Back-to-School Allergies: Tips to Survive the School Year

Your questions about managing allergies and asthma at school.
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While heading back to school can be exciting for many students and parents, there can be added anxiety for those dealing with allergies and asthma.

Dr. Maeve O’Connor of Allergy Asthma & Immunology Relief of Charlotte offered tips and answered questions on managing allergies and asthma at school in a recent live Facebook chat. Following are questions from Facebook users and live answers from Dr. O'Connor. (This transcript has been edited for clarity and grammar.)

What’s the difference between a food allergy and a food intolerance?

Dr. Maeve O'Connor: A true food allergy causes an immune system reaction that affects numerous organs in the body. It can cause a range of symptoms from itchy skin, rash, hives, throat tightness, wheezing, cough or stomach discomfort. In some cases, an allergic reaction to a food can be severe or life threatening. In contrast, food intolerance symptoms are generally less serious and often limited to digestive problems (loose stools or nausea) or vague symptoms such as fatigue or achiness.

Which foods cause allergic reactions?

Dr. Maeve O'Connor: Although any food can trigger an allergic reaction, the most common allergenic foods, also known as the big eight, are: eggs, fish, cow’s milk, tree nuts (cashews, hazelnuts, walnuts, almonds, and Brazil nuts), peanuts (legumes), shellfish (shrimps, mussels, and crab), soy, and wheat. Seeds such as sesame are becoming a more common allergen as well. In children, most allergic reactions to food are to peanuts, milk, soy, tree nuts, eggs and wheat.

Is the only "treatment" avoidance of the offending foods or is there medication that can help?

Dr. Maeve O'Connor: Unfortunately, there is no medication available to treat food allergies. Avoidance is key but, desensitization programs like ours at AAIR are finding success. There are also several research studies using sublingual immunotherapy, oral immunotherapy, and topical immunotherapy (such as a patch) and others. These methods are gaining ground and hopefully one day no one will suffer from food allergies anymore. Remember, epinephrine is the number one treatment "if an accidental food ingestion" occurs to treat a life threatening allergic reaction.

What's the best treatment for food allergies?

Dr. Maeve O'Connor: The most important first step is proper diagnosis of food allergy and identifying specific food allergy triggers. Testing by a board certified allergist includes skin testing and blood testing. The gold standard is still a double-blind placebo controlled food challenge, but these can logistically be difficult, so open challenges are more common. The best treatment is avoidance, having epinephrine on hand and an anaphylaxis action plan. Education of family members, friends, and all who come into contact with your child to keep him/her safe.

At AAIR, we are also performing oral immunotherapy with standardized protocols to help desensitize our food allergic patients to give them freedom and relief.

What if my husband was told he was allergic to dust what can he do?

Dr. Maeve O'Connor: This is a very common allergy and it is perennial meaning it cause symptoms year round. Dust mites can be avoided. Encase mattress, box springs and pillows. We have these available at AAIR. Wash sheet ta least once per week in hot water. For children, remove stuffed animals from the bed and wash regularly. Keep clutter to a minimum. Also, keep humidity below 50 percent. This does not mean we can prescribe a maid service, LOL!

If my child has allergies or asthma, where do I begin from an administrative perspective? Meet with the school nurse, homeroom teacher, principal, coaches, bus drivers? Where do you draw the line?

Dr. Maeve O'Connor: I don’t really draw the line. I believe the more people on the team of the allergic child the better. An efficient educational meeting about your individual child with all of the players involved is the best way to keep him/her safe. My best advice is to approach each person as a member of the team for you child. Respectfully teaching them your child's specific needs ensures a safe school year with as little stress as possible. Accidental exposures can happen ANYWHERE so the more people “in the know,” the better.

A 504 plan, Emergency Action Plan, Individualized Healthcare Plans (IHCP) … are all of these necessary?

Dr. Maeve O'Connor: It is always best to protect your child in every way possible. I am in support of these plans not only to protect the allergic person but also to enhance education. I refer you to PAK Charlotte to get guidance on these plans and the best way to get them effectively and in a streamlined manner.

What gets included on a child’s treatment plan with school staff?

Dr. Maeve O'Connor: The anaphylaxis plan should include the child’s name, photo, date of birth, EXACT ALLERGIES, and plan for possible or definite exposures to the allergen(s). This includes EPINEPHRINE as first line of defense followed by other medications as deemed fit such as albuterol or diphenhydramine. Also, emergency contact information for as many family members as possible and access to 911 should be included. Written and picture instructions are helpful so that a person of any educational level knows how to save your child.

I read that asthma flares peak during the third week of September. Any correlation to school stress or is that purely environmental allergens?

Dr. Maeve O'Connor: Asthma flares may increase in the first month or 2 of school, typically peaking around the 3rd week of September through early October. Increased contact with other children is a contributing factor as viral upper respiratory infections, including the common cold, are potent triggers. Ragweed is prominent in September so, for those children with an allergy their asthma can be exacerbated by this. Being in a closed classroom also increases exposure to dust mites, molds and animal dander and can trigger asthma. Monitor your child’s symptoms daily and help them to pay attention to them as well.

A question from our editor: My 10-month-old sometimes has puffy eyes, and what sort of looks like dark circles under his eyes. Could this be a sign of allergies?

