Backpacks, notebooks, calculators, pencils, and pens … these are some of our common back-to-school supplies. But with food allergies becoming more and more common, the other pen many of us should be thinking about is the Epi-Pen. The Epi-Pen is a portable auto-injector of Epinephrine, a drug that each year saves the lives of many children and adults who develop the most severe form of an allergic reaction—anaphylaxis.
Anaphylaxis is one of the most serious pediatric emergencies that we see in the Emergency Department at the Children’s Hospital of Philadelphia. The most severe symptoms can include: the throat “closing up” from airway swelling, the lungs “clamping down” from bronchospasm (as happens with a severe asthma attack), and passing out from a drop in blood pressure (shock). In addition to trouble breathing and swallowing, other findings may include swelling of the face, lips, and tongue, as well as a whole body rash or hives.
So why should “‘back to school” make us think about allergy and anaphylaxis? Well, the most common triggers are foods, insect stings, medications, latex exposure, and, believe it or not, exercise. The cafeteria, snack-time, the playground … even gym class can be the setting in which the cascade of anaphylaxis starts.
But let’s talk specifically about food allergies, the most common cause of anaphylaxis in kids. Approximately 3 million U.S. kids (6-8%) have food allergies. Statistics vary, but most agree that they are likely underestimates. Moreover, these numbers continue to rise. The Centers for Disease Control and Prevention states that this is an 18% increase from a decade ago. Shockingly, no one really knows why allergies are on the rise.
One of the more popular theories is that we are just too clean. As a society, we continue to get better at minimizing the “germs” around us. As individuals, we put fewer “impure” things into our bodies. The result? Our immune systems see fewer and fewer “foreign” invaders. Consequently, the immune system a) isn’t as sharp as it used to be, and b) goes overboard when the infrequent "foreign" protein or germ comes along.
Which foods are the biggest offenders? The following 8 foods account for 90% of all food-allergic reactions in the U.S.: milk, eggs, peanuts, tree nuts (e.g., walnuts, almonds, cashews, pistachios, pecans), wheat, soy, fish, and shellfish. Many of these ingredients are found in the foods we eat every day. The scary thing is that children may occasionally “develop” an allergy to something that they’ve previously eaten safely.
Importantly, we should teach our allergic children never to eat anything without its ingredients being scrutinized by an adult knowledgeable about allergies. (Fortunately, by their teen years, most children are comfortable reading the ingredient labels themselves.) All too often, two lunchtime friends share a bite of a sandwich (PB & J is a common culprit!) or a delicious, but nut-laden, cookie. The results can be fatal.
Because severe food allergies are becoming more prevalent, and some schools have “peanut-free” and even “dairy-free” tables in the lunch-time cafeteria. Along these lines, parent-parent and parent-teacher communication is crucial on “party days” when students bring food into the classroom. Moreover, mothers (and dads!) of allergic kids should, when possible, participate in class parties and school trips.
Parents of non-allergic kids can remind their children to be extremely careful when around their friends with food allergies. While sharing food is a clear ‘no-no’... lethal food allergens can even be transmitted between friends by “food-contaminated” hands. For example, a dairy allergic child can have a full-blown anaphylactic attack just by shaking hands with his friend who has cheese curls crumbs on his hands. The allergic child’s hand gets “contaminated” with cheese, then he merely has to touch his fingers to his lips—or even rub his eyes! These innocent exposures happen every day.
What we as parents should do is to ensure that our schools ALWAYS have someone on the premises (... and, yes, even on field trips!) who is “Epi-Pen trained.” In most cases, this is the school nurse. Unfortunately, not all schools have a dedicated school nurse, so someone else (principal, teacher, aide, etc.) must undergo the training. Sound onerous? It’s not. The training takes only 10-15 minutes.
We should also advocate for our children at the local, state, and federal levels, for allergy awareness and legislative reform. A tremendous resource to start with is the Food Allergy & Anaphylaxis Network (FAAN). This advocacy group is an outstanding educational resource for patients and their families.
So, now that September has rolled around, take the time to talk about your child’s allergies with the nurse, the teachers, the aides ... even “the cafeteria lady.” And don’t forget to go to the nurse yourself to deliver your child’s doctor-prescribed Epi-Pen ... It could save your child’s life.
Dr. Nicholas Tsarouhas (pronounced Tsa-Roo-Haas) has been an attending physician in the Children's Hospital of Philadelphia Emergency Department for 10 years and currently serves as associate medical director of the Emergency Department. He also holds an academic appointment with the University of Pennsylvania School of Medicine, as an associate professor of pediatrics.