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This chat was at noon CT on Tuesday, November 30. It was about how parents can manage their children's food allergies in the school setting.

In addition to getting their questions answered, during the chat, readers also learned about new guidelines from the American Academy of Pediatrics on this topic.

We had Dr. Jennifer Kim, a pediatrician and food allergy specialist from Mount Sinai School of Medicine in New York, on hand to answer questions. Dr. Kim is a clinician and clinical researcher at the Jaffe Food Allergy Institute, and a member of the Section on Allergy and Immunology of the American Academy of Pediatrics.

For questions about this chat, contact dshelton@tribune.com

Health Chat: Managing kids' food allergies

(11/30/2010)

  

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11:59

Deborah Shelton:  Hello everybody. We will be getting underway with our weekly health web chat shortly, at noon Central Time. Please stand by. Tuesday November 30, 2010 11:59 Deborah Shelton

12:01

Deborah Shelton:  Welcome to the Chicago Tribune health web chat! I am your moderator, Deborah Shelton, a Tribune health reporter. Today we launch the first of our weekly chats, which will alternate between topics on children's health and aging. Today we are talking about managing children's food allergies in school, the topic of a clinical report by the American Academy of Pediatrics released just yesterday. Tuesday November 30, 2010 12:01 Deborah Shelton

12:01

Deborah Shelton:  Joining us to talk about food allergies in the school setting is Dr. Jennifer Kim, a clinician and clinical researcher in the Jaffe Food Allergy Institute at the Mount Sinai School of Medicine in New York. Dr. Kim is a member of the American Academy of Pediatrics Section on Allergy and Immunology. Among other things, Dr. Kim will discuss the new American Academy of Pediatrics report on the dramatic increase in food allergies and how to best manage food allergies in the school environment. She will also take your questions. Tuesday November 30, 2010 12:01 Deborah Shelton

12:01

Deborah Shelton:  Hi Dr. Kim, thank you for joining us. Tuesday November 30, 2010 12:01 Deborah Shelton

12:02

Dr. Kim:  Thanks for having me. I'm happy to be here to answer questions! Tuesday November 30, 2010 12:02 Dr. Kim

12:03

Deborah Shelton:  We hear more and more about children and food allergies. Can you tell us how many children in the U.S. have food allergies? Are food allergies increasing? Tuesday November 30, 2010 12:03 Deborah Shelton

12:03

Dr. Kim:  Unfortunately, food allergy appears to be increasing. In the US, approximately 1 in 25 children has a food allergy, an 18% increase over a decade (from 1997 to 2007). Tuesday November 30, 2010 12:03 Dr. Kim

12:04

Deborah Shelton:  Who is most at risk? What foods are kids most likely to be allergic to? Tuesday November 30, 2010 12:04 Deborah Shelton

12:04

Dr. Kim:  Children from allergy-prone families (atopic) are at highest risk. Peanut, tree nuts (almond, walnut, cashew, etc), milk, fish, shellfish, egg, soy, and wheat are the msot common allergens. Sesame and other seeds have been reported as potent allergens as well. Tuesday November 30, 2010 12:04 Dr. Kim

12:06

Deborah Shelton:  How often do kids suffer severe food allergic reactions in school? Tuesday November 30, 2010 12:06 Deborah Shelton

12:07

Dr. Kim:  Results of studies of children with food allergy indicate that over 15% have experienced a reaction in school. Allergic reactions or treatment for anaphylaxis also occur in children whose allergy was previously undiagnosed (~25% of cases of anaphylaxis). Preschool-aged children may experience food-induced reactions more often than older children but the most of these are not anaphylactic. Tuesday November 30, 2010 12:07 Dr. Kim

12:07

[Comment From ShelleyShelley: ]  What are the allergies, non food related, that they suffer from the most? Tuesday November 30, 2010 12:07 Shelley

12:08

Deborah Shelton:  Chatters, we are focusing on food allergies in this topic. But Dr. Kim can you address briefly? Tuesday November 30, 2010 12:08 Deborah Shelton

12:08

Dr. Kim:  Today we are focusing on foods but other allergens include airborne allergens (pollens, mold, dust, pets, etc), medications, and bee sting venom. Tuesday November 30, 2010 12:08 Dr. Kim

