Think F.A.S.T.

I don't always peruse the food allergy news to the North, but I had a minute to do so today and I love this new acronym that the Ontario Medical Association and Anaphylaxis Canada have put together: Think F.A.S.T.

"F.A.S.T can include any of the following:

* Face: itching, redness, swelling
* Airway: trouble breathing, swallowing, speaking
* Stomach: pain, vomiting, diarrhea
* Total body: hives, rash, weakness, paleness, sense of doom, loss of consciousness." (https://www.oma.org/Mediaroom/PressReleases/Pages/ThinkFAST.aspx)

The focus of the campaign is to increase readiness of the general population to support those with food allergies through their ability to recognize a reaction. This is especially important for parents--you never know when your child will bring home a friend with food allergies. I love that it is easy to remember and it covers all of the main symptoms of anaphylaxis.

So what should you do if you spot F.A.S.T. symptoms? Administer epinephrine and call 911 if a child is experiencing symptoms in 2 or more areas of the list, or if a single symptom is worsening rapidly or severe on its own, such as difficulty breathing.

EpiPens in first aid kits?

Well, I haven't seen Epipens in first aid kits yet, but I think it's coming. Chances are good that if you ask around, you'll find that you know someone who is allergic to bees. And chances are also good that they don't carry epinephrine, even when they're engaged in outdoor activities that put them at risk for a bee sting. (I'm not talking about robbing a beehive here, folks, just going out for a hike, or a picnic, or even to the park.) But feeling safe won't protect you from a fatal reaction if you are stung by a bee and help is too far away. Which is why I think that Epipens should be in first aid kits on guided hikes, sleep away camps, and other similar situations.

It seems like others (like the people who get to make these kinds of decisions) are moving closer to the same opinion, based on this report:

http://www.newdesignworld.com/press/story/183980

In a meeting of the Wilderness Medical Society it was recommended that personnel who are otherwise trained to administer emergency medical treatment should be trained to administer Epipens as well. There may be some legal questions with implementation, so the WMS also recommended that organizations should obtain legal counsel concerning Epipen administration by lay persons in a time of need. Currently, WMS asks that individuals carry their own Epipen, and are supporting the idea of staff being trained to administer it. But in my mind, this is only a couple of steps away from including epinephrine in first aid kits. And that is a good thing.

Birthday Treats at School

The question of how to handle birthday treats at school comes up every year for Sophie. Occasionally parents will make the effort to find out what they could bring that she could have, but like many other kids with food allergies, our fall back solution is a box of safe treats kept by the teacher for those surprise birthday celebrations. This year is much the same. But it might not be that way for allergy kids forever...

My younger (non-allergic) daughter has a September birthday and she wanted to bring a birthday treat to share with her class. I had heard that there is a child with allergies in the class, but I don't even know his/her name. Being a procrastinator by nature, I didn't even think about asking the teacher about the child with food allergies until the day of--too late to contact a parent and buy an appropriate treat. Instead I suggested to my daughter that she choose a little toy to pass out instead. She brought bouncy balls--one for each student in the class--and the other kids LOVED them.

The next week, another student had a birthday, and he brought toys instead of food as well. A new trend perhaps? One can always hope!

Flu shots for people with food allergies

It's that time of year again, when people are getting their flu shots. Or they are getting their flumist. And the doctors lecture about how important it is to get, especially this year (why especially this year?). Over the last few weeks all 4 of my children have had their well-checks. 2 got a flu shot, 1 opted for the FluMist, and 1 is allergic to eggs. Last year I thought I would have her get the FluMist since she can't have the flu shot without taking extra precautions, but Sophie also has mild asthma, which is a contra indicator for the FluMist.

Our pediatrician recommended having a skin test at the allergist's office to determine whether Sophie will react to the shot, which is cultured in eggs. I have never been brave enough to go this route. I'm not worried about the skin test, but if she fails the skin test, she can get the shot "in doses", which essentially means getting 4 or so shots over a several hour period. It's just not my idea of fun! However, I am going to try it this year, after reading this article from Johns Hopkins:

http://www.newswise.com/articles/flu-vaccines-are-safe-for-most-allergic-children

For those of you with egg allergies, what is your approach to the flu shot? What is your experience?

Food as a Weapon?

Food as a weapon? Sounds a little far-fetched, depending on your experience. But for those of us who have swelled up at the touch of a nut or other allergen, or seen someone close to us do the same, it is easy to imagine. Unfortunately, it is also easy for school age children to imagine. A recent study published in the Annals of Allergy, Asthma & Immunology reports on the frequency of bullying targeting children with food allergies. According to the survey data, approximately 25% reported negative interactions with other children focused around food allergies. And of those, 1/3 experienced physical bullying regarding their food allergies.

Although we weren't contacted for this study, Sophie falls in that last third. Thankfully, she has only been physically targeted once, but once is certainly more than enough when it comes to this kind of thing.

