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Pediatricians can help children learn how to avoid allergy, asthma triggers
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Children with allergies and asthma should be educated on ways to avoid common causes of reactions while at school, according to the American College of Allergy, Asthma and Immunology.
Allergy triggers in classrooms and on playgrounds are responsible for more than 14 million missed school days each year in the United States, according to an ACAAI press release.
“Children with allergies and asthma should be able to feel good, be active and not miss any classes or activities this school year due to their condition,” allergist James L. Sublett, MD, clinical professor and section chief of pediatric allergy at the University of Louisville School of Medicine, said in a news release. “Helping your child understand what triggers their symptoms can keep them focused on their studies and not their allergies.”
Avoiding triggers
The ACAAI recommends that children should be informed about avoidance of triggers, including:
- Avoid chalk dust.
- Steer clear of stinging insects, especially hymenoptera.
- Bring lunch from home.
- Be aware of breathing troubles after physical activity.
- Avoid close contact with classroom pets.
Besides chalk dust, there are other potential allergy or asthma triggers to keep in mind, according to Infectious Diseases in Children Editorial Board member Gary S. Rachelefsky, MD. These include keeping grass-allergic children away from open windows when the grass is being cut and making sure of proper ventilation during construction, cleaning or painting of the classroom or areas near the classroom.
Exercise-induced bronchospasms are also common in children with asthma while they are running or playing outdoors. “A bronchodilator should be available during physical education classes and on the playground,” Rachelefsky said. “The school should make some effort to make the necessary items, including bronchodilators, inhalers, nebulizers and spacers, available for when the child needs it.”
Gary S. Rachelefsky
He said children who are allergic to hymenoptera should have an epinephrine autoinjector available when outside for recess or other outdoor activities and should not be allowed outside without shoes. Children with seasonal rhinitis should also have access to an antihistamine at school.
The beginning of cold and influenza season quickly follows the return to school. Rachelefsky said children with asthma should be advised to limit contact with students with upper respiratory symptoms to avoid exacerbating their asthma. The CDC also recommends that children with asthma receive yearly influenza vaccination.
Food allergies
Regarding lunchtime at school, Rachelefsky said although keeping the child safe is a priority, it is important not to isolate the child. These children should be recognizable to the teachers, aides, cafeteria workers and parent volunteers in the room where the children eat so that everyone is aware. However, it is equally important to be sure the children are not made to feel different from their peers.
“When they are thought of as ‘different,’ they are bullied,” said Rachelefsky, who is professor of allergy and immunology at the David Geffen School of Medicine at UCLA. “They don’t necessarily have to be isolated from other children, but there needs to be some education of the staff to keep them safe from a potential reaction.”
For children who can have potentially life-threatening reactions to food, Rachelefsky said they should have an epinephrine autoinjector (EpiPen, Dey Pharma) readily available.
“They should be kept near where the child eats and not locked away in a cabinet in the nurse’s office,” he said.
Regarding classroom pets, Rachelefsky said reptile and fish are best for allergic children. However, certain classroom pets can also carry diseases and should not be allowed in the classroom. Go to www.cdc.gov/features/AnimalsInSchools to view more information from the CDC. – by Cassandra A. Richards
Perspective
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Matthew J. Greenhawt, MD, MBA, MSc, FAAP
With school about to start, the key word for those who suffer asthma and allergies, in particular, food allergies, is preparedness. If parents haven't checked with the school already, parents need to determine what medication forms are needed to maintain essential items such as albuterol, epinephrine, or Benadryl at school. Most schools require a physician's signature and written plan — it is not too late to get this done. For any child with asthma or an allergy to food or insect, I'd strongly advise the family to maintain the essential medications to treat a reaction at school, and not leave anything to chance that their child "won't need this" at school.
Similarly, these children need to have their asthma action plan or food allergy action plan updated, and kept on file with the school. Again, if this hasn't been done already, there is still time, but having these forms on file is an essential part of doing all one can to keep their child safe at school. Similarly, it is not enough to just have a plan — please urge parents to take the time to go over the plan with the school nurse or person who is most likely to have to respond to a situation (eg, primary teacher). Make sure they can recognize the signs and symptoms of an attack or reaction, and know what to do to treat a situation that arises. If the child has exercise-induced asthma symptoms, make sure that pre-treatment with albuterol is worked into the routine approximately 15 to 20 minutes prior to gym or recess, and is specified in the action plan. This is also a good time for parents to determine if the school actually has a nurse on staff, and if that position is full-time or part-time.
Parents of food allergic children should also have met, or be planning on a meeting, with the school if any special accommodations are to be requested if your school or state do not have established guidelines. What a child may require can be unique, and is a decision that should be jointly made by his/her treating allergist/pediatrician, the school and the parents.
Parents should not assume that precautions are in place — the parent must be the advocate for their child. A section 504 plan may be needed, but often can be avoided if all parties can meet in advance and plan to help accommodate the child's needs.
School preparedness is a joint responsibility between provider and family. It is not too late to make last-minute plans for the upcoming year.
For additional information, please visit the following websites:
- www.aaaai.org
- www.acaai.org
- www.aap.org
- www.foodallergy.org (FAAN)
- www.faiusa.org (FAI)
- www.kidswithfoodallergies.org (KFA)
- www.apfed.org (APFED-- eosinophilic esophagitis)
- www.aafa.org (asthma)
- www.aanma.org (asthma)
- www.iaffpe.org (FPIES)
- www.thefpiesfoundation.org (FPIES)
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