PB&J: For some a tasty snack, deadly to others

For some children, a peanut butter and jelly sandwich is a favorite lunchroom standby.

For others, it can lead to serious problems.

One in every 13 children, or approximately two children per classroom, has a food allergy, according to the American Academy of Allergy, Asthma & Immunology. Peanuts are the most prevalent allergen, followed by milk and shellfish.

Some of the most severe allergy attacks can occur in schools, where children are constantly exposed to food – breakfast, lunch, snack time, birthday parties, holiday celebrations and even during lessons. According to the Centers for Disease Control and Prevention, 25 percent of anaphylaxis reactions – severe allergic reactions that escalate rapidly and may result in death – occur in schools among students who hadn’t been diagnosed with a food allergy.

Earlier this year, the Florida Legislature passed a bill, signed by Gov. Rick Scott, that allows public and private schools to keep EpiPens for emergency use and administer them to students with – or without – a known food allergy. The bill went into effect on July 1. Prior to this legislation, school nurses were prevented by state law from giving injections to students who didn’t have a prescription.

“The significance of this legislation being passed in Florida cannot be understated,’’ said Jan Hanson, founder of Educating for Food Allergies. “If there is a means to prevent a fatality – and there is – it is called epinephrine, then that is what needs to be done. There is no doubt that having stock epinephrine auto-injectors on hand in Florida schools will save lives.”

School personnel will be trained on how to recognize the symptoms of anaphylaxis: hives, tingling in the mouth, swelling of the tongue or throat, difficulty breathing, abdominal cramps, vomiting, diarrhea, coughing or wheezing, eczema or rash, loss of consciousness and dizziness. They will also be trained on how to use, and administer, the EpiPens.

Michael Pacin, a doctor and founder of the Florida Center for Allergy and Asthma Care, which has offices throughout Miami-Dade, Broward and Palm Beach counties, says the EpiPens are easy to use.

“You can’t miss,” he said. “They are idiot-proof. Just press and hold it against the thigh. It will go right where it is supposed to go.”

The EpiPen is made to go through clothes, including jeans and sweatpants, so children don’t need to undress to receive the treatment.

Pacin’s advice: Do not pull the EpiPen out too quickly. Press it into the thigh and hold it for five to 10 seconds.

In schools, peanuts and tree nuts are among the major areas of concern because they make up 90 percent of fatal allergic reactions in the country. Although many children are aware of their allergies, most allergic reactions occur from ingesting a hidden ingredient. Even the smallest amount of an allergen can provoke anaphylaxis.

Hanson says that peanut allergies have tripled since 1997 in school-age children.

“The potential for death is there, and our students are not immune to that,” she said.

The CDC says that 4 to 6 percent of children under age 18 have food allergies, and 16 to 18 percent of those children experience allergic reactions during school hours.

Gary Kleiner, the director of pediatric allergy and immunology at Joe DiMaggio Children’s Hospital in Hollywood, says the Florida amendment was “drastically needed” and most states are enacting similar laws around the country.

“If epinephrine is not administered usually in the first 20 to 30 minutes, the allergic reaction can be fatal,” he said. “This law provides a necessary medication, just as airports have a defibrillator available if someone is having a heart attack, it’s important to have a medication that is needed to treat an allergic reaction.”

Although non-medical personnel at schools will be allowed to administer the EpiPen, calling 911 will still be required because further medical assistance is often necessary. The first injection of epinephrine, although not common, may not always work, said Pacin, of the Florida Center for Allergy and Asthma Care. The EpiPen shot should work within five to 10 minutes. If not, a second EpiPen can – and should be – used.

The auto-injectors come in packs of two, or what Pacin refers to as a “dual pack,” just in case the first one doesn’t work or the child is in a place that is not close to a healthcare provider. “It buys more time,” he said.

Pacin says now that the law has been passed, it is important for allergists to educate the public more on the importance of administering the EpiPen.

“Don’t try using another measure first,” he said. “If you think somebody is having an allergic reaction to a food and you have the EpiPen available, use it. It is better to do it too soon than wait. Your big enemy with a severe food allergic reaction is time.”

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