Why Do Kids Have to Eat Peanut Butter At School?

Why do kids have to eat peanut butter at school?  This is such a controversial subject in the food allergy world, though I can't for the life of me figure out why it's so heated.  I've read the reactions to food allergy parents who have given their opinions in the past.  I know what peanut butter advocates think.  I know that on the extreme side of this argument, peanut advocates think that severely food allergic children should not even be allowed in school--that they should be homeschooled.  In fact, I've heard this opinion so many times that this type of verbiage no longer fazes me.

How many times have I heard a parent say, "But she'll only eat peanut butter for lunch!"  I just can't figure this out.  Because if my kid looked at me and told me he would only eat one thing for lunch, and that one thing was something that could potentially kill another student, I'd tell him no way.  Forget that, if my kid told me he would eat only one thing for lunch, period, I would tell him no, that's not acceptable.

I just can't wrap my head around parents who insist that peanut butter sandwiches are the end all. Do their kids eat these for breakfast and dinner too?  Do they have a peanut butter sandwich waiting for them when they get home for snack?

Okay okay, I get it, I do.  People have rights.  They want to eat peanuts and they should eat peanuts.  Just not at school.  There are personal rights and then there's social responsibility.  What are we teaching our children if we're only teaching them one side of the coin?

I mean, if my son was playing in the park with friends, found a long sharp stick and proceeded to wave it around recklessly at the other kids, I would tell him to put it down.  Sure, he has the right to play with sticks, just not around other kids.  Hey, it's unlikely that he'll poke someone's eye out, but it's possible.  He could also unnecessarily scratch or puncture someone.  Wouldn't we rather avoid the risk altogether and tell the boy to put the stick down?  Or would we all sit around on the edge of our seats waiting to see what would happen?  If your child was the one with the stick pointed at her, would you just sit around and do nothing so as not to offend the rights of the stick-brandishing child or his parents?

Do we share the responsibility of helping to keep our kids safe?  Every day, my kids go to school and I pray that I don't get a phone call from the school office.  When I see the number flashing on my phone, I'm immediately filled with dread.  I'm hoping the caller is not about to describe an allergic reaction, and that I won't need to rush myself over to the pediatric ER to meet my child.

So why the peanut butter?  Of course, 99.9% of the time, peanut butter sandwiches in the school cafeteria aren't hurting anyone.  It's the less than one percent of the time, the time that after eating a peanut butter sandwich, a classmate accidentally spits into the mouth of a peanut-allergic child during a conversation they are having in line about to leave the cafeteria.

Yep, it happened to my kid, yesterday at school.

Within moments, my son developed a stomach ache, told the principal, and was whisked away to the office.  While I was on the phone with the principal (thank God I answered my cell!), my son reported trouble breathing, so I told him he needed the epinephrine injection, which my son administered himself.  I told the principal that he needed to go directly to the ER, and I would meet him there.

My 9-year-old son is officially a rock star.  He recognized his symptoms, got help, related his symptoms clearly, and administered the Auvi-Q auto-injector successfully and calmly.  He rode an ambulance alone to the ER, readied himself for a four hour stay, and worried that he didn't have his books to do his homework.

Why can't we just say that there are no nuts allowed in school?  Because we know people won't follow the rules?  Because we know people won't like it?  Because we're worried about people's right to eat what they want for lunch?

All schools have drop-off and pick-up procedures which are not to everyone's liking, and which are probably going to be challenged by a few parents, but we still have them.  We have them because we know it's the right thing to do, and because we know if we didn't, we'd have a lot more accidents.  If we could avoid just one accident with rules about how to pick up our children from school, would that help to justify their existence?  Do we even feel the need to quantify how safe we could be with the implementation of a particular rule?

How many food allergy accidents have to happen before we change our food policies at school?

I don't think most people mean to put food allergic children at higher risk of reaction at school; I just think they don't understand.  They haven't had to respond to an emergency situation--adrenaline pumping, hands shaking.  They haven't had to live through the ups and downs of managing food allergies on a daily basis, spend literally thousands of dollars every year on medications, ER visits, and specialty foods...in a constant state of worry.

I've always known that food allergy education is a slow evolution.  One step forward, two steps back.  We had our two steps back yesterday, I'm looking forward to that step forward.

Callan's peanut challenge

My first time buying peanut butter in nearly 8 years.

Last week I took Callan in for his first ever peanut challenge.  Our allergist suggested that chances were good that Callan is not allergic to peanuts after evaluating his having no reaction to a skin test from December and his most recent blood test IgE results.  (The skin test was conducted right before his and Ryken's baked milk challenge.)  I had been operating under the assumption that Callan had peanut and tree nut allergies based on IgE blood tests from 2010 and 2011 with numbers pointing to a moderate allergy to peanuts (2.5 KU/L) and low or moderate level allergies to almost all tree nuts.

