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Food Allergies: Doctors Disagree on Peanut-Free Schools/Classrooms Plus Talk on Bullying

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The number of school-aged children reported to have food allergies rose 18 percent from 1997 through 2007. Currently, nearly 8 percent of children in the U.S. have at least one food allergy. Attempts by parents and doctors to keep these children safe has stirred public debate about the need for peanut-free schools and classrooms.

At the center of the fallout are the allergic children and teenagers who are sometimes left feeling unsafe, socially set apart from their peers at lunch or in classroom celebrations, and teased or bullied by other students, and, more disturbingly, their teachers and other school staff, as noted in my interview below.

What follows are email interviews (except where noted) with Stanley Fineman, M.D., Scott H. Sicherer, M.D., and Wayne Shreffler, M.D.

Dr. Fineman is immediate past president of American College of Allergy, Asthma & Immunology

Dr. Sicherer is a professor of pediatrics and a researcher at the Jaffe Food Allergy Institute at Mount Sinai in New York and author of "Understanding and Managing Your Child's Food Allergies" (Johns Hopkins Press). He is also a member of the Food Allergy & Anaphylaxis Network's medical advisory board.

Dr. Shreffler is the director of the Food Allergy Center at Massachusetts General Hospital.

It should be noted that specific needs of individuals vary, and that these allergists are addressing the typical patient case.

S.Z. Berg: Do you think it is wise under any circumstances to have schools or classrooms peanut free?

Stanley Fineman: The problem with schools becoming peanut free is that this presents a false sense of security. Parents and children will think their child is completely safe, when in reality, your child and his/her teachers should always be prepared for an allergic reaction. It is reasonable to have precautions, but children with allergies have to be aware that they're at risk and extra precautions need to be taken. Children should always carry their epinephrine.

Dr. Scott H. Sicherer: [...] There are many ways to manage food allergy in schools. It may be useful depending on the age of the children involved and manner of supervision to exclude peanut from a classroom or to have a specific table that is allergen safe. However, older children who are not going to take another child's food may prefer not to sit at a table like that. The primary goal is to avoid having the child ingest the food. Thus, not having the food in craft projects is a great policy as is "no food sharing." Younger children need more supervision. Presumably, the youngest children need the most supervision and may need to be in a situation that separates them from the food if they are likely to take it and eat it.

Dr. Wayne Shreffler: What's best practice will vary from school to school, but I'm not a big fan of the peanut-free approach, because it can paradoxically lead to a false sense of security and inattention to things like adequate monitoring of meals and snacks, clean up after food is served, and reinforcing good practices like not sharing food at school. That's especially relevant for my patients who are allergic to things other than peanut!

S.Z. Berg: What about other food allergens?

Stanley Fineman: Again, a false sense of security shouldn't be presented. Educating yourself and your child about food allergies, how to recognize symptoms of a reaction, and when to administer epinephrine are keys to successfully managing food allergies. Your child's school, teachers, nurse, and extracurricular coaches should all be aware of your child's food allergy. Parents, children, and teachers should also know how to Be S.A.F.E.

Dr. Scott H. Sicherer: There are children who are as severely allergic to milk or egg or many other foods. Clearly, it is harder for a school to decide to exclude milk or egg if they are interested in managing allergy through exclusion of the food. Thus, supervision and no food sharing are the main approaches. At snack time, a messy milk product might be a poor choice (like dusty cheesy cheese curls/puffs) compared, for example, to cheese.

Dr. Wayne Shreffler: Same considerations -- better to have reasonable policies that help protect any child with a food allergy.

S.Z. Berg: What are your experiences with patients being bullied?

Dr. Stanley Fineman: [Paraphrased from phone response] I had patients come to my office who reported being bullied or taunted, which most often happened at school...tempting my patients to partake in risky behavior.

Dr. Scott H. Sicherer: [Note: Dr. Sicherer and colleagues published a study, "Bullying among pediatric patients with food allergy" in the Annals of Allergy, Asthma & Immunology in October 2010.] [...] In this survey of 353 parents and caregivers of food-allergic children and food-allergic patients, nearly one quarter of individuals in all age groups were reported to have been bullied, teased, or harassed because of their food allergy. Of those affected, 86 percent reported multiple episodes. Additionally, 82 percent of the episodes occurred at school, 80 percent of the episodes were perpetrated by classmates, and 21 percent reported teachers or other school staff were the perpetrators. Comparing our study to one done on a general population, for those in grades 6-10, we found a rate of 50 percent bullied versus 17 percent not selected for food allergy. To sum up, this is a concerning issue that should be addressed. I speak to my patients about this, and I would suggest that parents talk to their children about it. If your child with food allergy has experienced bullying, talk to the responsible school personnel.

Dr. Wayne Shreffler: My anecdotal impression has been that it's rare, though I have had patients report this as an issue occasionally. I think that society is scrutinizing teasing/bullying behaviors that in the past might have been more often dismissed -- and that's a good trend for the most part. That said, I'm not really worried about my patients having contact on their skin with the allergens they are sensitive to, but rather that they accidentally ingest something that is a trigger.

S.Z. Berg: Many people think that parents with a child with food allergies generally overreact in trying to keep the child protected. What are your thoughts on this matter?

Dr. Scott H. Sicherer: I understand that people think that parents "over-react," and it is sad. This is an illness that causes a lot of anxiety. Parents want to keep their child safe. My main advice is to see a board certified allergist to be sure that you are doing what is needed to stay safe, and also not over-limiting activities.

Dr. Wayne Shreffler: This is a complicated issue that the medical community has not dealt with well. In some cases, of course, parents of food allergic children do over react, just as in many cases parents of unaffected children just don't get it. Part of the problem is that there is much confusion about food allergy and much over diagnosis. When unaffected people observe others with stated food allergies who can nevertheless eat the food (for example someone with lactose intolerance, not milk allergy or oral allergy syndrome, which causes limited mouth itching most of the time) they suspect that those who claim more severe reactions might be exaggerating. Those who are affected are often not well educated on what exposures are most relevant and actually dangerous, and they have not been helped [to] put the risk of their food allergy into a context that helps them relate that risk to other risks in life.

If you have a child with food allergies, visit the William Edwards Book Series website for links to free downloadable medical alert cards, more interviews, and blogs and information about the William Edwards Book Series for kids.