12:11

Deborah Shelton:  We are starting to get a lot of questions. We'll get to them in a minute. First let's cover a couple of issues. A reader wrote earlier and asked: Currently my child (who has a severe peanut allergy) is in kindergarten and the room is peanut free. For next year I fear the school will not continue to provide a peanut free room. My specific concern is that they eat lunch in the classroom so the peanut residue can be left on hands and surfaces where the allergic student is expected to stay and work. I would be much less worried if they ate in a cafeteria (with a peanut free table), but the school does not have one. I have a care plan in place for my child but not a 504 plan. What is the best way for me to manage her allergy in this type of environment? Tuesday November 30, 2010 12:11 Deborah Shelton

12:11

Dr. Kim:  There are many parts of this comment I would like to address: First: Care must be taken not to ostracize or physically separate the child with food allergies. For example, an “allergen-aware” table should include the child's friends who are eating safe meals. Experts have not espoused blanket "bans" on foods, particularly because peanut butter, milk, egg, and other common allergens may be a protein staple of another child's diet. Tuesday November 30, 2010 12:11 Dr. Kim

12:12

Dr. Kim:  Studies of skin contact and inhalation of peanut-butter vapors by children with peanut allergy failed to induce any systemic reactions. Lack of a reaction from these casual exposures is not unexpected because peanut-butter vapors do NOT contain protein. (Allergens are proteins.) However, concern remains for young children transferring skin contact to their mouths. Tuesday November 30, 2010 12:12 Dr. Kim

12:12

Dr. Kim:  A study showed that peanut can be cleaned from the hands of adults by using running water and soap or commercial wipes but not antibacterial gels alone. In addition, peanut was cleaned easily from surfaces by using soap, wet wipes, and commercial wipes but not dishwashing liquid alone. Typical eliciting doses are one-half to one whole peanut kernel. These observations indicate that standard cleaning and lack of visible contamination should suffice for most children with peanut allergies. Tuesday November 30, 2010 12:12 Dr. Kim

12:12

Dr. Kim:  Section 504 of the Rehabilitation Act of 1973 may also be used to document specific management plans and provides legal recourse for students and their families if they and the school are unable to come to terms on health care plans through normal channels. In some schools, Section 504 plans may not be necessary if the written emergency action plan and/or the individualized healthcare plan provide the necessary procedures for safety. Tuesday November 30, 2010 12:12 Dr. Kim

12:13

[Comment From GuestGuest: ]  How do you get teachers, parents and administrators to take the allergies seriously? I've found at my daughter's school, they use food as a "reward?" I think people think we are just being dramatic. Tuesday November 30, 2010 12:13 Guest

12:14

Dr. Kim:  Educate the school about how and when to administer self-injectable epinephrine because mistakes are common. Prompt access to a reliable source of epinephrine is critical. Procedures should be established that specify where the medication will be stored, who is responsible for the medication, who monitors and replaces outdated medication and who will carry the medication for field trips. Consider obtaining medical identification jewelry. Discuss the importance of avoidance strategies to prevent potential reactions. See http://www.foodallergy.org/page/food-allergy--anaphylaxis-network-guidelines for more details, but examples of these procedures include: Strict "no food sharing" policies; Use of commercially prepared and labeled, individually wrapped food items; Education of those providing foods regarding safe and unsafe foods and label reading; Education of cafeteria/food service staff; A ready supply of safe alternative snacks; Policies of no eating on the school bus and having a means of communication on the bus. Tuesday November 30, 2010 12:14 Dr. Kim

12:15

Dr. Kim:  I find sitting down in a meeting face to face is most helpful. Tuesday November 30, 2010 12:15 Dr. Kim

12:15

[Comment From daviddavid: ]  Our kids have food allergies. At their school, they are trying their best to keep environment safe. They have asked us what "wipes" are safe ie, kill the nut protein. We have heard that Wet Ones is most effective. Do we need to suggest another kind of wipe (one with ammonia or chlorine? Tuesday November 30, 2010 12:15 david

12:16

Dr. Kim:  Wjipes do not "kill" the protein. Rather, the remove the protein residue from the service. There is no specific type that is proven more effective than another. Any wipe will do. Tuesday November 30, 2010 12:16 Dr. Kim