I had gotten comfortable with having my kids get tested via blood.  I am a numbers kind of a gal so I appreciate having concrete information and being able to compare numbers from year to year.  IgE scores also get categorized into severity levels and this made it a little easier to talk to people about the gravity of my kids' food allergies.  With the skin test, reactions are measured by (W) wheal size (that bump that develops) and (E) erythema or inflammation/redness that you can see developing under the skin.  It's hard for me to recall how one reaction looks from one year to another.  So for me it is nice to have these neat reports with blood IgE numbers and a key for reading the level of severity of the reaction, reports that I can easily pull up in our online records. 

On the left: Callan was scratched with peanuts and various
tree nuts in areas 1 through 7.  He did not have reactions. 
Upper left is the control histamine while the wheal
on the right is for baked milk.

So last month's skin testing showed a discrepancy between what the blood test and skin test each suggested.  Our allergist explained that each of the tests can help predict whether a person has an allergy but neither is 100 percent accurate all the time.  (A double blind placebo-controlled food challenge is the best way to determine a food allergy...but you don't want to dive into those until you're confident there will be no reaction!) So it is often good to have information from both types of tests to confirm or challenge the high chance of an allergy. There is a new method for evaluating a peanut allergy, the uKnow Peanut molecular test, which is gaining more buzz as a more accurate means of determining a true peanut allergy.  (Apparently those with birch or ragweed pollen allergies may test positive for peanuts!)  I haven't checked out the uKnow Peanut test but it sounds promising albeit expensive.

When the IgE values are higher, there is a greater chance that an allergic reaction will occur.  According to research, the IgE of different foods has varying predictive value for allergic reactions and because of this, you cannot read the IgE results in the same way.  For example, for eggs, a IgE value is 7 KU/L or greater is 95 percent predictive of an allergic reaction.  For peanuts, 100 percent of individuals with IgE blood test result of 14 KU/L and above would react to peanuts in a food challenge.  Individuals with a peanut IgE of 1KU/L have roughly a 50 percent chance of reacting in a food challenge.

So there is definitely a chance that there might not be a true allergy if you are testing at IgE levels that are lower than these highly-predictive, minimum values.  This was probably the case with Callan.

The Challenge
This was the first food challenge I had ever sat through.  Veteran food-allergy moms advised me to bring entertainment (paper, markers, books, and DVD player and videos were popular with my son) and snacks for after the food challenge when we would still be required to stay under a nurse's care for 2 hours for monitoring.

The food challenge was scheduled for 8:30am.  Challenges are conducted first thing in the morning and patients cannot eat beforehand.  This helps to ensure that (1) patients are hungry enough to eat the challenge food, (2) nothing has been eaten earlier in the day that might cause its own allergic reaction and confuse the results, and (3) it keeps the stomach empty thereby lowering the chance of asphyxiation in case the food challenge induces vomiting.

I brought in the product to be used in our challenge, a jar of peanut butter.  The allergist double-checked the brand to make sure it was not made in a facility that also processes tree nuts as that could muddle the results in case there was an allergic reaction to the peanut butter.  I haven't thought of this!  Thankfully our Skippy brand was given the green light.  However, the allergist mentioned that Planters' nut butters have possible cross-contamination issues.

Callan was given peanut butter on a pretzel stick, also provided by me and not new to his diet.  He was given increasing amounts of peanut butter every 10 minutes: 1/8 teaspoon, 1/4 teaspoon, 1/2 teaspoon, 1 teaspoon, 2 teaspoons, and finally 1 tablespoon.

At first Callan was reluctant to eat, scared that there might be a reaction that necessitated medication.  After some reassurance from me he cautiously took his first lick on peanut butter.  It was curious but not too foreign since sunflower seed butter was a familiar taste already.  After a minute of no itchiness and no rash, I could see Callan's body relax.  His mouth widened into a big smile and declared that he really liked peanut butter!  The rest of the challenge went just fine -- no reaction whatsoever.  Callan had passed the peanut challenge!

A relaxed Callan made some cards for preschool friends
while we waited out the post-eating observation period.

We had started the challenge a little after 8:30am.  By the time the six quantities of peanut butter were consumed and the 10-minute wait periods had expired, it was about 10am.  We had to stay in the challenge room until 12pm to make sure no delayed reaction set in (and none did).  These two hours were probably the hardest because we just stayed in the room.  We were given a choice to walk about the allergy office's hallways to stretch but besides that we were not allowed to leave.  We ate snacks, drew pictures, and then I finally busted out the DVD player to pass the time.

