Once my son, at the age of 1, was diagnosed with a severe peanut allergy, his two vials of Epi Pen Jr. came with us everywhere. The supermarket, short walks around the neighborhood and to the park. I carried it with us religiously. So when I was informed after Kindergarten registration that he would not be able to have his Epi Pens with him when traveling on the school bus I was shocked, worried and concerned about him and others like him. How could a school district, located in the suburbs just outside New York City, which accommodates those with food allergies by having a “peanut allergy class” throw caution to the wind and not allow the only medication that could save him if he came into contact with a peanut allergen on the school bus?
As a School Psychologist I am aware that children share snacks on the bus. I have first handedly been informed of food allergic reactions on the school bus because a child (age 7) tasted another child’s cookie. And, as educated as a 4 year old can be about a peanut allergy, children are still curious and are still void of good judgment from time to time.
Thus, the only way to completely ensure the safety of a student with a food allergy, especially a severe, life threatening one, is to have emergency medication accessible with staff educated to administer it at all times. 504 Plans are meant for just this type of special accommodation, but according to the school nurse my son’s life saving medication would not be allowed on the bus.
In New York City, students with asthma are given special accommodations by being able to carry their nebulizers with them in case of an attack, as well as given small air conditioned buses to prevent the attack from occurring in the first place. There is action taken to prevent an attack, which is exactly what I believe is the right of every child on the school bus. The transportation of students to their school is an extension of the school environment and one that I believe should be covered under the 504 Accommodation Plan. A safe and appropriate environment is part of the school staff’s responsibility to keep our children safe….right?
Note that 504s are not specific to my state (NY) but are part of the federal ADA act signed into law in 1990, which means that ALL states must comply. ALL students who have special needs and those who have needs that may restrict major life activities are entitled to special accommodations under the 504. The written law is that they “cover all programs of a school or college, including academics, extracurricular, and athletics. Also the laws apply to the activities of a school or college that occur off campus”, which should include traveling to and from school. I urge all of those who are denied Epi Pens on school buses to refer their school administrators to the law regarding 504s and to not take no for an answer. We must stay the advocates for our children and the pioneers in situations that have yet to be challenged and changed.
For more information on 504s, you can reference the link below which gives a broad overview of the plan. As the law for each particular state differs slightly, the site also provides links for detailed information on each particular state.(http://specialchildren.about.com/od/504s/f/504faq1.htm)
Debbie at http://www.peanutfreesweettooth.com
Peanut Free Sweet Tooth
In general I haven’t given much thought about the heritability of my son’s peanut allergy, since food allergies are not an issue in my family or my husband’s. I ignored all of the advice to avoid eating peanuts while pregnant (though I am quite convinced there is more to it than this) and barely knew how allergies affected one’s health before the diagnosis.
Lately, there has been some great new information and theories, though some conflicting, that grabbed my attention to understand on a deeper level how someone “gets” a peanut allergy. Of all the studies listed here, none seem to rule out the environment and an unexplainable mystery factor. Actually, most researchers suggest that there is an environmental factor at play, which they cannot quite pinpoint.
According to a recent article in February from the New Yorker, “From an evolutionary-biology point of view, food allergy makes no sense at all,” Dr. Sicherer, a pediatric allergist at Mt Sinai inNew York, said. “It seems pretty clear that food allergy is a condition that resulted from the environment we created.” “Basically, we are all in limbo, he added. “Even the experts are not certain what to advise” regarding whether to avoid or not avoid certain types of foods in the early years in order to prevent allergies from developing.
According to BBC news article posted on March of 2011, scientists claim a peanut allergy “gene flaw” link. “A gene defect that can triple the risk of a child developing an allergy to peanut has been identified”, scientists have claimed. Only 20% of peanut allergy cases, however, were found to have this Filaggrin gene defect, and between 4% to 11% had the gene defect, yet, were not allergic to peanuts.