12:18

Deborah Shelton:  Dr. Kim, Let's talk about medical treatments. How are they administered in the school, and by whom? Tuesday November 30, 2010 12:18 Deborah Shelton

12:18

Dr. Kim:  First let's review the medications used for treatment: Epinephrine is generally safe (ie, when in doubt, inject). Common adverse effects of epinephrine include tremor, tachycardia, and flushing/paleness. Antihistamines may be used to treat a MILD allergic reaction (ie, a few hives) but cannot be depended on to treat anaphylaxis. Inhaled bronchodilators (ie, albuterol, xopenex) may be given for respiratory reactions but must not be depended on to treat anaphylaxis. Medication should not be exposed to extremes in temperature. Expired units should be replaced. Tuesday November 30, 2010 12:18 Dr. Kim

12:19

Dr. Kim:  As for who administers the medications, this depends on the age of the child. Because the adolescent age group is at highest risk of fatal food reactions, special attention should be paid to them. His or her peers should be educated as to how to use the medication in case the food-allergic person is unable to self-administer. Staff should be educated, including teachers, coaches, trainers, and after-school advisors. Affected students should be permitted to wear/carry clothing/bags/purses that facilitate carrying medications. Regardless of what is administered (antihistamine, epinephrine, etc), it is essential that the child continue to be monitored by trained personnel for progressive symptoms or until EMS arrives to take over their care. Tuesday November 30, 2010 12:19 Dr. Kim

12:19

[Comment From markmark: ]  i work in a school setting, i have a parent who does not that there childs allergies serious. any thoughts or ideas.. Tuesday November 30, 2010 12:19 mark

12:20

Deborah Shelton:  That's a really good question Mark. Sometimes parents don't understand the seriousness of food allergies. Tuesday November 30, 2010 12:20 Deborah Shelton

12:21

Dr. Kim:  It is difficult for me to make a comment on a specific situation. There is a spectrum of severity with regard to food allergy. Some people may experience mild oral itching whereas develop life-threatening anaphylaxis. So it is difficult to judge any individual situation without a more lengthy evaluation. Tuesday November 30, 2010 12:21 Dr. Kim

12:23

Deborah Shelton:  Isn't this an issue of parent-school interaction? Tuesday November 30, 2010 12:23 Deborah Shelton

12:24

Dr. Kim:  Indeed yes. I think communication between the school and the family is KEY to a positive interaction. Meeting face to face is ideal to make sure everyone is on the same page. Tuesday November 30, 2010 12:24 Dr. Kim

12:25

Deborah Shelton:  We're seeing some questions now about diagnosing food allergies. Dr. Kim, can you talk about that? Tuesday November 30, 2010 12:25 Deborah Shelton

12:25

Dr. Kim:  Any concerns of a potential food allergy should be discussed with your pediatrician or pediatric allergist. That being said, symptoms of IgE-mediated allergy can involve the skin (hives or welts, itching, flushing, rash, swelling), the gastrointestinal tract (abdominal pain, vomiting, diarrhea), the respiratory tract (throat itching/tightening, hoarseness, hacking cough, wheeze, shortness of breath), and the cardiovascular system (low blood pressure, decreased consciousness, confusion). Symptoms generally occur shortly after ingestion (within minutes usually but up to several hours). Confirmation can be provided by testing by skin and/or blood to look for specific IgE antibodies. Tuesday November 30, 2010 12:25 Dr. Kim

12:26

Dr. Kim:  Diagnosing on tests alone may not be accurate however. The bigger the skin test size and the higher the value on the blood test, the higher the probability there will be a reaction... even if the child has never ingested that food before. Tuesday November 30, 2010 12:26 Dr. Kim

12:27

Dr. Kim:  I generally advise yearly testing. Tuesday November 30, 2010 12:27 Dr. Kim

12:28

[Comment From GuestGuest: ]  my daughter is 5, the school nurse wants her to know how to inject herself...isn't that too young? Tuesday November 30, 2010 12:28 Guest

12:28

Dr. Kim:  My opinion is yes. Tuesday November 30, 2010 12:28 Dr. Kim

12:29

Dr. Kim:  I would not advise self-injection until adolesence. Regardless, an adult should be with the child to monitor them until EMS arrives. Tuesday November 30, 2010 12:29 Dr. Kim

