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April 21, 2006

Safe School Bus Policy?

I read an article last week about a family who was fighting with their school about how to handle the school bus ride for their food allergic child. It brought up some interesting points.

Should there be a written policy for preventing and responding to life-threatening food allergies on the buses? Parents of children with severe food allergies probably have reason to be worried.

Is the solution to have epinephrine on the buses with drivers who are trained to use EpiPens? Or could a bus driver simply carry a cell phone to call 911 if they see something wrong?

If there is an agreed upon allergy response policy in the classroom, what makes the bus any different? Is it that the driver holds in his/her hands the lives of many children during the ride and should not be expected to handle the extra burden of food allergy preparedness?

Remember, life-threatening allergies are a federally defined disability, requiring school departments to make accommodations for those with such allergies under the Americans with Disabilities Act. Also remember, going down that path with school adminstrators is a bit of a slippery slope. (You might become one of THOSE parents.)

What role do the parents play in making sure their child is safe on the bus? Gloves? Allergen barrier lotion? Should the child always sit by themselves in the front row? (We wouldn't want them to stand out too much, would we?)

As with most of what we deal with as parents of food allergic children, there are no easy answers. My opinion is that well thought out planning and open discussion will always work better than pointing to legislation and demanding action. Try getting to know the bus driver. Maybe bake them an allergen-free treat once a week and have your child say thanks as he/she hands the driver the treat with a smile. You can always get more done by showing kindness.

Posted by David at 11:48 AM | Comments (2)

April 18, 2006

Emotional Rollercoaster of Flying on US Airways

source: dailylocal.com

When Greg Robino, 36, of Downingtown, recently decided to take his family on vacation to visit relatives in Texas, his main concern amounted to peanuts. Greg Robino’s son, 4-year-old Nathan, is allergic to peanuts and tree nuts, long-known as the traditional mid-flight snack of commercial airlines.

But he and wife, Heather, did their homework. Greg Robino, a software salesman and frequent flier, said a customer service representative assured him that the flight crew could accommodate Nathan by not serving peanuts in the rows around his seat.

On the morning of the March 24 flight, Greg Robino said he was even told that attendants would go the extra step and not serve any peanuts on the flight as a precaution.

"Then the head flight attendant told us that they were required to serve peanuts by company policy. In fact, she used the word required several times. And I just didn’t understand that," he recalled.

The Robinos asked to speak to a customer service representative at Philadelphia International Airport, but they soon learned that the flight crew would not allow Nathan to board the plane anyway, as not to risk an in-flight medical emergency.

"We were on an emotional roller-coaster. We weren’t going to risk our son’s health anyway, and then they concluded that we could not go on even if we wanted to," he said. "My kids were devastated. They had been looking forward to this for months."

Phil Gee, a spokesman for US Airways, said the airline does not differentiate between what snacks are served.

"It’s kind or hit or miss," Gee said. "It depends on where the flight was last catered whether it serves peanuts or pretzels."

He defended the company’s stance, saying there was not a way that any airline could guarantee a peanut-free flight for those with severe food allergies.

"We’ve come to the realization that even if we didn’t serve peanuts we could not guarantee that no one would bring them on board. We would have to search every passenger and sanitize every flight," Gee said. "There may be some airlines today that do not serve peanuts on flights, but no one can guarantee a peanut-free flight."

But the Robinos are not alone. About 1,689,000 Americans have peanut allergies, according to the Food Allergy and Anaphylaxis Network (FAAN).

The same applies to tree nuts, meaning the number of Americans with both is more than 3 million. In addition, children can be particularly vulnerable to food allergies.

There are more than 2 million American children (ages 6 to 18) with food allergies, according to FAAN.

And the prevalence of peanut allergy in children doubled in the five-year period from 1997 to 2002, and the trend shows not sign of stopping.

"Fly at your own risk," is what Kim Easterday, of East Fallowfield, said she was told by US Airways representatives, while planning a May vacation to Walt Disney World for her family.

Kim Easterday’s son, 5-year-old Eddie Jr., is allergic to both peanuts and tree nuts.

"They couldn’t accommodate us. They have finally refunded the airfare. But it is hard to find someone else. There are only peanut-friendly airlines, there are not many peanut-free airlines. And I am concerned about the (peanut) dust," she said.

Kim Easterday said her family has learned to deal with Eddie’s allergies, though it is not easy to be a kid when a peanut-butter cookie can be like a hand-grenade.

