New guidelines for how Texas public and charter schools should handle students with food allergies took effect August 1. In this KERA Health Checkup, Dr. Drew Bird of Children’s Medical Center talked about the need for state guidelines when many schools have food allergy response plans in place.
Dr. Bird: I think there’s a lot of variability and not all guidelines were necessarily in line with recommendations on a national level. What we were establishing to do is to help provide some framework for families and parents, that they could know what to expect when talking to schools, and the schools in turn could also feel like they were complying with best practice recommendations.
Baker: Would it go so far as schools actually having an epipen or actually using said epi-pen?
Dr. Bird: The epi-pen is an auto-injection epinephrine device that can be used in case of a severe allergic reaction. One in five children may have their first reaction at school. So it’s important to recognize what food-induced allergic reaction looks like, and then how we treat it. For the kids who are already diagnosed with food allergy, the signs and symptoms of a food-induced allergic reaction will be taught to the teachers and to the school personnel so they’ll understand how to recognize that and how to have access to epinephrine. For kids who are diagnosed, we are asking them to have their epinephrine at school and, in addition, have a food allergy action plan. And the action plan itself describes what the reaction looks like and then goes step by step as far as how you treat the reaction should one occur.
Baker: This must be welcome news to parents.
Dr. Bird: It’s been encouraged for a long time. The families have really wanted some standardized guidelines and so it’s been some relief for parents in addition to the schools. They expressed to us they need the education, they want the guidance.
Baker: How widespread a problem do we have in food allergies in Texas?
Dr. Bird: I’ve seen, over the past decade, about an 18 percent increase in kids under the age of 18 nationwide being diagnosed with food allergy. The most recent estimates have estimated approximately 1 in 13 children have a food allergy. Best estimates say between 1 in 13 to 1 in 25 kids. So regardless it seems that everyone has at least one kid in the classroom that has a food allergy. There may be more.
Baker: Are we seeing an increase in food allergies or perhaps we’re seeing greater awareness of the problem?
Dr. Bird: I think it’s likely a combination. There is some recognition of food allergy but for symptoms like anaphylaxis which is a severe reaction to food. Its hard to mistaken that disease itself, so we are definitely seeing more cases of anaphylaxis, seeing more kids with food allergy and then studies that have looked in individual areas. For instance, New York state, they’ve noticed an increased incidents, almost more than doubling in just peanut allergy alone in a short time period. So we don’t really know why that’s increasing but we are seeing more if it, the past decade at least.
Baker: You mentioned peanut allergies which has gotten some amount of press, publicity on its own. But what are some of the other, more common forms of food allergies?
Dr. Bird: So 90 percent of all food-induced allergic reactions are caused by eight major foods or food groups: milk, eggs, peanuts, tree nuts as a group, things like walnuts, pecans, cashews; fish, shellfish, wheat and soy.
Baker: We know from all the reports we’ve seen on peanut allergies that it can be deadly. The others that you’ve mentioned, can they produce as serious a reaction?
Dr. Bird: The most commonly fatal food-induced reactions are common to peanuts, tree nuts, fish or shellfish. But sever anaphylaxis can occur to any food, so it is possible. But it is more likely with those foods like peanuts, tree nuts, fish and shellfish.
Baker: But with a problem this widespread among kids, how much of an impact has this made on schools already? How does it change the environment in schools?
Dr. Bird: I think it’s brought more awareness. Certainly more teachers are aware they’re moving more away from having projects in the classroom that involve foods, for instance. I think there still is a lot of controversy over how exactly to care for kids in the cafeteria. The best practice guidelines recommend that we have safety guidelines in place where the tables are cleaned. Between eating, we do ask that kids are able to eat a place in the cafeteria where at least the children sitting beside them do not have the allergen within their lunch. But the kids, in order to have a fatal reaction to the food, in most cases, need to ingest the food. So we really ask that the families really educate the kids as well as the staff on keeping that child’s plate very safe.
Baker: Does the food allergy begin mostly or only in childhood or can it develop at any point?
Dr. Bird: It can develop at any point, though we see it more commonly in childhood. Most often children will outgrow their food allergies, especially to foods like milk and egg and what and soy, it’s the foods like peanuts, tree nuts, fish and shellfish that tend to be more persistent. In adults, we often will see things like shellfish allergy develop.
Baker: Are we even close to a cure for any of the food allergies?
Dr. Bird: There are quite a few research studies ongoing that are really promising. Some of those involve giving small amounts of the food over time. Others have looked at giving Chinese herbs in combination and seeing if that is helpful in blocking anaphylaxis and perhaps treating food allergy. We’re doing more studies on transdermal patches that will release part of the allergen. And we’re hopeful that within the next ten years at least we’ll have a standard treatment.
Dr. Drew Bird is Director of the Food Allergy Center at Children’s Medical Center in Dallas.
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