12:29

Deborah Shelton:  Lots of questions about kids outgrowing their allergies. Does that happen? Tuesday November 30, 2010 12:29 Deborah Shelton

12:29

Dr. Kim:  Yes this does thankfully! The most common foods to be outgrown are milk, egg, wheat, and soy. Tuesday November 30, 2010 12:29 Dr. Kim

12:30

Dr. Kim:  About 20% of peanut allergy is outgrown. About 10% of tree nut allergy is outgrown. About 20% of sesame allergy is outgrown. Tuesday November 30, 2010 12:30 Dr. Kim

12:30

Dr. Kim:  peanut, tree nuts, fish, shellfish are the most common allergens in US adults (particularly shellfish). Tuesday November 30, 2010 12:30 Dr. Kim

12:31

Deborah Shelton:  We're getting some questions about medical studies and the latest research. Tuesday November 30, 2010 12:31 Deborah Shelton

12:31

[Comment From JustinJustin: ]  I've read studies that indicate a "cure" for peanut allergies is on the horizon - that researchers are finding they are able to ween the allergy away by administering very slight (but increasing) doses of peanut exposure to children over time (months/years), and by the end the children who previously had been highly allergic are now able to consume numerous whole peanuts. My question is two-fold: 1) What are your thoughts on this and 2) Do you believe such "treatment" would also work for a tree-nut allergy? Or is it unique to peanuts? Tuesday November 30, 2010 12:31 Justin

12:32

[Comment From BethBeth: ]  Ms. Shelton: I would like to know why the Tribune decided to begin its chat series with this topic? Does the Tribune have a particular interest in food allergies and if so, could you elaborate? Tuesday November 30, 2010 12:32 Beth

12:33

Deborah Shelton:  We chose this topic because it's timely. A new clinical report by the American Academy of Paediatrics on this subject was released just yesterday. Tuesday November 30, 2010 12:33 Deborah Shelton

12:33

Deborah Shelton:  Sorry, that's American Academy of Pediatrics. Tuesday November 30, 2010 12:33 Deborah Shelton

12:34

Deborah Shelton:  Also, this is a topic that many parents are interested in. Tuesday November 30, 2010 12:34 Deborah Shelton

12:34

Dr. Kim:  In answer to Justin's question: I believe you are talking about oral immunotherapy. So far there have been studies for milk, egg, and peanut allergy because these are the most common allergens among children. So far these studies have indicated that children can be 'desensitized' -- meaning as long as they are on the therapy (taking a specific dose of the allergen daily), they are able to eat more before they develop a reaction. However, it has not proven to be a cure. Also, I would like to point out that among numerous studies, the side effects are relatively high, especially in the beginning of the therapy. Tuesday November 30, 2010 12:34 Dr. Kim

12:35

Dr. Kim:  Presumably if this proves to be effective, it can be tailored to any specific food, including tree nuts. Tuesday November 30, 2010 12:35 Dr. Kim

12:35

Dr. Kim:  I would caution against trying this at home however as this is still under research protocols. It is potentially dangerous to do this without medical supervision. Tuesday November 30, 2010 12:35 Dr. Kim

12:36

[Comment From KimKim: ]  What is the purpose of yearly testing? I mean, I already know he's got the allergies (per original blood testing). Why draw more blood to tell me what I already know? Tuesday November 30, 2010 12:36 Kim

12:37

Dr. Kim:  This is to see if there are indications that your child may be outgrowing the allergy on her own. Tuesday November 30, 2010 12:37 Dr. Kim

12:37

Dr. Kim:  If the test indicates a reasonable likelihood that the child has outgrown the allergy, we would perform an oral food challenge (feeding test under medical supervision) to see if the child could eat the food without a reaction. Tuesday November 30, 2010 12:37 Dr. Kim

12:39

[Comment From JessicaJessica: ]  Is it possible to test positive for an allergy in skin and blood tests, but not actually have an allergic reaction? Tuesday November 30, 2010 12:39 Jessica

12:39

Deborah Shelton:  Getting lots of questions! Great!! Please be patient with us everybody. We are trying to get to as many as possible. Tuesday November 30, 2010 12:39 Deborah Shelton