"It is hard and I feel bad for him. He cannot eat cake at a birthday party and has to be careful with candy on Halloween," she said. "But I’ve learned to pack a snack ahead of time and we live with it."

Of course, travel does not make the situation any easier.

But the Easterdays are determined to get to Orlando, even if they have to rent a car and drive down, she said.

The Robinos, however, have yet to reschedule their vacation plans.

But Greg Robino said he plans to file a discrimination complaint with the U.S. Department of Transportation’s Aviation Consumer Protection Division on the basis that his family was prohibited from boarding due to his son’s peanut allergy, which qualifies as a disability.

According to the FAAN website, www.foodallergy.org, airlines that do not serve peanut snacks include: American, United, Northwest, Jet Blue, Spirit and ATA.

Posted by David at 7:49 PM | Comments (1)

April 17, 2006

Peanut Allergy Risk Associated with Exposure to Peanut in Infancy

Exposure to peanut during infancy promotes sensitization, but low levels may protect atopic children, according to a new study presented today at the 2006 Annual Meeting of the American Academy of Allergy, Asthma and Immunology (AAAAI).

Adam T. Fox, MD, Imperial College, London, United Kingdom, and colleagues hypothesized that peanut sensitization occurs as a result of exposure. The study was a survey of children with suspected peanut allergy and also looked to see what affect early exposure to peanuts had on the children for later allergy. Questions on the survey ranged from how much peanut the mother ate during pregnancy to how much peanut was eaten by other family members during the child's first year of life. Exposure was compared in three groups of children of the same age: Children with peanut allergy, children with egg allergy but not peanut sensitized and non-allergic children. The average weekly peanut consumption for the allergic children was 77.2g, while the totally non-allergic children averaged 29.1g.

The study concluded that exposure to peanuts during infancy promotes sensitization, and that low levels may protect atopic children. In addition, researchers didn't observe any signs that mothers eating peanuts during pregnancy or breast feeding lead to the children developing the allergy.

source: American Academy of Allergy, Asthma and Immunology

Posted by David at 8:45 AM

April 13, 2006

Allergic Anaphylaxis Often Unreported and Untreated

Life-threatening anaphylactic reactions to foods are under-diagnosed and under-treated, both in the community and in the emergency room, according to researchers here.

So found two studies -- from Massachusetts General Hospital in Boston and the Albany (N.Y.) Medical College -- that were reported at the American Academy of Allergy, Asthma, and Immunology meeting.

"Anaphylaxis has for decades been considered a rare disease, even by physicians, even by other health care professionals," said F. Estelle R. Simons, M.D., of the University of Manitoba in Winnipeg, who is president of the American Academy of Allergy, Asthma and Immunology.

But in fact, the rate of anaphylaxis -- not just anaphylactic shock, but any type of acute, severe allergic reaction -- is likely much higher than published estimates, said Dr. Simons, because many episodes of anaphylaxis occur outside the emergency room.

"They experience anaphylaxis at home, at school, at camp, or on a plane or a bus or wherever they may happen to be," she said.

A consensus panel of the National Institute of Allergy and Infectious Diseases defined anaphylaxis as "acute onset of illness (within minutes to several hours) with involvement of the skin, mucosal tissue or both," following exposure to an allergenic substance, combined with one or more of the following: respiratory compromise, reduced blood pressure or associated symptoms of end-organ dysfunction, involvement of skin or mucosal tissues such as hives, and persistent gastrointestinal symptoms."

But even when anaphylaxis is recognized correctly in the emergency room, only about half of the patients receive epinephrine to treat it, although about a quarter of all such patients have symptoms serious enough to require hospitalization, reported researchers at Massachusetts General Hospital and Harvard Medical School.

Carlos Camargo, M.D., Dr. Ph., and colleagues drew on the National Hospital Ambulatory Medical Care Survey to sample data on emergency department visits from 1993 to 2003.

They included all cases with a diagnosis of acute allergic reaction, including anaphylaxis, as identified by diagnostic codes for angioneurotic edema, unspecified adverse effect of drug, medicinal or biological substances when properly administered, unspecified allergy, and anaphylactic shock, food allergy, and other anaphylactic shocks.

They found that acute allergic reactions account for more than one million emergency department visits each year, but only about 1% were recorded as anaphylaxis.

