Allergic Reaction Schools, parents grapple with solutions for complex problem

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On a recent morning at the Asa Adams School in Orono, Leah Prince Ruck, 5, and her friend Rachael Wingard, 4, sat in pint-size red plastic chairs, comparing lunches – carrots, a sandwich and milk for Leah; applesauce, an apple, a soy nut butter sandwich and chocolate soy milk for Rachael.

“So, do you like our classroom?” Leah asked a visitor, who nodded in assent. “Yeah, it’s pretty nice.”

It was a little after 11, and the girls, both in kindergarten, had stayed behind while their classmates filed into the cafeteria. Because each has a severe food allergy – Leah to peanuts, Rachael to peanuts, tree nuts (almonds, walnuts, pecans, etc.), milk and eggs – the girls have chosen to eat in their classroom and rejoin their friends at recess.

In Maine and across the nation, food allergies have changed the landscape of school lunch, and in some cases sparked fierce debate over child safety and civil liberties.

According to the Food Allergy and Anaphylaxis Network, the incidence of food allergies in the United States has doubled over the last 10 years. Today, more than 12 million Americans – about 4 percent of the population – suffer from food allergies. The most common allergens are milk, eggs, wheat, soy, peanuts (which are actually legumes), tree nuts, shellfish and fish.

Dr. Dora Anne Mills, director of the Maine Center for Disease Control and Prevention, says the state doesn’t keep allergy data unless a person dies as a result of a reaction.

“That’s so rare, it wouldn’t be an indicator,” she said.

Anecdotally, allergies seem to be on the rise in Maine, Mills says, but some of that could be attributed to better testing technology. As a girl growing up in Farmington, Mills didn’t know anyone with a peanut allergy. Today, her two children each have peanut-free tables in their school cafeterias.

“That’s fascinating to me, I don’t remember ever even knowing that existed,” she said. “I suspect that’s the experience of a lot of people. Today, it’s very common to have a peanut-free table or peanut-free accommodation.”

Federally, severe allergies of any sort – food, insect stings or otherwise – fall under Section 504, the under-18 version of the Americans with Disabilities Act. This only applies to public schools. However, there is no statewide mandate in place regarding food-service protocol for children with allergies.

“It’s almost becoming a public-health issue,” said Dr. Paul Shapero, a Bangor allergist. “I would think it would be easier if there were a single policy applied to everybody. As people become more knowledgeable and organized, it’s nice for someone to bite the bullet and draft a uniform policy as a place to start and then it could be modified from school system to school system.”

Some schools, such as Bangor High, have banned all nuts. Asa Adams has peanut-free classrooms, as well as designated cafeteria tables where pupils are allowed to eat peanuts or tree nuts. In Brewer’s elementary schools, peanut butter and peanut products are no longer served in the school lunch program; pupils with allergies must sit at the hot-lunch tables, even if they bring food from home.

Each policy has its benefits and drawbacks, but educators, parents, children, medical professionals and state officials agree there are no easy answers.

“It’s hard because people don’t always get it; they don’t understand how dangerous it can be,” Deanna Prince, Leah’s mother, said. “It’s a difficult situation because you have to rely on others oftentimes to keep your child safe.”

For school, Leah totes her lunch in a small, insulated satchel. She brings her own treats to birthday parties. At Halloween, she trades in the candy she collects for sweets purchased from a nut-free specialty store in Vermont. Though Prince says Leah’s friends and their parents have been very accommodating, it’s nerve-wracking to know that trace amounts of nuts and nut oils can pop up in the most unexpected of places – bread, potato chips, chocolate chips and cake mixes, to name a few.

The anatomy of a reaction

Though the triggers and degree of severity vary, the science behind every allergic reaction is the same. The body encounters proteins from an allergen – say, peanuts – and mistakenly thinks they’re harmful, like a virus. The immune system then responds by producing antibodies, which lay in wait until the body ingests or encounters said allergen again.

“They’re primed and ready, like a gun loaded with a bullet,” Shapero explained. “All you have to do is pull the trigger.”

At that point, one of two things can happen: either the immune system goes into overdrive or it doesn’t.

When it does, a range of symptoms can occur – everything from sneezing, runny nose and itchy eyes to anaphylaxis: a severe reaction that could cause a drop in blood pressure, respiratory distress, loss of consciousness, or, in some cases, death. This was the case with Eric Overlock, a 17-year-old from Belfast who died in 1999 after eating a sandwich with peanut oil in it. An estimated 150 people a year die from anaphylaxis to food.

“Unless they have a [child or a friend or a sibling] who has a food allergy, a lot of people say, ‘What’s going to happen? They’re just going to get sick and throw up,'” said Rachael Wingard’s mother, Jennifer, a nurse at Eastern Maine Medical Center. “No, they’re not going to get sick and throw up. They could get anaphylactic shock and die.”

On the other end of the spectrum, there are times when the body is primed and nothing happens. And science can’t explain why.

“Something else goes on that only God knows,” Shapero says.