12:40

Dr. Kim:  Yes. Unfortunately, our tests are not always accurate. In fact, there is a fairly high false positive rate. The rule of thumb is: if your child is eating the food without any problems or reactions, then don't remove the food from his/her diet just because of a positive test. Tuesday November 30, 2010 12:40 Dr. Kim

12:40

[Comment From EliEli: ]  2. Is a sibling of a food-allergic child more likely to be allergic than a typical child? Tuesday November 30, 2010 12:40 Eli

12:41

Dr. Kim:  Yes. There was a twin study that looked at identical vs. fraternal twins. The fraternal twins both had peanut allergy about 7% of the time. Tuesday November 30, 2010 12:41 Dr. Kim

12:42

Dr. Kim:  So subsequent siblings have about a 7% chance of developing peanut allergy. Tuesday November 30, 2010 12:42 Dr. Kim

12:42

Dr. Kim:  among the general population, the prevalence of peanut allergy is between 1 and 2%. Tuesday November 30, 2010 12:42 Dr. Kim

12:42

Dr. Kim:  this is in the US. Tuesday November 30, 2010 12:42 Dr. Kim

12:44

[Comment From BethBeth: ]  Could you give a synopsis of the clinical report released yesterday? And what it means. Tuesday November 30, 2010 12:44 Beth

12:45

Deborah Shelton:  The report is called Clinical Report -- Management of Food Allergy in the School Setting. It is written for pediatricians. It's from the American Academy of Pediatriatrics. Tuesday November 30, 2010 12:45 Deborah Shelton

12:46

Dr. Kim:  Here is a synopsis. This is what parents and pediatricians can do to prevent any problems at school. 1. Notify the school. This may necessitate a meeting between parents and the school staff. 2. Determine how adults will be able to access the autoinjectable epinephrine. For example, one can be carried by the child in a dedicated pack. Another can be kept in the health office in case the self-carried pack is misplaced or if an additional dose is needed. 3. Provide a written emergency plan along with a list of foods to be avoided. The report provides more specifics on how to implement this plan but this is a short summary of what we recommend that the pediatrician (in conjunction with an allergist) address with schools and families. Partnership is KEY! Tuesday November 30, 2010 12:46 Dr. Kim

12:47

[Comment From MargretMargret: ]  If you child has asthma and food allergies, what is the best advice to tell teachers and administrators on how to treat (i.e., epi pen or albuterol inhaler) Tuesday November 30, 2010 12:47 Margret

12:47

Dr. Kim:  This is a very good question. I tell patients, when in doubt, INJECT! Tuesday November 30, 2010 12:47 Dr. Kim

12:48

Dr. Kim:  The side effects of epinephrine are fast heart rate and jitteriness. perhaps the child will get pale. But side effects are transient. Tuesday November 30, 2010 12:48 Dr. Kim

12:49

Dr. Kim:  also patients with asthma who also have food allergy are at higher risk of more significant reactions. I would empower the teachers to administer epinephrine if necessary. Also epinephrine used to be used (before albuterol was available) to treat asthma. Tuesday November 30, 2010 12:49 Dr. Kim

12:49

[Comment From MargretMargret: ]  To Deborah: You may know this but local readers might find help a new Illinois law called, Public Act 96-0349, Illinois State Board of Education (ISBE), in conjunction with the Illinois Department of Public Health (IDPH), has released the Guidelines for Managing Life-Threatening Food Allergies in Illinois Schools. They need to be followed by Jan. 1, 2011. Tuesday November 30, 2010 12:49 Margret

12:50

Deborah Shelton:  Thanks for telling us. It's another important resource. Tuesday November 30, 2010 12:50 Deborah Shelton

12:50

[Comment From CheriCheri: ]  Dr. Kim, How should parents handle classroom parties at school involving food? Although a note was sent home to the parents stating that all items must be store bought and that a student(s) has a peanut allergy, I am in constant contact with the teacher about this. Our rule is that if there is no label, our child cannot partake. If the product contains peanuts or cashews, our child also is not supposed to eat the food item. I hate seeing my child left out. Should I do as the teacher suggested and send in alternative food items for my child? Tuesday November 30, 2010 12:50 Cheri

