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Preparing Children with Food Allergies for School

August 25, 1992

NEW YORK (AP) _ A new school year can be frightening for any child, but for the rare child with severe food allergies, one wrong bite can mean serious illness or death.

″It’s real scary for people who have kids who are milk- or peanut- allergic, especially, because every kid is drinking milk or eating a peanut butter sandwich,″ said Anne Munoz-Furlong, who founded the Food Allergy Network in Fairfax, Va., because of her experience with her daughter’s allergies to milk and eggs.

An estimated 1 percent of school age children have food allergies, but serious reactions are rare. Reactions range from hives and nausea to potentially fatal anaphylaxis. That is the release of large amounts of histamine, which causes blood pressure to fall dangerously.

Among foods that most often cause allergies in children are milk, eggs, soybeans, nuts, and fish or seafood, said Dr. Steve Taylor, an allergy specialist at the University of Nebraska.

″Peanuts are a frequent offender, and tend to cause real severe allergic reactions,″ Taylor said. Half a peanut could be deadly.

″All of the foods, unfortunately, could end up being fed to kids at school in some product - school lunches or some snack. The foods aren’t labeled and kids aren’t going to be very good at knowing what the components of a food might be,″ he said.

Researchers writing in the New England Journal of Medicine this month said it appears that the frequency of fatal and nearly fatal food-induced anaphylactic reactions has increased in the last several years.

Dr. Hugh A. Sampson of Johns Hopkins Children’s Center in Baltimore and colleagues reviewed six fatal and seven nearly fatal cases of children ages 2 to 17. All of them knew they were allergic, but inadvertently ate food containing the allergen.

Only two of the six children who died received medicine, epinephrine, within an hour of eating the problem food, and four of the six were at school when they became ill, the researchers said. That, others said, makes it critical that schools and day-care centers be prepared.

The first reaction from schools and teachers sometimes ″is hands off,″ said Munoz-Furlong, who faced a battle at her daughter’s school.

″When I showed up and said here’s her (medicine), the teachers said she might have to be home-schooled - ‘We can’t take responsibility for this.’ That’s illegal, but I didn’t know that at the time,″ she said.

Taylor’s daughter is allergic to peanuts.

″We requested that she never be given any snacks at school, and we told her never to accept them if offered. Not only at school but at friends’ after school,″ he said. ″It’s very difficult. You have to impress upon the child the seriousness of the reactions that might occur.″

Now 14, his daughter has had no problems.

Parents need to talk with school officials about medications the child may need, said Robert Bush, an allergist and University of Wisconsin Medical School.

″I can tell you what can happen if you don’t stay on top of things,″ said Cindy Ney of Herndon, Va. Three years ago, her 14-year-old daughter, and only child, died.

Natalie Ney knew she was allergic to peanuts, but ate a piece of candy containing cashews and developed anaphylaxis, her mother said. She believes if her daughter had been treated sooner she might have lived.

Ney advises parents not to assume school officials will know what to do about food allergies, and suggested making certain that medication and records are available in school.

″Don’t ever give up, and be a complete nag,″ she said.

The drug used to treat what killed Natalie Ney, epinephrine, is available in self-injectable syringes. But fewer than 20 states have laws protecting lay people, such as teachers, from liability in the injection of epinephrine, Dr. John Yunginger said in an editorial in the New England Journal of Medicine.

It’s not only lunch or snacks that can cause problems at school, Munoz- Furlong said.

For example, a popular project is to roll a pine cone in peanut butter and cover it with seeds as a bird feeder. That can be dangerous for a severely allergic child.

″Kids will eat a peanut on a dare, or other kids will force them,″ Bush said. ″It takes a very disciplined kid to be able to handle this.″

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