But that 1% "is very different from our experience, where we found that 30% to 50% of acute allergic reactions in the emergency room are anaphylaxis," said Dr. Camargo.


Posted by David at 11:38 AM

April 11, 2006

Daycare Rejects Peanut Allergic Boy in San Diego

Here in Southern California there was recently another case of illegal treatment of a food allergic child. Channel 10 in San Diego reported that the day care facility, "A Brighter Future", wrote a letter to parents of a peanut-allergic child that states that they do not accept children with peanut allergy because it can't guarantee their child's safety and gave the family 12 days to find another facility.

The preschool website states, "Your child is always treated as an individual and with dignity, understanding and care. Our talented and dedicated teachers are the most important element in our programs." In the school's promotional literature, they claim the school is a "peanut free zone". Both very interesting from an evironment that doesn't admit peanut allergic children.

Now remember, according to the ADA, peanut allergic children are entitled to equal treatment and cannot be excluded on the sole basis of having severe allergies to bee stings or certain foods. Based on the law, the parents are considering a lawsuit.

I don't know what good a lawsuit would do but I do know that writing about the questionable child care practices of "A Brighter Future" school should keep some families away.

And to show our disappointment with how they treat food allergic children, feel free to provide comments to the owner, Dr. Sandra A. Edwin, via their website.

Posted by David at 7:21 PM

April 10, 2006

Study Finds Teens at Highest Risk

A sizeable number of food-allergic teens admit to risk-taking that varies by social circumstances and perceived risks, according to a new study presented today at the 2006 Annual Meeting of the AAAAI.

Adolescents and young adults who live with food allergies often leave home without their epinephrine kits, and almost half would be willing to eat a food that is labeled as potentially containing allergens.

Scott H. Sicherer, MD, Mount Sinai School of Medicine, New York, NY, and colleagues looked to identify why adolescents and young adults are at high risk for fatal food anaphylaxis. Participants, of which 49 percent male, were 13-21 years of age, with three-quarters suffering from peanut allergy or 2 or more allergies, 82% having anaphylaxis and 52% more than three lifetime reactions.

Nearly three-quarters (74%) said they always carry epinephrine, but that percentage varied during activities (ranging from 94% when traveling to 43% when playing sports). Three-quarters said they always read food labels, but 42% said they would eat a food labeled "may contain" an allergen. Teens don't always tell their friends about their food allergies (60% do) and 68% feel educating their friends would make living with food allergy easier.

The results imply educating teens, and people around them in social activities, may reduce risk-taking and its consequences.

source: American Academy of Allergy, Asthma and Immunology

Posted by David at 11:31 AM

April 4, 2006

Child Food Allergy Survey

New research from the University of Maryland shows that parents take special care to tend to their kids’ food allergies. The study appears in the Annals of Allergy, Asthma & Immunology.

Doctor Mary Bollinger’s team studied 87 families with children treated at the University of Maryland Allergy Practice for food allergies. Parents completed a survey covering topics including grocery shopping, meal preparation, and kids’ social activities.
Most parents reported that their child’s food allergy significantly affected meal preparation, grocery shopping, and social activities.
Most of the children in Bollinger’s study were allergic to peanuts, tree nuts, or shellfish. On average, they avoided four foods due to food allergies.

Kids’ food allergies also had a major social impact. Other activities including birthday parties, field trips, and sleepovers at friends’ houses were often affected by kids’ food allergies. If you've been parenting a food allergic child for awhile, you know the challenges at these events oh so well.

Working with the school nurse and staff can be so challenging that 10% of parents said they homeschooled their child because of the child’s food allergies.

A concerning finding is the parents who said they avoided (although not totally banned) letting their child take part in these activities:

> Playing at friends’ houses: 11 percent

> Day care or after-school care: 14 percent

> School parties or birthday parties: 10 percent

> Sleepovers at friends’ houses: 26 percent

> Camp: 26 percent

While relatively few parents totally banned those activities, many noted that their child’s food allergy had significantly affected those activities. Most parents noted food-allergy impact on social activities outside the home.

We've addressed this issue by bringing safe foods for our kids to outside events and rarely rely on others to have sufficient knowledge of label reading and cross-contamination issues. We realized early in our food allergy parenting research that even in educated environments, food allergic children can have exposures that lead to serious reactions.

Research Source: American College of Allergy, Asthma & Immunology.

Posted by David at 8:56 AM | Comments (2)