Finding Food Allergy Allies

Schools, States, Restaurants Take Steps; Beyond the Peanut-Free Table
By LIZ RAPPAPORT

Many parents of children with life-threatening allergies say they are seeing changes at schools, day-care centers and restaurants. This comes after years of being dismissed as overbearing or overprotective in their efforts to insure school lunches and play-date snacks didn't expose their kids to danger.


Parents used to address this issue preschool by preschool and classroom by classroom. Now school districts and state legislatures are stepping in as the general public has become more aware of the issue.


The new awareness is partly because the number of children with severe food allergies has increased sharply. About six million school-age kids in the U.S., or one out of every 13, has serious food allergies, according to the latest medical research published in 2011 in the American Academy of Pediatrics' official journal. The number of children with food allergies rose 18% from 1997 through 2008, according to the Centers for Disease Control and Prevention.


As the number of children with severe food allergies grows, parents are finding that their worries are beginning to be heard in some high places. Elizabeth Rappaport has details on Lunch Break

Researchers have been unable to explain with certainty the increase. Some scientists theorize that greater attention to cleanliness has made people more sensitive to allergens and their bodies have become confused about what is genuinely a dangerous substance.


More than 100 laws or regulations have been enacted by U.S. states in the last decade to address the needs of people with food allergies, according to the Food Allergy and Anaphylaxis Network, a nonprofit group. One recent measure, passed by Illinois legislators last summer, encourages schools to stock epinephrine, a potentially lifesaving drug for people experiencing anaphylactic shock. Similar bills are pending in at least five other states and the federal government.


After Massachusetts passed a law in 2009 requiring restaurant managers to receive training about food allergies, a handful of other states are considering similar moves.


Parents and activists say there is still a long way to go in protecting children from attacks. Children die each year from food allergy attacks; there is no clear data on the number of those deaths. And while peanut allergies are on most people's radar, food allergies such as dairy or eggs—which are growing in number and severity—are often confused with simple lactose intolerance. Worries about dangers like consuming dark chocolate that has touched machinery used to make milk chocolate seem to some odd or paranoid.

Taking Action

In Restaurants…

Eateries in Massachusetts must post information about food allergies in their kitchens and add notes to menus asking diners to inform waiters of allergies. State inspectors verify that managers have watched a video about food allergies in routine inspections. (Massachusetts Food Allergy Awareness in Restaurants Bill, in effect since 2009)

In Schools…

Illinois schools are encouraged to stock epinephrine for students and staff who don't already keep the medication at school. About 20% to 25% of the time epinephrine is used in school settings it is for a child whose allergic condition was unknown. Chicago's public school system recently said it will stock epinephrine in schools. (Illinois Emergency Epinephrine Bill, passed in 2011)

In Arizona...

The Department of Health Services published a 30-page manual on allergic reactions in schools (most happen in classrooms) and how to recognize the signs (itching, wheezing, stomach cramps). It highlights how children describe reactions ('my tongue is hot,' 'my lips feel tight') and how to use epinephrine. (Arizona Resource Guide for Supporting Children With Life-Threatening Food Allergies, developed in 2007)

In Ambulances…

The drug epinephrine must be available on all emergency vehicles—ambulance, fire truck and aircraft transport—in Minnesota. Responders must be trained on how to recognize an anaphylactic reaction and administer the drug. Following Minnesota, about 35 other states have passed similar measures. (The Minnesota Ambulance Act, passed in 2002)

Still, greater awareness of food allergies has come as restaurant diners ask for lists of ingredients in meals and preparations and more people know someone with another type of food intolerance such as gluten sensitivity.

Some common allergy triggers are milk, shellfish, legumes, sesame, eggs and tree nuts like almonds and walnuts. Consuming these can bring on an anaphylactic reaction, in which a person's throat closes, cutting off oxygen, or the stomach convulses and the lungs eventually swell up. Death can occur within a few minutes, or it can take time for the reaction to spread.