Dr. Maeve O'Connor: Absolutely this could be a sign of allergies! We call those dark circles "allergic shiners". It is difficult to diagnose allergies in a child this young but, it is important as children with allergies can go on to develop asthma. I would also look for anything that could be irritating your child's eyes, such as: strong scented laundry detergent, soaps, or lotions, animal dander, or dust. If there is any discolored discharge, be sure this is not an infection.

Do I need to worry about seemingly innocuous craft materials, like empty egg or milk cartons or certain kinds of clay, that can also contain potential hazards?

Dr. Maeve O'Connor: These are typically safe and kept away from potential food/environmental allergens. However, classmates with pets may transfer dander to these and mold and dust mites of course can collect. With proper controller medication for allergies and asthma, these are typically very safe. Most teachers and aids are well-versed in minimizing exposure to food allergens on or in these important educational tools. If there is a potential hazard such as a stain, these are thrown away and the play/educational area is sanitized.

Hot-topic question here with EpiPens: Do schools keep stock of epinephrine in case a student doesn’t know they have a food or sting allergy?

Dr. Maeve O'Connor: From the Asthma & Allergy Network-North Carolina has a stock epinephrine law that went into effect on Nov. 1, 2014. Each school must have at least two auto-injectors stored in a secure but unlocked and easily accessible location for use by trained school personnel in an emergency. Each principal must designate one or more school personnel to be trained in the emergency use of the devices. The training must be conducted by a school nurse or a qualified representative of the local health department. The school nurse or other trained person for each school must obtain a nonpatient-specific prescription for epinephrine auto-injectors from the local health department.

It requires each principal to collaborate with other appropriate school personnel to develop an action plan for use of EpiPens in an emergency. Minimum components of the plan are specified in the new law and include calling emergency services and notifying affected students’ parents and physicians when the devices are used. In addition, the law provides qualified immunity from civil liability for local health department health care providers, school officials, school employees, and school volunteers for acts or omissions relating to the new requirements. An amendment to G.S. 115C-238.29F requires the Department of Public Instruction to ensure that charter schools comply with all of the new requirements.

When is a child old enough to carry her own epinephrine auto-injector or self-inject?

Dr. Maeve O'Connor: This is an individual decision for your board-certified allergist and you as the parent. I have children as young as 6 who are “savvy” and can handle this but there are kids as old as 12 (and even adults!) who are terrified to self carry. Typically middle school is the norm, but I treat each case individually to maximize safety and comfort.

What steps can I take to have my child carry and use his or her own inhaler?

Dr. Maeve O'Connor: Speak with your doctor and school to see if the child is mature enough but I am a HUGE advocate of patients managing their own health care … even CHILDREN! You need a written action plan signed by you and your MD.

My oldest child was diagnosed with asthma at age 2, but appeared to "grow out of it" by age 10. He is now 19 and still seems to be asthma-free, but do asthma sufferers really ever grow out of it? Can it still flare up later in his adult life?

Dr. Maeve O'Connor: For children under the age of 2 years, it is difficult to accurately test for asthma as spirometry (the diagnostic test used) can not be performed by children of this age. It is also common for children under 2 to wheeze when suffering from viral infections. There are studies that show in children who had asthma under the age of 10 years, about 20 percent truly outgrew their asthma by age 19. If allergies remain uncontrolled, asthma can return which is why it is important to consider desensitization immunotherapy to prevent asthma, stop the progression of asthma, and in some, eliminate asthma.

There is a 50 percent chance of outgrowing asthma, but if allergies continue there is a 25 percent chance that asthma can return in adulthood.

Do asthma medications cause concentration problems?

Dr. Maeve O'Connor: Uncontrolled asthma and allergies have actually been shown to reduce school performance. Albuterol and other rescue inhalers can cause nervousness so keeping asthma controlled is best.

Birthday cupcakes, pizza parties, candy rewards and holiday celebrations. How do we navigate edible treats in the classroom?

Dr. Maeve O'Connor: KEEP IT SIMPLE. Bring your own. Help your teachers, other parents and your child’s friends by keeping the responsibility mainly on you. Yes YOUR CHILD HAS RIGHTS but it is easier to just keep it simple. Then everyone can enjoy a SAFE and HAPPY party. Also, inform other parents and kids so nobody has to worry.

It’s not easy to hand over food allergy management to my moody, eye-rolling teen. Got any tips?

Dr. Maeve O'Connor: Ha! I cannot wait to find the cure for adolescent attitude. As tough as it is and may sound, strange or scary, I remind my teenage students about life-threatening allergic reactions and asthma — LIFE THREATENING. No fear factor, just a fact. Time with this age group is so important as there is much confusion. Our psychologist Dr. Jane Marcus can help.

Emergency wristband, dog tag, or shoe tag, temporary tattoos, awareness t-shirts? Are these overkill in getting the message across to administration, students and parent volunteers or a necessary evil? I don’t want to isolate my son or get bullied for his differences.

Dr. Maeve O'Connor: A simple bracelet or necklace is sufficient. To speak to “overkill”— I do not think there is any however, education is paramount. I also keep the message on the medal alert devices simple and easy to decipher.

Ok, last question. Is it out of line to ask school administrators to limit or not use your child’s classroom for after school activities? I’m worried about cross-contamination.

Dr. Maeve O'Connor: I do think this is a bit too much. There are numerous studies that prove that good old-fashioned soap and water break down food protein, including peanut protein, and environmental was well. If these practices are being followed, I would not worry.