We met with the allergist after the 2-hour wait period who congratulated Callan on passing.  She advised me to give Callan a peanut product at least twice a week in order to keep peanuts in his system.  She said that research has shown that individuals with siblings with peanut allergies do have a higher chance of developing the allergy at some point.  Keeping up with exposure to peanuts can help protect Callan from (re)developing sensitivities down the road.

I was worried about how Ryken was accept the reality that his brother was not allergic to peanuts while he is still very much allergic.  For the days leading up to the food challenge, Ryken had been telling his adoring little brother, "If you can eat peanuts, I'll be allergic to you!!"  Words like these offered little encouragement to Callan and, not surprising, he did not want to take the peanut challenge.  The morning of the challenge I took Ryken aside for a talk.  I looked him right in the eyes and told him that, while Callan would be under a doctor's care and that his skin tests showed he had good chance of not being allergic to peanuts, a food challenge still was a little dangerous.  I needed him to hope for the best for Callan and give him confidence to take this test.  I promised Ryken that I am always looking out for both of my boys' safety -- Callan's at his food challenge and Ryken's if Callan should pass and need to eat peanuts to protect him.  Ryken looked at me and clearly understood.  He got into big brother mode and has been positive since finding out that Callan passed.

So now my newest task is figuring out when to give Callan peanuts (I'm sticking with peanut butter) and how to ensure that his peanut-allergic brother remains safe.  I might have them use separate toothpastes and designate one special "peanut butter spoon" to always use for Callan to reduce the chance of accidental contact.  There are some details to work out but I am more than happy to have this problem!

Logan's Peanut Challenge

Last week, Addi and I went to see her allergist for a peanut challenge.  It went so smoothly, we couldn't have asked for anything more!  I was hoping, praying, wanting so much to have the same experience with Logan.  And although he didn't have a severe reaction to peanuts, it was disappointing.

Let me start from the beginning.  We had known from an early reaction that Logan is egg-allergic (he vomited immediately after having a bite of a scrambled egg when he was around one).  He had also had an early reaction to penicillin at around 2 years old (broke out in a rash on day 8 of a dose of penicillin for an infection).  When he was about 3, I noticed that his taste aversion to shrimp was probably more than that, when a bite of dim sum containing shrimp immediately caused "itchy tongue," as he called it.  Gradually, Logan became an more of an allergy enigma than I had originally thought. 

And so, about a year ago, Logan tested negative for peanuts on his very first skin test.  It was encouraging, but, like with Addison, I couldn't muster up the courage to challenge him with his first taste of peanut butter in our previously nut-free home.  I requested an in-office peanut challenge.

With Addi paving the way for Logan, he entered the allergist's office self-assured and happy.  He spoke to the doctor, got along like old buddies, and had his first bite of peanut butter. 

Logan was in a happy mood at the allergist's office

Part of the challenge is trying to get your child to describe how the food tastes in as clear a way as humanly possible for a five-year-old.  Words with negative connotations for kids like "spicy" could be an indication of an allergic response.  Sometimes the tongue will feel "prickly" or "itchy," or even sting or hurt.  So the first child's first response to the food is important.

Unlike Addi, who loved peanut butter after the first lick, Logan made a face.

Doctor: Do you like it?
Logan: No.
Doctor: Why?  How does it taste?
Logan: It tastes like salad.  Smirk.
Doctor: You don't like salad?
Logan: I do. 
Doctor: Then why don't you like this?
Logan: (Very matter-of-factly) It's not salad.

Unfortunately, the words that come out of my five-year-old's mouth are completely unpredictable.  He was in a bit of a silly mood, and the doctor and I kind of looked at each other with amusement, with a bit of frustration (at least on my part).

Logan passed the time between peanut butter tastes by pulling out superhero books and figures from his pack.

Right before the doctor came out with the second taste of peanut butter, Logan started scratching his arm.  He had irritated the skin, and although there weren't any hives, there were about 4 or 5 small bumps resembling a heat rash, and it was red and itchy.  Not unbearably so, but I showed the doctor before he gave him the peanut butter.  He took note of it but didn't seem too concerned.  He looked inside Logan's mouth, at his tongue and lips, and asked him if his mouth hurt in any way.  Logan said it didn't.

Doctor: So Logan, are you ready for some more?
Logan: It tastes like poop.
Doctor: (Without skipping a beat) So do you want some more poop?
Logan smiles, opens his mouth, and eats the peanut butter.
Logan: Tastes like poop.

(I have three young kids so it takes a lot to faze me, but Logan was doing a pretty good job).