"I take a risk" every day, says Kelly Rudnicki of sending her 9-year-old son, John, to school. He is allergic to dairy, peanuts, tree nuts and legumes. When John started preschool, Ms. Rudnicki says she got "deer-in-headlights looks" from other parents and teachers because her son was the only child with allergies. Now, people are more conscious, she says. John's fourth-grade class in a suburb of Chicago recently invited Ms. Rudnicki to consult with the planning committee for a spring fair to help select refreshments that won't trigger John's allergies.


I have noticed changes, too. When my daughter, Georgia, was attending preschool in Brooklyn, N.Y., five years ago, we arrived at a school party to find sesame bagels and plates of egg salad, both dangerous foods for Georgia to come into contact with. And that was after an email discussion among class parents that week about her allergies.


Now managing Georgia's allergies, which include eggs, nuts, legumes, sesame and soy, has become easier. "Does anyone in the class have food allergies?" one mother asked in an email during planning for a recent Valentine's Day party, much to my surprise and relief.


The Massachusetts law requires restaurant managers to go through a training session about food allergies. They are required to know which foods cause reactions, including nuts, fish, shellfish, and eggs, and are encouraged to have a list of every ingredient for each menu item. The state's restaurant inspectors verify that managers have gone through the training in regular inspections.

The recent legislation in Illinois to ensure schools are equipped with epinephrine began after the 2010 death of Katelyn Carlson, a seventh grader in the Edison Regional Gifted Center in the Albany Park area of Chicago. Katelyn had an allergic reaction and died after eating peanuts in the Chinese food her class had brought in for a holiday party.


But some parents feel the law doesn't go far enough. For one thing, stocking epinephrine in schools is voluntary. And, in most states, it can only be administered by the school nurse, who, in the event of a child having an anaphylactic reaction, might not be able to reach the child's classroom or lunchroom in time. Some parents and food-allergy advocacy groups believe administering epinephrine should be part of a teacher's regular first-aid training.


Laws currently pending in Florida, Maryland, New York, Oklahoma, and Virginia would expand the school personnel permitted to give epinephrine in schools.


Meanwhile, some doctors are concerned that these laws give too much authority to people who aren't medical professionals, says Edward Pont, chairman of the government affairs committee for the Illinois Chapter of the American Academy of Pediatrics.


"We aren't opposed outright, but the laws have to strike the right balance," says Dr. Pont.


Dr. Pont worked with the Illinois Medical Society to stipulate that only a school nurse may give epinephrine to a child having a reaction who isn't already known to have an allergy. Epinephrine can make a person's heart race, and can interfere with other drugs.


The number of people in the U.S. with one or more EpiPens, the dominant brand for delivering epinephrine, has grown by 72%—to 1.8 million—since December 2002. Children make up 46% of EpiPen users.


Stacey Saiontz, in Westchester, N.Y., worked with legislators in her state to draft a bill that would require teachers to be trained to administer epinephrine before they can be certified to teach in the state.



"Kids need to be able to get this medicine in a matter of minutes," Ms. Saiontz says. Nurses now keep epinephrine prescribed for children often locked in the nurse's office. Ms. Saiontz's son, Jared, age 4, is allergic to dairy, egg, nuts and many grains including wheat. Jared attends a preschool that stocks epinephrine in his classroom.

As children get older, the awareness their parents fought hard to bring can start to seem like unwanted attention.

Ms. Rudnicki, in Chicago, says that as her son has gotten older, he is more self-conscious about his allergies. He doesn't want to be the reason that his friends can't eat something they want.


Mary Lenahan of Geneva, Ill., says she believes things have improved for kids like her daughter, Alex Simko, now 17. Ten years ago, Ms. Lenahan says other parents suggested she home-school her daughter because they didn't want to be limited in what food their children could bring to school. Alex herself says she was the lone child at a peanut-free lunch table and that other children acted afraid of her.


Alex now earns extra money by baby sitting children with food allergies. She says she eventually wants to be an emergency room nurse. "I don't want anyone else to go through what I went through."