Let kids know that these symptoms typically appear soon after eating and tell them to speak up (even interrupting a teacher) if they are concerned they are having an allergic response.  [Read: React? Act! to help teach this important lesson.]

4. When age-appropriate, demonstrate how to carry/use epinephrine auto-injector.

Carrying an auto-injector is a big responsibility and a big relief to some children.  Teaching kids how to carry their epinephrine auto-injector (always have it with you, don’t let your friends play with it, etc) and how to use it is key.  In fact, invite one or two close friends over and demonstrate how to use the auto-injector with the trainer or firing off an old one on an orange or grapefruit will also help protect your child should an emergency arise.  We’ve adapted an old medical school mantra from my father-in-law for food allergies, “If you think you need to use the auto-injector, you DO need to use it!” Remember, administer epinephrine and go to the hospital immediately for further treatment and monitoring.

 

Food Allergy Treatment: OIT 101 January 21, 2020

[DISCLAIMER: Oral Immunotherapy is always conducted under the direction and supervision of a medical doctor.  It is an individualized plan.  Please talk to your doctor if you’re interested in learning more about OIT.  This is not an endorsement of OIT and is for informational purposes only.]

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UPDATE:  Palforzia was approved by the FDA in late January 2020 and is use today.  If you choose to pursue OIT, discuss whether Palforzia or other OIT programs are best for you with your healthcare provider.

While the U.S. Food and Drug Administration considers whether to approve Aimmune’s  Palforzia – possibly the first drug to be approved for peanut allergy, let’s get an overview of OIT.

Oral immunotherapy isn’t a new concept.  In fact, it has been discussed in medical journals for over a century and used for decades to help patients desensitize to environmental and drug allergies as well as build a tolerance to venom.  OIT has been studied in food allergy (mostly for peanut allergy) for the last 20 years and been in medical trials for just over 10 years.

Following a successful presentation to the U.S. FDA in September 2019, we stand on the cusp of seeing the first oral immunotherapy drug (Palforzia) approved.  Until now, food allergic patients have had no other option but to avoid their allergen for the life of their allergy.  FDA-approved drugs, like Palforzia, and other therapies would offer some patients progress, giving them much-needed treatment options to increase tolerance and protect them from life-threatening reactions for the very first time.

What is OIT?

Oral immunotherapy – or OIT – is a treatment option for some with food allergies that is managed and is strictly monitored by a patient’s allergist.  [NOTE: OIT and desensitization should ONLY be done under medical supervision and with guidance from your personal doctor.]

Oral immunotherapy is a safeguard.  It is a therapy intended to protect patients should they accidentally be exposed to their allergen.  It can also bolster a patient and caregiver’s mental health by reducing anxiety and stress caused by the heavy burden of food allergy management and unexpected, potentially life-threatening reactions.

Immunotherapy (whether oral, epicutaneous, sublingual or otherwise) is a treatment option to help patients tolerate a higher level of allergenic protein and is NOT a cure for food allergies.

boy and girl eating cookies

Photo by cottonbro on Pexels.com

How does it work?

OIT is a form of desensitization – that is, the process of retraining a patient’s body to tolerate a larger amount of the allergen to which they are allergic without causing a reaction.

For example, if a patient is allergic to peanuts, a doctor would give a patient an amount of peanut protein (beginning with a tiny dose of 1/100th of a peanut or three milligrams). That dose is gradually increased until that patient can safely eat a level of protein that would otherwise cause a reaction.  The goal of many OIT programs is to get the patient to tolerate at least 600 mg of peanut protein (or the equivalent of 2 peanuts), although these goals vary from practice to practice and patient to patient.

milk OIT

Dairy OIT solution – photo by OakleyOriginals via Flickr (CC BY 2.0)

Is OIT only for those with a peanut allergy?

Although the FDA is currently only reviewing a drug aimed at peanut allergy, oral immunotherapy trials are available for those who suffer from other food allergies as well.

How effective is oral immunotherapy?  Does it work?

Peanut, egg and milk OIT has been studied most closely and shown to desensitize 60-80% of participants.  Studies related to peanut oral immunotherapy specifically have between 85-90% success rates.  Other food allergens have not been studied as thoroughly and initial results show they may not be as effective at increasing a patient’s tolerance.  These  numbers are the result of oral challenges and not real-world accidental exposure.

Can anyone pursue oral immunotherapy?

If you’re interested in OIT, it’s best to speak with your doctor.  The process of going through OIT can be demanding and does not fit every lifestyle.  And, there are certain food allergy-related conditions (such as eosinophilic esophagitis – EOE – and others) that might make immunotherapy more difficult.

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Photo by Negative Space on Pexels.com

Consider this…

There are a few side effects that are possible while undergoing OIT.  The most common issue patient’s experience is gastrointestinal (reflux, cramping and vomiting), followed by oral itching, hives, and wheezing.  The risk for anaphylaxis is higher for those going through immunotherapy due to a patient’s regular exposure to their allergen.   Patients also risk  developing/inciting EOE – which often goes away when therapy discontinues.

The process of oral immunotherapy can be rigorous.  It requires an oral challenge, frequent doctor’s visits, and a comfort with using an epinephrine auto-injector.  Therapy also puts some restrictions on the life of patients as a precaution. For example, after dosing patients are required to rest to keep their body temperatures steady for 2 to 4 hours. And, daily monitoring is required.

