Efforts needed to keep students with food allergies safe and included

Food allergy is a growing epidemic in the United States, affecting approximately 12 million Americans.  It impacts the food allergic child, the child's family, as well as the people with whom the food allergic child and family interact. We as a nation need to have awareness that food allergens can be life threatening and that avoidance of these foods is often not an easy task. This is a global social issue, which requires shared responsibility to protect the health and self-esteem of these children.

The chances are high that you or your child interacts with someone affected by food allergy every day.  The recent situation surrounding a peanut allergic girl in Edgewater, FL is disconcerting and has become a highly polarizing national media story. With emotions running high, it can be difficult for empathy, understanding and objectivity to prevail, but they must.

The Kids With Food Allergies Foundation (KFA) turned to its Medical Advisory Team to obtain some insight into the clinical evidence to help make sense of the issue. According to Matthew Greenhawt, M.D., M.B.A., F.A.A.P., one of KFA's medical advisors and pediatric allergist with experience in investigating reactions occurring in educational settings, knowing the real risks versus the perceived risks can be helpful in school planning for children with food allergies. It is important, therefore, to review the facts about food allergy at school when thinking about this case and others that may be similar. Several published studies can help us understand this situation better.  Key findings include the following:

• Reactions do occur at school, and can be severe in certain circumstances. These tend to occur more frequently in younger children. However, the vast majority of food allergic children (even those with severe food allergy) can and do attend school safely every day.  
• Physical and verbal bullying of students with food allergy occurs. In survey studies and observations, it is very common for food allergic children to report being teased, taunted, and harassed because of their food allergy.
• The risk of a severe allergic reaction occurring to an environmental accidental contact exposure that does not involve ingestion appears to be extremely low. In one study, researchers failed to detect peanut in air filters at the level of the neck after volunteers walked on peanuts on the floor of a poorly ventilated room. In another study, subjects inhaling from a jar of peanut butter at very close range did not experience significant allergic reactions. In a study looking at environmental exposures, there were no detectable peanut levels found on common school surfaces after they were cleaned with commercial products, and hand washing (but not liquid hand sanitizer) was sufficient to remove peanut from one's skin.  
• Although schools sometimes employ peanut or tree nut free policies, one study found that despite such measures, upwards of 19% reported that a reaction still occurred.  
• When reactions do occur, treatment is sometimes delayed or the wrong treatment is used.  There is evidence that emergency action plans are not always followed as written, and that many food allergic students neither maintain an emergency action plan nor maintain emergency medication such as epinephrine at school.  
• In published registry studies, the vast majority of fatal food reactions occur among adolescents and young adults. Among this population, intentional risk taking and general indifference to their food allergy has been documented; examples of risk-taking behavior include increased willingness to take chances by knowingly consuming known food allergens and not always carrying epinephrine.

Thus, despite a recognized risk, it's unlikely for an allergic reaction to occur without the child actually ingesting a peanut containing product. Unfortunately, in many cases both the school and the food allergic family are not always prepared to treat such reactions. The following are some important points to consider:

• Kids with food allergy, even to foods associated with severe reactions such as peanut, can and do safely attend school each day, and this is the common goal that we all must work together to achieve. Good school policy as well as community and school education can help achieve this goal.
• Students with food allergy need to have a current emergency action plan and maintain emergency medication such as epinephrine at school. Parents should, if necessary, take the responsibility to ensure staff are trained to recognize a reaction, and use self-injectable epinephrine.
• Simple strategies, such as hand washing after food contact, not sharing food, and heightened awareness of dietary restrictions when planning craft projects or class celebrations can be of great utility, and pose minimal disruption to both the food allergic child and the unaffected children.
• Restrictive policies and sentiment that these children should be home-schooled are not helpful and can be quite damaging to a child's self-esteem.
• This case clearly illustrates that management of food allergy in the school setting has to be a shared responsibility, since it affects EVERYONE, not just the food allergic individual.  
• The frustration expressed by parents of unaffected children should not be dismissed by those who are affected by food allergy. Similarly, the fear and anxiety that may be experienced by the family of those with food allergies also needs to be taken into account. It is important to recognize that both sides have the right to express their feelings, and this expression can hopefully be used to foster a productive debate that leads to a mutually satisfactory solution.
• Efforts should be focused on common sense approaches stressing empathy, understanding of the true risk, and a sense of a communal effort to protect all students– those with and without food allergy.  
• Until there is a cure, it is important for school communities to aggressively work to devise a tenable compromise that allows children to just be children and attend school normally.

Just remember, food allergy can occur at any time—if you are unaffected, this could be your child one day. We all need to work together to keep students with food allergies safe and included.