FeaturesAug/Sep 2009 Issue

Back to School: Tips for your Food-Allergic Child

Tips for keeping your food-allergic child safe in the classroom


Most mothers feel a little trepidation when their children start school for the very first time but Terri Esterowitz, MD, had a lot more than the jitters when she prepared her little girl for kindergarten. Understandably so. Her daughter Ellie has life-threatening allergies and Esterowitz knew that sending the 6-year-old into class was introducing her to a whole new world of risk.

Esterowitz, an internist who lives in Rockville, Maryland, discovered her daughter had allergies when Ellie was five months old. Her husband fed the baby an ounce of new formula and within minutes, Ellie had an anaphylactic reaction. She began vomiting and breaking out in head-to-toe hives and then became lethargic. Fortunately, Esterowitz’s husband, a pediatrician, knew exactly what to do. He quickly gave Ellie an antihistamine and called 911. Ellie recovered but the memory still haunts Esterowitz.

“We were lucky we had an antihistamine at home that was appropriate for an infant,” she says. “I can’t imagine what would have happened if we hadn’t.”

Afterward, Ellie, who’d always had some eczema, was tested for allergies. Results confirmed a serious dairy allergy. Tests also revealed that she was allergic to eggs and sesame and extremely allergic to peanuts.

“Her peanut allergy measured off the charts,” says Esterowitz.

Although Ellie had never ingested a peanut, she had a high level of antibodies due to exposure through her mother’s breast milk. “The allergens were fi ltered really well through the breast milk,” which likely prevented an anaphylactic reaction, Esterowitz says. When Esterowitz stopped eating peanuts, which she did immediately, Ellie’s eczema markedly improved.

With Ellie’s peanut allergy so severe, Esterowitz had no way of knowing what level of exposure the young girl could safely tolerate. Would Ellie have a reaction just by inhaling aerosolized peanut, say, in the school cafeteria? Esterowitz sent her daughter to kindergarten not knowing.


Safe at School

The first day of school is a watershed moment for every child but for food-allergic children, it’s particularly momentous. School plunges them into a food-flooded environment with exposure to potential allergens over which parents have limited control.

It’s a challenge that more families are facing as the number of food allergic students continues to increase at an alarming rate. Today, almost 5 million school-age children in the United States have food allergies. With the rate of peanut allergy alone doubling from 1997 to 2002, the issue is gaining attention.

Robyn O’Brien of Boulder, Colorado, didn’t think much about food allergies until her daughter Tory, age one at the time, had a severe reaction after touching some scrambled eggs.

“I went in to check on her after putting her down for a nap and her face had puffed up so much that her eyes were swollen shut,” says the mother of four. She rushed the baby to the doctor’s office where an antihistamine reversed the symptoms.

After that episode, O’Brien began earnestly looking into the issue and was shocked to discover how many children suffer from food allergies and how difficult it is for moms to protect their food allergic kids.

“When did a peanut-butter-and-jelly sandwich become a loaded weapon on a lunch table?” she asks.

Founder of Allergy Kids and author of The Unhealthy Truth: How Our Food is Making Us Sick and What We Can Do About It (Random House),O’Brien created a symbolto alert peopleto her daughter’s allergy—a neon-green stop sign with a black exclamation point in its center. AllergyKids sells school supplies (medication bags, lunch sacks, wrist bands, etc.) which bear the emblem and O’Brien hopes it will become universally recognized, a pink ribbon of sorts for the food allergy community.

“The problem of food allergies is becoming so prevalent now that schools cannot ignore it,” she says. Her back-toschool advice for parents is three fold:

1. Find other moms of food-allergic kids,

2. Enlist an allergist as an advisor, and

3. Approach the school as a group to improve the safety of your school.


Advocate for Change

Terri Esterowitz didn’t have the benefit of knowing other moms whose kids have life-threatening food allergies. She learned from neighbors that the public school which Ellie would attend had no peanut-free zone in the cafeteria. In fact, she says, “there was nothing at all in place there” for food-allergic kids.

Esterowitz contacted her daughter’s allergist who gave her marching orders. Establish a peanut-free table in the cafeteria. Create a peanut/nut-free snack policy in the classroom. Set a protocol for hand washing when arriving at school in the morning, as well as after snacks and lunch. And enforce this rule: No one touches Ellie or her food during snacks and meals.

“I’m not a naturally pushy person,” admits Esterowitz, who set to work to advocate for her daughter’s safety. She approached the school the spring before Ellie enrolled.

“It’s best to start early. Nothing happens over the summer," she advises.

Esterowitz went directly to the principal because “there were so many changes to be made.” Fortunately, the principal was responsive and agreed to the recommendations made by Ellie’s allergist.