12:51

Deborah Shelton:  Thanks for submitting your question Cheri. This is a big issue for many parents. Tuesday November 30, 2010 12:51 Deborah Shelton

12:52

Dr. Kim:  Yes, you are trying to enlist others to help you. Unfortunately, not everyone will be receptive. I would agree with your rule, but I also think there can be ways to make the child not feel left out. I think this requires sometimes some creative thinking (providing a list of possible options). I think a discussion is helpful to develop a plan. Tuesday November 30, 2010 12:52 Dr. Kim

12:53

Dr. Kim:  I would talk to other families and see how others dealt with the same issues as this is not an unusual situation. Support groups are a great resource! Tuesday November 30, 2010 12:53 Dr. Kim

12:54

[Comment From A.H.A.H.: ]  what is the latest thinking on the apparent increase in food allergies? or is it just improved detection? Tuesday November 30, 2010 12:54 A.H.

12:54

Dr. Kim:  This is because it is not entirely clear which environmental factors are contributing to this increase. There is a higher risk for food allergy to develop among atopic (or allergy-prone) families but there are many children with food allergy without any family history of allergic disease. This discussion may be beyond the scope of this web chat since we are focusing on school-related issues. Tuesday November 30, 2010 12:54 Dr. Kim

12:55

Dr. Kim:  Sorry... I meant to start out.. it is not clear as to why there is an increase. Tuesday November 30, 2010 12:55 Dr. Kim

12:55

Dr. Kim:  The tests, as mentioned earlier, have a high false positive rate. Thus, making a diagnosis SOLELY on the test results may lead to misdiagnosis. Tuesday November 30, 2010 12:55 Dr. Kim

12:56

Dr. Kim:  or overdiagnosis. Tuesday November 30, 2010 12:56 Dr. Kim

12:56

Dr. Kim:  This should not detract from the serious problem that food allergies has become. Tuesday November 30, 2010 12:56 Dr. Kim

12:57

[Comment From BethBeth: ]  Why do you think food allergies are more prevalent in the US than in other countries? Tuesday November 30, 2010 12:57 Beth

12:57

Dr. Kim:  Food allergies is similarly prevalent in the US, UK, and Australia. Tuesday November 30, 2010 12:57 Dr. Kim

12:58

Dr. Kim:  It seems that in most Westernized countries, there is a higher prevalence of food allergy. This leads us to believe that environmental factors are important in increasing the risk of development of food allergies but these specific factors have not yet been identified. There is research to find these answers. Tuesday November 30, 2010 12:58 Dr. Kim

1:00	Deborah Shelton:  Dr. Kim, we're nearing the near of our chat. Any final thoughts? Tuesday November 30, 2010 1:00 Deborah Shelton

1:01

Dr. Kim:  There have been many good questions asked that I was not able to answer. I would counsel the chatters to consult their physicians or allergists. Physicians play a key role in helping families, schools, and the general public about food allergies. Unfortunately this short hour has only touched on some of these very important issues. Thanks for inviting me! Tuesday November 30, 2010 1:01 Dr. Kim

1:01	Deborah Shelton:  Dr. Kim, Thank you very much for joining us today and for sharing your expertise. And thanks to everyone who sent questions and linked to our health chat today. Tuesday November 30, 2010 1:01 Deborah Shelton

1:02	Deborah Shelton:  This chat will be archived so people can come back and read through the entire chat. Tuesday November 30, 2010 1:02 Deborah Shelton

1:02	Deborah Shelton:  Come to the health page on the Chicago Tribune web page to find the link. Tuesday November 30, 2010 1:02 Deborah Shelton

1:03

Deborah Shelton:  Next week, join us for a discussion of The ABCs of Medicare. The first baby boomers turn 65 next year. Experts from the Medicare Rights Center in New York City will join us to talk about what they need to know -- and to take your questions. That'll be a week from today, Tuesday, at noon Central Time. Tuesday November 30, 2010 1:03 Deborah Shelton

1:03	Deborah Shelton:  If you have suggestions for future talks on children's health, please drop me a note at dshelton@tribune.com. Have a great day. Tuesday November 30, 2010 1:03 Deborah Shelton

1:04	Dr. Kim:  Happy holidays! Tuesday November 30, 2010 1:04 Dr. Kim

1:04