Keeping children with food allergeries safe at home is simple — the food the child is allergic to is banished from the home. But children with food allergies often face complications when they head off to school, and clinicians must do their part to diagnose and document life-threatening allergies, educate parents and work with them to create action plans for their child.

One in every 25 children has a food allergy and 16% to 18% report experiencing an allergic reaction at school, according to data from a 2010 study published in Pediatrics.

“In reality, there is no such thing as a nut-free school or a nut-free table,” Nancy Sander, founder and president of the National Allergy & Asthma Network: Mothers of Asthmatics (AANMA), told Clinical Advisor.

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Children with allergies are always a risk for exposure at school, and although fatal reactions are rare among school-aged children, a number have died due to major delays in receiving an epinephrine injection when experiencing anaphylaxis at school.

 “Although many clinicians do not have the time to work with schools directly, they can provide parents with the tools they need to make school a safer place for their child,” Anna Mendenhall, MD, a board certified pediatrician with the Children’s Physicians Medical Group in Encinitas, Calif., said.

Diagnosing allergies

Food allergies are on the rise, increasing 18% among school-aged children from 1997 to 2007. Children with eczema and asthma are at even greater risk for food allergy, according to Mendenhall, who emphasized that asthma further complicates the condition.

Food allergies can involve a number of different foods and vary in severity. The most common allergies include: peanut, tree nut, milk, fish, shellfish, egg, soy and wheat. Allergy-related deaths among school-age children are most often attributable to nuts, milk and seafood, data indicate.

Any child suspected of a food allergy should undergo testing, according to Mendenhall. “Gone are the days when allergy testing required numerous pokes. Today, one test (immunoCAP) can screen for a host of different allergies at once.”

Any allergy test can produce false-positive or false-negative results and should be used in context with other available information. For example, if a test comes back positive for a cow’s milk allergy, but the child has been eating milk, cheese and yogurt without a problem, the test may not be accurate.