This particular school, like many others, does not have a full-time nurse on location but Esterowitz met with the health technician during the summer to discuss Ellie’s condition and medication. She also drafted a letter for the principal to send to the families in Ellie’s class, alerting parents to the food allergies and informing them that their children’s classroom would be designated peanut free and nut free. The letter included Esterowitz’s contact information so that the parents could call or e-mail their questions.

A second letter went out to all three of the kindergarten classes, announcing the creation of a “common” lunch table, one to be shared by all kindergarten students.

“Kids can sit with their friends and any child can sit there, regardless of whether or not he or she has food allergies,” explains Esterowitz. “The only catch is that there are no nuts or peanuts allowed at the common table. Everyone’s lunch must be free of peanuts and tree nuts and it must be labeled ‘peanut/nut free.’”

The letter offered parents helpful hints on packing a peanut-free, nut-free lunch, including suggestions to re-read ingredient lists and that products labeled, “Manufactured in a facility that also produces nuts,” were not allowed at the table.

The effect of the common table was positive and inclusive. Rather than foodallergic kids feeling isolated, they and their non-allergic friends were excited to sit at the special table. One precautionary measure that Esterowitz implemented in Ellie’s classroom was to give each student his or her own tray for snack time. She bought the trays and labeled them with each child’s name.

“The trays help confi ne crumbs during snack time, making cleaning up a little more controlled,” she says. For unexpected celebrations, Esterowitz gave Ellie’s teacher a big bag of safe cookies to stash, just in case.

Esterowitz says she learned several things after working so closely with Ellie’s school. 1. Your child’s class should be the fi rst lunch period of the day. “The cafeteria is cleaner.” 2. Choose a veteran teacher. “Newer teachers may be overwhelmed with the basics of their profession and may not have the energy or resources to deal with a food allergy.” 3. Monitor the situation closely. “Even in a great school staffed by responsible and responsive teachers, glitches are inevitable.”

Before school began, Esterowitz completed an Emergency Action Plan, a one page instruction sheet with directions on administering care should there be an emergency. “In my opinion, every child with food allergies should have a plan.” She reviewed the plan personally with the school’s health technician.

With everything in place, Ellie Esterowitz strode confidently into her kindergarten class—but her mother remained nervous the entire fi rst week.

“I came to lunch every day with an EpiPen in my pocket,” she says.

To her great relief, Ellie did not have an allergic reaction and sailed through her kindergarten year without mishap.


There Ought to be a Law

Every public school in America has students with life-threatening food allergies and every school deals with the issue differently. As yet, there are no federal guidelines to help schools implement precautionary measures.

Senator Christopher Dodd (D-CT) aims to change that. He recently introduced The Food Allergy and Anaphylaxis Management Act of 2009, a bill to develop voluntary school guidelines across the nation. It would also provide incentive grants to schools that implement the guidelines. The Food Allergy and Anaphylaxis Network (FAAN) and the American Academy of Allergy, Asthma, and Immunology (AAAAI) have endorsed the legislation.

Robyn O’Brien says the bill is a step in the right direction but “it’s unfortunate that compliance has to be voluntary.”

O’Brien would like to see the U.S. Department of Agriculture, the agency responsible for administering the National School Lunch Program (NSLP), develop mandatory guidelines for the over 100,000 public and not-for-profit private schools and day care centers in which the NSLP operates. The NSLP already has mandatory guidelines for nutritional requirements. In O’Brien’s opinion, adding guidelines for preventing exposure to potentially lethal food allergens would be a natural extension of that program.

“Guidelines should be mandatory so that children are protected,” she says.

Esterowitz agrees that school lunch programs could do more. In Ellie’s lunchroom, tortilla chips made with peanut oil are a regular offering.

“It’s easy enough to fi nd tortilla chips made with a safe oil. When peanuts are potentially deadly, why even sell peanut products in the cafeteria?” she asks.


Getting Better

According to a national poll conducted by Harvey Leo, MD, and Matthew David, MD, of the University of Michigan, more schools are taking action to manage food allergy issues. About 74 percent of parents who know of a food-allergic child reported their school makes at least some accommodations for these children. Clearly, more work has to be done but with the number of food-allergic kids increasing, many parents of non-food-allergic kids are perhaps more understanding than they were in the past.

“A mom called me recently to make sure Ellie could have what she was serving at her daughter’s birthday party,” says Esterowitz. After all the effort, energy and time required to keep Ellie safe at school, that phone call was particularly meaningful.

“Just that little bit of support meant so very much. I am really thankful to that mom.” LW

Chow Down!

Tell Me More -


American Academy of Allergy, Asthma & Immunology (AAAAI)

Food Allergy & Anaphylaxis Network (FAAN)

Safe@School Partners



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