What is known is that the incidence of food allergies has doubled nationwide in the last 10 years. In the United States, 2.2 million school-age children have some form of food allergy.

There are many theories about the increase, the most popular of which is the “hygiene hypothesis.” This holds that in industrialized countries, people keep things so clean that children are exposed to fewer germs, thus building up fewer immunities. “Deprived of its customary, full-time, germ-fighting job, [the immune system] misidentifies certain foods as harmful,” according to FAAN literature.

Though some have suggested a possible link between a mother’s diet during her pregnancy and a child’s susceptibility to allergy, a study by Dr. Gideon Lack of the Imperial College of London, published in a 2003 issue of the New England Journal of Medicine, found no association. However, genetics do play a role, as do viral infections. Having asthma can increase the severity of a food-related reaction, according to FAAN.

There’s another, less tangible trigger, which makes the science of allergy even trickier: mental conditioning. In other words, a person’s thoughts and fears can actually cause a very real – and very threatening – reaction.

“People can have any type of an allergic reaction to any food,” Shapero said. “They could be allergic to it; it could be that they don’t have the right enzymes to deal with it; or they could be afraid and they talk themselves into it.”

To make matters even more complex, the issue of airborne allergens such as nut dust or vaporized peanut oil raises further concern. According to a 2003 study by Dr. Michael Young at Harvard Medical School, peanut-allergic children who were not aware of their airborne exposure to peanut butter didn’t develop allergic symptoms or anaphylaxis.

Shapero compares the typical inhalation reaction to a cat-allergic person entering a room with a cat in it and developing itchy eyes and a runny nose. He maintains that one must eat the food – rather than inhale it – to develop a severe reaction.

Food for thought

Regardless of whether the reactions are conditioned or a direct result of ingesting a food, all allergies qualify as “hidden disabilities” under Section 504 of the Rehabilitation Act of 1973. Public schools and their lunch programs are subject to the law.

“The federal regulations are pretty specific,” said Walter Beesley, the state’s education specialist in child nutrition services. “If it’s life-threatening, the food service program [must] address it. If it’s not life-threatening, they can address it [if they so choose].”

Beesley said he gets a lot of allergy-related questions from food service directors – many want to know what other schools have done to address the issue. Though the idea of a statewide policy was discussed six years ago, it remains a local issue.

And it’s not just a food service issue.

In Orono, the nut tables came to be years ago, to accommodate a pupil with a severe allergy. Because the cafeteria doubles as a gym, it’s easier to focus nut-specific cleaning efforts in a small area rather than the entire room. In addition, as part of Section 504, teachers, administrators and the school nurse work to address a pupil’s specific needs.

“There are a lot of people involved,” said Lisa Erhardt, a school counselor and assistant principal at Asa Adams. “It really takes a whole school.”

In addition, it takes the support – and understanding – of other parents. Schools that make accommodations for food-allergic students send out a letter at the beginning of the academic year to explain the situation. Often, that letter will ask parents to make sure their children wash their hands and face if they eat peanut butter for breakfast. In some cases, the letter urges parents to bring nut-free foods when it’s their turn to provide snacks. In others, it tells parents that nuts are off-limits entirely.

However, not all parents desire such a blanket policy.

“I think it sets up a false sense of security for parents and for children,” Jennifer Wingard said. “It sets up the school for the potential of a lot of lawsuits. Who’s to say a student isn’t having a peanut butter sandwich in the parking lot? … I just don’t think you can police something like that.”

Although they’re 4 and 5 years old, Rachael and Leah already know there are certain foods they need to avoid. And their parents have taken precautions to avoid potentially dangerous situations. The Prince-Ruck family doesn’t go out to eat very often, and the Wingards don’t go to restaurants at all. Neither family keeps nut products in the home. At home and at school, they have EpiPens, which are self-injecting syringes filled with epinephrine, a synthetic, fast-acting form of adrenaline that counteracts an allergic response.

“When I asked Leah about it, she said, ‘It’s really not so bad; I just get to eat different food,'” Deanna Prince said. “In the whole scheme of things in what kids can have, it’s something we can manage.”

However, it’s not foolproof. During Friday’s emergency evacuation drill at Asa Adams, the girls’ EpiPens got left behind, according to Jennifer Wingard. And despite Rachael’s 504 plan guidelines, a substitute teacher wasn’t made aware of her egg allergy, and birthday cupcakes were the day’s classroom snack. These lapses were a point of frustration – and worry.

“She’s 4 years old,” Wingard said. “If somebody offers her a cupcake, she’s going to take it.”

At press time, the situation hadn’t been resolved, and Erhardt declined to comment on a student-specific incident.

On Friday morning, Wingard planned to revisit the issue with the special education director and school officials. She said she thinks the issue can be resolved in the long term, but she feels the need to be a vociferous advocate for Rachael in the meantime.

“I think that schools need to be aware,” she said. “They need to not take food allergies so lightly. It is a big thing now.”