Identical twins, who share all 25,000 genes, were used in researching whether or not there is a biological program for having a peanut allergy. A study from 2000 from the Elliot and Roslyn Jaffe Food Allergy Institute, Mt Sinai School of Medicine, concluded that there is a higher rate of peanut allergy among identical twins, strongly suggesting a genetic influence. Yet, not all identical twins having identical genes had a peanut allergy.
Information by geneticist, Dr. Barry Star (StanfordUniversity) states that while peanut allergies tend to run in families, in 36% of the cases this is not true. Thus, there is a strong environmental role which remains unknown.
And lastly, a newly released book, The History of the Peanut Allergy Epidemic by Heather Fraser, gives us a new perspective of why some “get” a peanut allergy. She places the increase in allergies, beginning about 20 years ago, at the same time of changes in vaccination combinations, ingredients and schedules. Fraser clearly states this as a possible environmental contributor.
All seem to have one common theme, which is environment cannot be ruled out. Uncovering this mystery environmental factor will hopefully lead us to more food allergy prevention and putting a cap on the growing numbers of peanut allergy and food allergy in general.
Debbie at Peanut Free Sweet Tooth
When my son was first diagnosed with a peanut allergy I thought I would never eat out again, especially in fast food restaurants. Before doing any research, I remember being of the naive belief that it was no longer safe to eat in restaurants and that my child would need to eat homemade food all the time. After looking into it though, I learned that there are options out there for parents of children with peanut allergies, even in fast food restaurants. Thank goodness, since having a break from cooking once in awhile is a good thing.
While I had previously looked into which restaurants are “peanut safe” a few years back, I thought I would brush-up by calling a few major fast food places to get their official response. Below are my findings, which only include “peanut free” food items and not “nut free” ones. Many allergists recommend staying nut free if there is a diagnosis of peanut free due to cross-contamination.
I had a conversation with a customer service rep there (800 244-6227) and she mentioned that McDonalds has a strict policy that foods with allergens must be stored separately from other foods. That being said though, McDonalds does serve products may contain both peanut and peanut oil. The women I spoke with asked that I refer to a document on their website which lists all ingredients for all products (http://nutrition.mcdonalds.com/nutritionexchange/ingredientslist.pdf). Reading this led me to focus on the following 3 products which you should stay away from:
a) Fruit & Walnut Salad: Made with peanut oil and may contain shell parts, peanuts and other tree nuts
b) Sundaes: These include peanuts
c) McFlurry: These include M&M candies which may contain peanuts and are made on the same equipment as peanuts.
While I personally try to limit the amount of fast food my child eats and concentrate on more healthy options, I will say that there is McDonalds a few blocks away from my house and I am ok taking my son there from time to time. We completely avoid all their desserts and get their burgers/fries instead (we specifically request apple slices for the Happy Meal desserts and do not use the caramel dip that goes along with it).
The Wendy’s website features a menu which is much more user friendly and includes a dedicated column for all products that contain peanut/tree nuts at the following link (http://www.wendys.com/food/pdf/us/nutrition.pdf). Similar to McDonalds, there are a few salads which must be avoided as well as several desserts, including the following:
a) Apple Pecan Chicken Salad
b) Most of the Twisted Frosty with the exception of the Oreo (though there is the issue of cross contamination in the Oreo since other twisted frosty desserts are made alongside it)
I had a conversation with a customer service rep there (305 378-3535) and she pointed me to the following allergen information link on their website which says that there are NO products which contains peanuts (I was surprised to hear this, but the lady I spoke with verbally confirmed it). Just to be safe though, I still always avoid all their desserts.
Their website has the following allergen list (http://www.kfc.com/nutrition/pdf/kfc_allergens_aug10.pdf) which states that the only product containing peanuts is the Reese’s Peanut Butter Pie Slice.
Here is the allergen list from their website (http://www.tacobell.com/nutrition/allergens) which does not list any items under the “Peanuts” column. The site also specifically contains a footnote that states “Peanuts and tree nuts are not used at Taco Bell restaurants. May be used in common manufacturing plants”.