When Sophie was in 1st grade, a girl she didn't know sat down next to her at lunch. Sophie's food allergies came up in conversation, and the girl held up a cookie from her own lunch, asking, "Can you eat this cookie?" When Sophie said, "No, it probably has wheat and eggs in it," the other girl put the cookie down right next to Sophie's food, getting crumbs all over the place. Sophie was shaken by the incident. She decided she was finished with her lunch anyway and hurried outside to recess.

Thankfully, that afternoon she spoke to me about the incident and I had the opportunity to speak with her teacher. Her teacher was furious and quickly took steps to educate the child about the seriousness of the action.

In this case, we don't really know if the "bully" understood the potential damage she could inflict. Sophie interpreted her tone as negative, but without another witness we couldn't say for sure. But in other cases, intent seems much more clear. There have now been several cases in the United States in which the bully has actually been arrested and charged with a crime for food allergy related bullying.

On the surface, bullying is bullying is bullying. But the fact that many adults, including those in a position of authority at schools, underestimate the severity of food allergies increases the risk for the targets of food allergy bullying. Threatening a child with a food he or she is allergic to is tantamount to threatening that child with a loaded gun. Both can kill, and equally quickly.

Decisions, decisions...

How do we make decisions that affect our children, especially with food allergies? When trying to negotiate their schooling, classrooms, socials events, friends, how do you decide when to speak up and when to let things take their own course? As I look back over my decisions as a parent, I think there are a couple of major things that I considered (or wish I had!) to aid me in decision making.

1. Health/Endangerment: is this situation putting my child in the way of physical harm? Is my child likely to end up in the hospital if this situation continues?

2. Emotional/Spiritual Health: is this situation likely to cause my child emotional damage? Will this situation adversely affect my child's spiritual growth?

3. Discomfort: will my child be extremely uncomfortable in this situation?

Balanced against possible benefits, these questions can guide us as parents as we try to navigate things like:

Should I send my child to spend an afternoon with the aunt who doesn't believe in food allergies?

Do I need to stay with my 7 year old at a classmates birthday party?

Should I become homeroom mom and coordinate the daily snacks again this year?

Does it makes sense to take my child to the doctor on day one of her fever, or should I wait?

Should I let the doctor give my child the newest vaccine, or this year's flu shot?

After considering the options, benefits, and drawbacks, I have found it is often helpful to ask one more question:

Who does this decision benefit, and am I okay with that?

Looking back, I realize that I sometimes have made decisions about caring for my children that were for my benefit, or a decision about one child that actually benefits another child more. While it is important to do what's best for the whole family, I also like to be aware of why I have taken certain actions. I believe motives can be as important as actions, so I try to be sure that my motives are in line with my values and goals as much as possible.

As a parent of a child with food allergies, I find that my decisions inherently have more potential damage than they did before Sophie was born. If you have found that to be the case as well, I hope you will benefit from my decision guidelines.

Food Bans

(Please note that I realize that my views do not cover every possible scenario, and I also realize that younger children may have different needs.)

I have thought a lot about food bans in schools, since Sophie has food allergies and since our school has considered a food ban. I am personally not in favor of food bans. I have three basic reasons to oppose them. First, a food ban is unnecessary for most people with even severe food allergies. Second, a food ban creates a false sense of security for those who do have an extremely sensitive allergy. Third, other measures would be more effective in preventing classroom contamination than a food ban.

Food bans--completely eliminating a particular food or food group--are unnecessary for most people with food allergies. Very few people over the age of 4 will have a reaction solely based on the presence of their food allergen. There are many anecdotes about reacting when a sibling ate a peanut butter cup or other similar things, but in reality most children will not react unless they come into direct contact with the allergen. In the rare instance that a child does struggle with allergies after eating with other children, special arrangements might be made for that child to eat in a separate area.

In the event that a food is prohibited from a school (or other environment), it can create a false sense of safety because, in actuality, it is nearly impossible to monitor or enforce a ban like this. While children may move away from peanut butter sandwiches, they will continue to bring other items containing peanuts, such as granola bars and cookies. A situation could easily arise where an allergic child makes an assumption of safety about foods that are contaminated. Additionally, banning a single food, like peanuts, will not solve food allergy problems for most schools. Most children have more than one food allergy and peanuts are not necessarily their biggest concern. Should we start banning multiple allergens from schools?

There are several alternatives to food bans that should be considered. Schools can designate specific areas for eating, and allow food only in those areas. One model might be that children eat all of their snacks and meals in the lunchroom. For a school with no lunchroom, all food could be consumed at the child's own desk. In both scenarios, the areas would be cleaned immediately after every meal. Schools can also institute hand washing before and after lunch, to prevent contact with allergens on the playground and in other areas of the school. Another possibility is to institute partial bans; based on the allergens affecting each classroom, ban the offending foods for that classroom only.

These alternatives to the whole school peanut ban are easier to implement and enforce, can be customized for the needs of the particular student, are less restrictive to the students in general, and model solutions that are more adaptable to the outside (of elementary school) world. In the long run, I believe that students with food allergies will be safer and better equipped to manage their food allergies if these types of ideas are utilized in place of the more generalized food bans.