A 7-year-old Virginia girl died last week as a result of a severe allergic reaction to peanuts. Apparently, the girl had been given a peanut (or peanut-containing food) from another child while on the playground. The girl developed shortness of breath and hives and sought help, although apparently no treatment was given at the school. When emergency medical services arrived at the school, the girl was already in cardiac arrest. She was taken to a local hospital where she was declared dead. This sad story will surely bring up the question of whether or not peanuts should be banned from school. There are other questions that arise -- such as the availability of medicines at school for children with medical problems -- such as injectable epinephrine. And, whether or not that medicine was prescribed by a physician for a specific child, or if that medicine is available for "general use". This could lead to multiple problems, especially since most schools don't have a nurse or other healthcare professional on staff, who would have the ability to recognize and treat a medical emergency. The most important take-home lesson from this tragedy is to ensure that if your child has a life-threatening medical condition, such as food allergies, to have an action plan in place for school officials to follow should an emergency occur.
Peanut allergy is the most common form of food allergy in school age children and adults. Milk and egg allergy are more common in infants and toddlers, but allergies to these foods are commonly outgrown by school age. Recent studies show that in North America and the United Kingdom, 1% of children have peanut allergy. The occurrence of peanut allergy has doubled in the past 10 to 20 years, and the reason for this increase is not completely clear. Possibilities for this increase include topical exposure to peanut proteins in skin creams containing peanut oil, exposure to peanut proteins in breast milk or during pregnancy, as well as exposure to cross-reacting (similar) foods, such as soy. At the present time, it is not known why peanut allergy is becoming more common.
The answer might surprise you. The logical answer is that most food allergy reactions at school occur in the cafeteria during lunchtime, but this isn't the case. In the U.S. Peanut and Tree Nut Registry, 79% of allergic reactions to nuts occurred in the classroom, usually as a result of contact with peanut butter during class projects. Massachusetts's schools reported that 46% of food allergy reactions occurred in the classroom compared to just 9% in the cafeteria.
The key to successful treatment of severe food allergy reactions is the early administration of epinephrine. Therefore, injectable epinephrine should be readily available to treat students with food allergy. Preferably, epinephrine should be accessible within minutes, and should be kept in a secure but unlocked location. Keeping epinephrine in a locked drawer or cabinet is not a good idea, since quickly finding a key for the lock may be difficult when a reaction is occurring.