Anaphylactic Reactions in School Age Children For many parents, sending their child off to a classroom is one of the safest things you do as a parent. New mommies and daddies send their children off to school where they mix common items from a kitchen pantry to learn about science. Their kids gain social skills while gathering around a lunch table and trade snacks brought from home, in their lunch boxes, prepared by a dotting parent. But for a portion of the population, these innocent activities that are very much part of a traditional school setting are just as unexpected and deadly as a random school shooting.
These are the parents of children with severe food allergies that result in anaphylactic reactions. For my family, we had our first brush with food allergies early in my son’s academic life. At almost two years old, Nicholas’ preschool aide did not think much about the peanut butter crackers that another parent had brought in to share with the class. What seemed like a normal part of his school day, quickly turned life threatening. Nicholas had yet to be exposed to peanuts in our home, since the doctors normally tell parents to hold off introducing the food until the child turns two.
Unbeknownst to the preschool aide, and us his parents, Nicholas suffers from a severe peanut allergy. Snack time quickly turned Nicholas from a “normal looking child” into a disfigured, unrecognizable two year old, whose throat was quickly closing, almost resulting in his death. What is most concerning is that the staff reportedly was unsure of what was happening to my son. After a conversation with one of the staff members present, it was clear that no one connected the increased symptoms with an anaphylactic reaction and a plan of action was not in place (S. Watson, personal communication, December 20, 2015).
An ambulance was not called, but I the parent was called to pick up Nicholas. Had we not lived near a hospital, I am not sure how the outcome would have been different. Nicholas’s situation is unfortunately not an isolated incidence. If you have ever seen a child suffering from a severe anaphylactic reaction it is a sight you will never forget.. So how many people are affected by severe food allergies? Current estimations state that “1-2% of the general population is at risk for experiencing anaphylactic reactions caused by food allergies” (Hay, 2006).
Current research also states that children under 3 are more likely to experience an allergic reaction to foods, with about 5% of the population at risk (Hay, 2006). This is most concerning, because it is at that age that children are most often introduced to a school setting. Research shows that this number is growing. Kimberly Holland and Dr. George Krucick sites in his article, “Managing Your Child’s Anaphylaxis at School” that allergies occurring in school age children have seen an 18% increase in the last 10 years (2013).
The American Medical Association defines anaphylaxis as follows: Anaphylaxis is an acute systematic (whole body) type of allergic reaction. It occurs when a person has become sensitized to a certain substance or allergen (that is, the immune system has been abnormally triggered to recognize that allergen as a threat to the body). On the second, or subsequent exposure to the substance, an allergic reaction occurs (2013). The symptoms for a reaction occur rapidly, so it is important to be able to identify them quickly.
According to a brochure published by The Food Allergy & Anaphylaxis Network on Food Allergy Awareness, some of the symptoms include: complaints of a tingling, itchiness, or metallic taste in the mouth; hives; difficulty breathing; swelling and/or itching of the mouth and throat area; diarrhea; vomiting; cramps and stomach pain; paleness (due to a drop in blood pressure); loss of consciousness (2007). Of course, a child may not be able to express his symptoms in medical terminology; therefore, it is important to be familiar with how they may describe their symptoms.
When my son, who we now have discovered has multiple allergies, describes his symptoms by saying things like: my tongue is hot, my mouth feels funny, my tongue itches or it feels like there is a bump on the back of my throat. Our family has become well accustomed to recognizing signs of an allergic reaction, especially in our large family gatherings where Nicholas is more prone to come in contact with food prepared outside of his normal safety guidelines. Since our family is now aware of all of Nicholas’s allergies, everyone who comes in day to day contact with him is careful to read labels on all foods brought into the house.
On some occasions, he may come in contact with food that is not safe for him, and he will start to show symptoms of an allergic reaction about to occur. In addition to his verbal indications of a reaction, you can also start seeing a large red rash also known as hives or raised bumps on various parts of his body. This happens more than one would think. There have been numerous occasions where we have deemed an item to be safe, only to find that something has changed at the manufacture and now that item is potentially deadly.
