Consumer Environment Health Nation World — 21 February 2012

Max Rosland, a 7-year-old elementary school student from Carter Lake, Iowa, was placed on a heart-lung bypass machine last month because of a severe allergic reaction to a peanut he ate at school. He survived. Ammaria Johnson, a first-grader from Richmond, Virginia went into anaphylactic shock and tragically died January 2 after eating a peanut her classmate gave her during recess.

The frequent and harrowing stories of food allergies have prompted a national outcry for schools to carry epinephrine (an emergency medicine that combats allergic reaction) and for parents to have their children tested for food allergies.

“This type of tragedy happens more often than you think,” said Darshana Alle, MD, an immunologist certified with the American Board of Allergy and Immunology, and practicing physician with the Allergy and Asthma Care Centers in Arlington, Virginia. “It’s something that parents and schools must be prepared to address.”

The National Institute of Allergy and Infectious Disease (NIAID) reports that food allergies alone cause 30,000 anaphylactic shock episodes and 140 deaths each year.

Those are too many Max’s and Ammaria’s.

Dr. Alle strongly recommends equipping homes and schools with epinephrine, and teaching both parents and school faculty the appropriate use of this potentially life-saving medication. She stressed that, “In emergency situations, epinephrine can neutralize anaphylactic shock, and that can mean the difference between life and death.”

Dr. Alle’s opinions are being echoed in federal and state legislatures around the country. Senator Richard Durbin (D-Illinois) recently introduced the School Access to Emergency Epinephrine Act (S. 1884) to provide incentives to require schools to maintain and permit school personnel to administer epinephrine.

In Virginia, Delegate Peter Farrell (R-56th) introduced HB 1156 which would allow school officials to administer epinephrine to students believed to be in anaphylactic shock.

“This bill is in direct response to the Chesterfield (county) situation,” Virginia Delegate Riley Ingram (R-62nd) told Capital News Service when referring to Ammaria Johnson’s tragic death.

Six other states have similar legislation underway. But, parents cannot afford to wait for legislation to address the hidden, and sometimes deadly, dangers of food allergy.

Anaphylaxis: The Potentially Deadly Allergic Reaction

The most dreaded manifestation of food allergy is anaphylaxis, a rapid-onset allergic reaction that can cause death. It most commonly presents with skin, respiratory, cardiac or gastrointestinal symptoms, where at least two organ systems are affected. If the cardiovascular system is affected, it can lead to potential shock and death. Anaphylaxis is always a medical emergency.

The primary treatment for anaphylaxis is epinephrine, which is the hormone adrenaline. Epinephrine is available only through a prescription and is administered through an auto-injector, or spring-loaded needle called an EpiPen.

It is this treatment that legislators want to make available in schools, and physicians want parents and school officials to learn how and when to use it.

Steps Parents Can Take to Avoid Tragedy

1. Be diligent about the signs of food allergy

Dr. Alle recommends parents be diligent about the signs of food allergy, and ask these important questions:

• Does one kind of food seem to cause problems?
• Is there an immediate reaction in the hour or so after the food is ingested?
• What type of reaction does it cause (hives, tongue swelling, wheezing, vomiting, eczema, etc.)?

She further stresses that “Children who have food challenges should be seen by an allergist for a complete diagnostic assessment, and at least once a year, thereafter.”

2. Consult an immunologist / allergist

An immunologist, or allergist, is a physician trained in diagnosing, treating and managing allergies, asthma and immunologic disorders.

“As allergists we often are playing the role of detective to investigate what might be causing the symptoms,” Dr. Alle stated. “Whether the patient is an adult or a child, we need to define the problem through a detailed history, thorough exam, and if indicated, a skin test, blood test or ‘food challenge’. Then, we determine how to best approach and manage the problem.”

3. Be prepared at home and school

If an adult or child has been diagnosed with a food allergy, or is predisposed to food allergies, an allergist may prescribe epinephrine. The allergist or another healthcare provider provides training on how to administer the medicine in an emergency.

“Being prepared and trained on how to use an EpiPen, or other epinephrine auto-injector, is a necessity for parents and school personnel who care for children with food allergies,” Dr. Alle stressed.

About Food Allergy

A food allergy is an abnormal immune response to a certain food that the body reacts to as harmful. A reaction to food that may suggest possible allergy consists of immediate-onset (within one hour) of symptoms such as:

  • Hives
  • Tingling in the mouth
  • Swelling in the tongue and throat
  • Difficulty breathing
  • Abdominal cramps
  • Vomiting or diarrhea
  • Eczema or rash
  • Coughing or wheezing
  • Loss of consciousness
  • Dizziness

The Centers for Disease Control and Prevention (CDC) notes the following specific risk factors associated with food allergy:

  • Family history of allergy or asthma
  • Genetic predisposition to allergic disease
  • Being under the age of 3
  • Elevated allergen-specific serum immunoglobulin levels

Foods that are commonly implicated with allergy include:

  • Peanuts and tree nuts
  • Wheat
  • Eggs
  • Milk
  • Soy
  • Shellfish

Even with improved diagnostic tools, treatment and management, the number of children with allergies in general has increased 18% from 1997 to 2007, according to the National Center for Health Statistics.

“There’s no cure for food allergies,” summarized Dr. Alle. “Obviously, as physicians, we want to help recognize early which foods are a problem, make sure the patient avoids them, and be vigilant in monitoring the health of the patient regularly with visits to the doctor. Food allergies are just too important to ignore.”

Thankfully, physicians and legislators alike are taking steps to minimize the chance of another tragic food allergy death, like Ammaria Johnson’s.

RESOURCES:

http://www.niaid.nih.gov/about/organization/dait/documents/june30_2003.pdf

http://www.cdc.gov/healthyyouth/foodallergies/

http://www.cdc.gov/nchs/data/databriefs/db10.htm

http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020800s020lbl.pdf

http://www.opencongress.org/bill/112-s1884/show

http://leg1.state.va.us/cgi-bin/legp504.exe?121+ful+HB1156

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(3) Readers Comments

  1. Hey Barbara: thanks for the info! We need moms n dads to call congress and drive prevention. Got the link you sent and will bring to schhol. The state n fed bills are listed in the last links in the article, but who do we call? Any help?

  2. In terms of access to epinephrine, it is especially important to call your congressional representatives in support of the School Access to Emergency Epinephrine Act currently making its way through the legislative process. But it’s not enough to have access to *counter* the effects of anaphylaxis – it’s important to make sure the most egregious allergens are kept out of the classroom. There’s a great open letter to parents on SnackSafely.com entitled “Why Your Child Can’t Bring Peanut Butter to School (and What You Can Do About It)” that addresses the issue of peanut butter bans in the classroom in a non-confrontational way. I urge *all* parents to read it regardless of whether or not they have a food allergic child and to distribute it to their school officials. Find it here: http://snacksafely.com/2011/11/why-your-child-cant-bring-peanut-butter-to-school/

  3. So tragic and preventable.