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By Todd Neale, MedPage Today – 11/29/2010

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Pediatricians can play an important role in helping to manage food allergies in schools, according to a clinical report from the American Academy of Pediatrics (AAP).

Pediatricians should first consult with a board-certified allergist-immunologist to get an accurate diagnosis before working with families and school personnel to develop plans to manage the child’s allergy, said Scott Sicherer, MD, of Mount Sinai Medical Center in New York City, and other members of the AAP’s section on allergy and immunology in the report.

The report, published online ahead of the December issue of Pediatrics, was issued by the AAP to highlight the contribution pediatricians can make in managing food allergy in school-age children.

Childhood food allergy appears to be a growing problem; according to recent CDC data cited in the report, there was an 18% increase in food allergy among schoolchildren from 1997 to 2007.

It’s currently estimated that about one in every 25 school-age children have a food allergy — and that 16% to 18% of kids with food allergies have had a reaction at school. The most common childhood food allergies are to nuts (such as peanuts), a frequent (and often hidden) ingredient in many foods including bakery products.

However, pediatricians should be aware that any food can elicit an allergic reaction, according to the AAP report. While the most significant reactions occur in response to peanuts and tree nuts (e.g., walnuts) allergic responses such as urticaria or wheezing can also be induced by milk, fish, shellfish, eggs, soy, and wheat.

Although 25% of anaphylaxis cases occur among children with previously-undiagnosed food allergies, anaphylaxis and death are rare in school-aged children, Sicherer and co-authors stressed.

Diagnosis or clinical confirmation of food allergy are typically done through modalities such as skin-prick tests or food-specific serum immunoglobulin E (IgE) testing, but the report points out that such laboratory tests are not always accurate and may not paint a true picture of how severe an allergy may be.

The authors advised caution in making a diagnosis of a life-threatening food allergy because of the significant effort involved in avoidance of the food allergen and preparations for treatment.

Families of children with a food allergy should notify the school of any prescriptions for self-injectable epinephrine, after which the pediatrician can become involved in developing an easily understandable personalized emergency action plan — created in collaboration with the families, school nurse, and other school personnel, according to the AAP.

Pediatricians can help teach children about the storage and use of epinephrine. They might also want to consider prescribing additional autoinjectors for administering epinephrine at school — one to be carried by the child and others to be kept in the health office, according to the authors.

Sicherer and his colleagues also said the allergy action plan should include simple instructions as to when epinephrine should be administered — such as at the first signs of significant respiratory or cardiovascular symptoms, if symptoms progress, or involve more than one organ system.

Because a reaction can reoccur even after successful treatment with epinephrine, action plans should include instructions to activate emergency medical services and transport for the child to a facility for additional observation and care.

In terms of avoidance strategies, pediatricians can help parents understand the risks of various exposures — such as ingestion versus inhalation versus touching food residues — “so that parents are appropriately vigilant without becoming needlessly hypervigilant about avoidance strategies, particularly because they might affect schools or neighbors,” the authors wrote.

The AAP report did not offer strong recommendations for any particular food avoidance strategy because of the lack of controlled studies.

“Avoidance strategies appropriate for a specific child may vary on the basis of the nature of the allergy, circumstances unique to the particular institution, age of the child, and the child’s developmental stage and disposition,” they wrote.

If you live in Virginia Beach, Norfolk, Chesapeake, Portsmouth, or Hampton Roads, and your child may be suffering from food allergies, we can work with your Pediatrician to form an Allergy Action Plan. Please call us at any of our 3 locations listed below. Our Allergists are here to help you.


About Allergy & Asthma Specialists
Our Allergists work with Pediatricians to diagnose and treat childhood food allergies and to create Allergy Action Plans for patients in Virginia Beach, Norfolk, Chesapeake, Portsmouth, and Hampton Roads.