One would not normally think of nut-free items as dangerous, but unfortunately if a manufacture uses a facility that produces a nut based item, cross contamination now takes something that was once harmless and makes it potentially lethal. Treatment for anaphylactic reaction is based on the severity of the reaction. Mild cases can be treated with children’s Benadryl, or other over the counter antihistamines. In the case described above, there was not direct contact with the allergen, instead there was cross contamination.
Therefore, Nicholas’ symptoms were mild, and were treated with a dose of children’s Benadryl. More serious reactions, like the ones that cause fatalities from laryngeal swelling leading to asphyxia can be treated with an Epi-pen until you are able to get the child to a hospital. Most of the cases that result in a fatality are due in part to a failure to promptly administer the Epi-pen (Hay, 2006)) An Epi-pen can be carried by the child at school, and it can also be kept in the school clinic. An Epi-pen can be administered by the child himself.
Any child with severe allergies should be trained in how to administer their Epi-pen by their physician. Any other adult nearby who has been trained can also administer the Epi-pen. An Epi-pen is injected in the anterior (outer) side of the thigh. Whoever is administering the medication, should hold the pen in place for a count of ten, and then continue by massaging the area. Once an Epi-Pen is injected, the child should be taken to the hospital immediately (Powers, Bergen, & Finnegan, 2007). The more individuals who are trained, the safer a child suffering from severe allergies becomes.
It is clear that school based staffed should be properly trained in recognizing symptoms of anaphylactic reactions, as well as acute care responses. By preventing common mistakes, the child suffering from the reaction has a much greater chance of survival. School districts should consider a three prong approach to training staff to be prepared. The schools should have an emergency plan in place for persons with known allergies, require that emergency medications are available, and have written policies and guidelines for staff to follow (Morris, Baker, & Edwards, 2011).
If a student with a known allergy is a public school student, their “school must comply with the physician’s emergency treatment plan and the American Disabilities Act (ADA), which mandates accommodations for students with allergies” (Hay, 2006). The goal of the accommodations should be to maintain the child’s ability to perform all school activities, despite their allergy. A child should not be made to lose part of their educational day, just because the school does not want to take precautions to protect the child. A typical care plan would be allergy specific.
It may include directions for where to sit at lunch and who can sit near the child. This will change with age. As the child gets older, they become more aware of their allergies and the environment. The shift can move from the school protecting the child, to the child protecting themselves from unsafe substances. The crucial step to a care plan is to properly train the classroom teacher on the steps of the plan. By taking the time upfront to come up with an emergency plan, the child should see limited disruptions of their activities.
The second part of a well-made policy includes having an emergency stock of Epi-pens on site. In most schools, keeping an extra stock of medication is not a normed practice. In most cases, nurses rely on the student’s medications in the case of an emergency. A recent study by the Journal of School Health, indicated that “despite the awareness of possible death within minutes”, only half of the nurses surveyed supported stocking a cabinet with extra Epi-pens (Morris, et al, 2011).
What was shocking is that even though the nurses had previously administered a lifesaving dose of epinephrine, they still did not find that sufficient motivation to having a stocked epinephrine program (Hay, 2006). Finally, a school needs to keep written guidelines available to staff. Staff should know where to find the protocol in case of an emergency, even if they were not part of the initial care plan. In any given day, a child will see more than their classroom teacher. They will come into contact with administrators, secretaries, and cafeteria aides.
All of these individuals should know where to find written guidelines that will guide them through the necessary steps of caring for a child with severe allergies. Those guidelines should include how to administer basic first aid and even CPR. Children with severe allergies need to be supported by those in their environment. If they are in a school setting, that means those people should be aware of symptoms of a food allergy, as well as have a basic understanding of the level of care that should be administered.
They should know the common symptoms of an allergic reaction, but they should also be aware of how children describe their symptoms. A basic care plan should be developed for each child with a severe food allergy that addresses an emergency plan tailored to the child. Since in many cases, allergies first appear on school grounds, a stock of Epi-pens should be made available on campus. Keeping the lines of communication open, and being prepared for an emergency is a sure fire way to keep children safe while they are at school.