Here are some facts about why it can be a complex matter to manage food allergy exposures, based on my personal experiences managing food encounters for my nut-allergic preschooler.
1. Oftentimes the only way to know if a child is allergic to a particular food is only after he or she encounters the allergen and has a reaction. Such was the case for my son. It wasn’t until after he broke out in hives after tasting peanut butter ice cream for the first time did we even realize he might be allergic. A pediatric allergist’s test later confirmed that he was allergic to peanuts and tree nuts, but prior to the ice cream incident, we had absolutely no idea or suspicion that my son was allergic. Luckily, his reaction was limited to hives — we were near a pharmacy when we went out for ice cream that day, and a dose of children’s Benadryl brought down the hives. It scares me, however, to think what would have happened if he had a more severe reaction, such as anaphylaxis.
2. Even if different children have the same food allergy, every child’s sensitivity level and limits of exposure can be different. Some children with nut allergies only react if they ingest the food. Other times, they can be so sensitive that merely touching the food, or even touching a surface (such as a bus seat) with food residue, or even being near the food and inhaling the smell sets off a reaction.
Additionally, the severity of a reaction can be different in different students: Some could come down with a mild case of hives while others have a severe and potentially fatal reaction like anaphylaxis.
Another important issue is cross-contamination: when a food item doesn’t contain nuts but was produced on the same factory machinery that produced a nut product. This can be true with a whole range of foods including (but not limited to) cookies, candy, crackers, pretzels and chips, and cereal and cereal bars. Some children with peanut allergies are so sensitive they cannot eat, smell or touch the residue of a food that is cross-contaminated (even though the food itself does not have any nuts).
The same cross-contamination issue applies to other common food allergens like eggs and milk. Today’s food labels include this important information regarding if the food item “contains” or “may contain” or “was produced on the same machinery as” as particular common food allergen.
The bottom line for my family: We cannot know exactly how badly my son will react to peanut foods or cross-contaminated foods until and unless he has a reaction, but my son is not a science experiment and I would never risk trying to find out, so I avoid all “peanut encounters” whenever possible.
All this leads me to my third and fourth points, which are:
3. Given the individual nature of a child’s peanut (or other food) allergy, it is necessary to create individualized prevention strategies for each child with a peanut (or other food) allergy. These strategies may end up being very similar if not exactly alike between different students, but you cannot start by assuming “one strategy fits all.”
Such was the case at the preschool my son formerly attended — another parent provided a list of the foods their peanut-allergic child could and could not eat or be around, and the preschool staff assumed the same would be true for my son. Even though the other parent did a lot of research and provided an extensive list of “safe” and “unsafe” brands and products, there was no way I was going to let my son eat any food that I did not research and approve specifically for him.
4. Each parent’s comfort level with the potential for exposure is going to be different. In our house, even though my youngest son is the only one who is peanut allergic, no one in our family eats peanut products. This was a personal decision we made because of the age of my allergic son and the age of his older, non-allergic brother. My older son is protective of his younger brother, but is still young enough, I feel, to mistakenly expose him to peanuts. Some families may look at our decision and think such all-around precautions are unnecessary if the majority of family members are not allergic, while others would agree with our decision.
When my peanut-allergic son is at preschool, he sits at a one-person table that is next to the larger table where the rest of his classmates eat. His classmate’s parents have been encouraged to (but are not mandated to) not send in food with peanuts. I feel comfortable enough with this strategy for my son, but other parents may not think it goes far enough for their allergic child. (Accordingly they might opt for a peanut-free preschool.) Still other parents might believe it is OK for their allergic child to sit next to a friend who is eating a PB&J sandwich so long as their child and his or her friends don’t share each other’s food.
5. To date, the only way to ensure a food-allergic child isn’t exposed to the allergen is to not have the food present. This is why I encourage a no-eating policy on a school bus. But such a statement comes with obvious caveats. Clearly, kids are bringing their lunches onto the school bus, so I am not talking about having no food present.
Additionally, other students, such as those with diabetes, may have a compelling reason to be able eat food in an emergency. The trick (and I know it can be tricky) is to know these details about your students with special needs who grouped together on routes, and then be able to be take part in outlining, or be privy to information in, say, a 504 plan or other school-medical plan.
Reprinted from the October 2009 issue of School Transportation News magazine. All rights reserved.