Patients often need to take a daily or weekly maintenance dose indefinitely to keep up their tolerance.

Finally…

Oral immunotherapy is a much-needed treatment options for those seeking some protection and relief from the demands of living with food allergies.  Safeguarding patients against cross-contamination and accidental exposure is important for a patient’s physical as well as mental well-being.  But OIT is not for everyone.  If you’re interested, talk to your doctor about OIT and see if it’s a good fit for your lifestyle.

For more information, please read:

The Current State of Oral Immunotherapy from AAAAI

 

Managing Food Allergy Anxiety April 20, 2017

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According to a study out of the Children’s Mercy Hospital in Kansas City, Missouri, children with food allergies are more likely to experience anxiety and depression than their non-allergic peers.  And, the more foods they are allergic to, the more likely they are to internalize those feelings of helplessness and vulnerability.

 

How does anxiety present itself in children?  What are the signs parents should look for?

Because children often lack the ability to identify the source of their stress and articulate their feelings clearly, anxiety tends to present in a number of different ways.  Some of these include:

  • stomach aches
  • headaches
  • clinging
  • avoidance: not wanting to go to events or school
  • changes in sleep and eating
  • tearfulness
  • daily persistent worries

 

Periods in a child’s development also make them more susceptible to anxious feelings; such as ages 7-10 when kids are old enough to understand serious health risks but are still too young to manage their fears efficiently.  Similarly, pre-adolescents (tweens ages 10-14) typically develop an awareness of germs, disasters and things that could possibly go wrong, making this age range primed for feelings of nervousness and worry.

 

What can parents do to help their children manage their anxiety?

  1. First and foremost, parents need to model calm. (More on that below…)
  2. When speaking about their food allergies, frame risk in a positive way.  For example, “reading ingredient labels, asking questions and carrying your epinephrine will help keep you safe;” “eating peanuts may make you feel sick;” “having regular cheese can make it hard for you to swallow and breathe…”.  DO NOT talk to kids about death, dying or their mortality.
  3. Give them words for their emotions so that they can express themselves and relieve some of that private, pent-up worry.
  4. Validate their feelings.  Anxiety about food allergies can spill over into more generalized anxiety.  Their fears and perspectives are real to them.
  5. Tell your child a story about a time you had anxiety.  And, if possible, maybe something you did to overcome it!
  6. Explain to your child that everyone experiences some level of anxiety.  It’s a normal part of being human.  But when it becomes overwhelming we need to talk about it to help let it go.
  7. Encourage your daughter or son to socialize with friends and family.  Being with others is a great distraction and reminds them of the support that surrounds them.
  8. Teach them skills to relieve stress, such as breathing techniques, getting out to exercise, or compartmentalizing the discussion of food allergy worries to 10 minutes a day and then moving on.  These are important techniques for life!
  9. Reassure your child that they are in good hands, both at home AND away, like at school, at grandma’s, etc.  Kids need to know they are secure and that those in charge know what they’re doing.
  10. Empower them!  Practice what to say to their friends, family, teachers, and restaurant staff about their food allergies.  Teach them what to do in case they suspect they’re having an allergic reaction.  Work together to read ingredient labels and manufacturing warnings.  Allow them to ask questions at the doctor’s office. The more capable they feel, the more in control they will be!

 

What about us?  

As food allergy parents, we – too – are familiar with the stress and anxiety related to the management and realities of food allergies.  It is as, OR MORE, important that we manage our own anxious feelings as parents so that we can be a model of calm and security for our kids.

 

Anxiety – in all forms – clouds good decision-making (it’s science!).  Keeping worries in check allows us to be more effective parents by approaching decisions and assessing situations with cautiousness and calm.

 

When adults feel out of control, they tend to overcompensate.  This primal need to protect our children kicks into overdrive, leaving parents spinning their wheels in a world they cannot sanitize or make safe enough.

 

Kids tend to absorb the perspective of their parents and they can become frightened if adults around them are very stressed or scared.  Therefore, it’s critical for parents to adopt a healthy attitude towards food, food allergies and the greater world to help their children manage their own food allergies.

 

What can we do to keep ourselves calm?

  1. Find support.  Connect with other food allergy parents or spend time with understanding friends.  Socializing reminds us that we’re not alone with our concerns.  Feel free to use Allergy Shmallergy’s Facebook page to post questions or connect with like-minded parents.
  2. Arm yourself with information.  Familiarize yourself with food labeling laws, causes and symptoms of a reaction, and your emergency action plan.  If you can, learn to cook!  In short, empower yourself!
  3. Adopt simple solutions for your food allergy hurdles.  Resist the pressure to be the perfect baker, for example, and focus on surrounding your child with LOVE.
  4. Trust in others who’ve shown understanding towards food allergies.  A lot of food allergy parents only feel their child is safe when he or she in in their total control.  It’s important to let go a little and let others help.  If you’re at a friend’s house, let the host find a safe snack  – you can still approve the ingredient list, but it will give you a window into their decision-making abilities.  Let your child’s teacher become his or her food allergy-ally while they’re at school.  Every child needs a village.  More importantly, every parent needs one too.
  5. Prepare and approach food-related situations with CAUTION without assuming CATASTROPHE.
  6. Get out and exercise.  Talk a nature walk.  Have a date night.  Be sure to find outlets and activities that bring you joy.

 

 

 

 

 
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