In summary, your child does not have to feel left out since there are many fast food options to have a peanut-free meal. Please note though that even if a restaurant states that they are 100% peanut free, I still ALWAYS carry an EpiPen wherever I go and NEVER leave the home without it (it is forever glued to my side). Also, please use the information in the company links I’ve provided as only a guide, and always verbally confirm the peanut content of every meal with the server (preferably a manager since most servers are usually unsure).
A common theme I’m found from this research is that you should always be extremely careful about ANY dessert you give your child. This daily stressful concern to provide my son a peanut-safe treat is one of the reasons I decided to start a business that sells delicious 100% peanut free desserts (cookies, cupcakes, candies, etc). It is called Peanut Free Sweet Tooth (http://www.peanutfreesweettooth.com) and I’ve made it a point to offer a wide assortment of products at the best prices so that all children can experience the sweet things in life. Please check us out when you get a chance!!
Recently, while registering my soon-to-be preschooler, the administrators asked me a question that I struggled to answer: “how severe is your son’s peanut allergy”? This innocent question that I get all the time from my friends and family brought back memorizes of when I first found out that my son had an allergy. It was 2009 and we were at a children’s birthday party. When I had turned for a moment my one year old son started eating a cookie that was on a table. Nothing happened at first but within minutes he started breaking-out in hives and vomiting. In a panic, we rushed him to the emergency room and luckily everything was fine, however the doctor recommended that I make an appointment ASAP to see an allergist.
The next day the first question I asked the allergist was “how severe is my son’s allergy?” I was expecting him to reply with either “severe”, “moderate” or (hopefully) “not too severe”….and was bracing for the bad news. His answer surprised me though as he mentioned that unfortunately there is no “right” answer. As I learned, reactions are completely unpredictable, as someone can have a minor reaction one time but then suffer a severe reaction (like anaphylaxis) the next time. It is true that some people show obvious signs of what is classified as a severe reaction (such as in inhalation exposure), but others just haven’t had that severe reaction yet. Severity of reaction is unfortunately a roll of the dice and is not necessarily dependent upon previous reactions or allergy testing results.
Allergists typically measure an allergy by the CAP-RAST, which tests the IgE antibodies to a particular allergen, the skin prick test and a rating scale, which is based upon previous reactions. According to FAAN, “overall, fewer than half of individuals with a positive skin test to a food will develop allergic symptoms if they eat that food”.
These tests do not need to correlate positively with each other either, actually often they don’t. My son has a high rating scale number of three (based upon a rating scale from 1 to 4), a positive skin prick test, yet his IgE antibodies were very low. His allergist informed us that this doesn’t predict a future reaction’s severity in any size or form, but only that he is allergic to peanuts. These are significant discrepancies that need yet to be explained.
Case in point, reactions are difficult to predict and test results can be confusing and misleading. Precaution, due diligence regarding label reading, and always being prepared with Epi Pen and a medical plan, are the only ways to effectively treat those with a diagnosis of food allergy. Each and every person with a food allergy should be given equal treatment of their food allergy regardless of their food allergy testing results and previous reactions.
So, going back to the question raised by the school administrator….how should I answer? What is the best approach to both educate a person on this topic without coming across as preachy or lecturing? I decided that being honest and direct with them took priority over how I may be perceived. Keeping the conversation light, but still educational, we ended-up having a great talk that ended with the administrator thanking me tremendously (she even invited me to speak in a class on the topic!).
While I’m still learning as each new stage brings its own set of challenges, I feel passionately about the health and well-being of the food allergy community. Everyone deserves the basic feeling of safety and security at home, in school and in any public setting. This is one of the reasons why I have started a site that offers hard-to-find foods, snacks and treats that are peanut-free, nut-free and mostly allergen-free. It has given my family and me the comfort in knowing that foods which often contain peanuts can be found without any and eaten safely and happily. Come and visit us at http://www.peanutfreesweettooth.com and let me know your thoughts and in what other ways this site might be helpful.