At this point, the doctor explained to Logan that even though he might not love peanut butter, it's important that we have him taste it a few times so we'll know whether he could have peanut butter if he ever wanted it.  Magically, logic prevailed and Logan seemed satisfied with this explanation.

More itchy red arm before the next dose, so the doctor decided to scratch the challenge.  He put some cold water on Logan's arm, and applied cortisone.  Logan felt much better and was ready for some fresh air, but I was disappointed over an inconclusive test.  We will try again another day.

Through the ups and downs of being an allergy mom, we must remember that keeping our kids safe is our number one priority.  And even after forgetting to bring an allergy-safe treat to a birthday party, unsuccessfully trying out a new allergy-safe recipe to a less than enthusiastic brood, or going through an inconclusive peanut challenge, life is still pretty darn good.

Addi's Peanut Challenge

Our family has been avoiding peanuts (and all nuts, for that matter) for so long that I was terrified when the allergist suggested I challenge Addi with peanuts at home after a negative skin test.  As much as I wanted to believe she wasn't allergic to peanuts, I couldn't get myself to sit her down and feed her peanut butter.  The scenario of an anaphylactic reaction, Epipen injection, and frantically tossing three kids in the car to get to the ER ran through my mind, over and over again.  Finally, I requested an in-office challenge.

Considering my neurosis over peanuts, you can only imagine Addi's response when I told her we would be going to the allergist to try some peanut butter.  She cried and screamed.  I held her and reassured her, and told her what would happen.  I explained how lucky she was to try peanut butter as it tastes just like soy nut butter--one of her all time favorite things to lick off her plate, her spoon, her fingers, a celery stick...

On the way to the office, she seemed confident, and so did I:
"We're seeing the doctor and I'm going to have peanut butter, just like soy butter.  Right, mom?" 
"Right sweetie.  Lucky you."

We sat down with the allergist for a few minutes so he could explain to her about the challenge.  Here's how it went:

1:14 pm Dr. gave Addi a crumb-sized portion of peanut butter.  She held it stuck to the back of her teeth for a few seconds before licking her teeth and lips, and swallowing.  Big smile.  Proceeded to dress her ballerina magnets and sing the theme song to "Little Einsteins" while she awaited the next dose.  No allergic signs.

1:35 pm Allergist came into the waiting room to greet Addi who had run out of lyrics to "Little Einsteins" minutes ago, and was starting to get bored.  Jar of peanut butter, double crumb portion = another big smile.  Some jumping around, drawing "potato people" and scribbling of "words" with my pen and piece of scratch paper for another 20 minutes.  Some whining that naturally comes from skipping a much needed afternoon nap.  But still no allergic reaction.

1:55 pm Big smear portion.  Happy girl.  Realizes she loves peanut butter.  Finds a friend in the waiting room to be silly with.  Some jumping and twirling, giggling.  Still no reaction. 

2:15 pm  Last check by allergist.  All clear.  Mom and daughter go home with one less suspected allergy, a little bit lighter, a new confidence to slowly introduce tree nuts into her diet. 

Addi after her peanut challenge--all smiles!

 It was a good day.  A great day.  A happy day.  Happy Monday everyone!

A Classroom Presentation on Food Allergies

We are so excited about this post from our friend and fellow allergy mom, Michelle K. In it, she outlines how to give a 30 minute lesson full of practical, important, and age appropriate information about food allergies to a class of elementary school students. Read on for some helpful tips and useful resources. You rock, Michelle! A Classroom Presentation on Food Allergies

"Until there's a cure, education is key."

-Eleanor Garrow, Vice President of Education and Outreach for FAAN.

On my quest to become an ever-vigilant food allergy mom, I stumbled upon the opportunity to do a classroom presentation on food allergies. With open arms, my son's 2^nd grade teacher warmly invited me into her classroom to read a book and discuss food allergies with the kids and of course, I happily accepted. So where was the first place I went to seek info? You all win: Online, of course. I really wanted to find out if anyone had done a classroom presentation on food allergies before and posted details, but to no avail I came up with my own agenda. Here are the tools I used:

And within the 30 minutes that I had, I was able to:

1) Read two books 2) Discuss the Be a P.A.L. Program 3) Review the signs and symptoms of an allergic reaction 4) Establish a lunch buddy system 5) Honor the teacher

What I found out is that a short and simple agenda such as the one above is all you need in order to execute a successful presentation on food allergies. Now to elaborate…

1) Read two books. Never having owned a storybook on food allergies, I came across a good list online at the KFA: Food Allergy Book Shop which you can find here. So I ordered any that I thought would be most relevant to a 2^nd grade class. I then narrowed it down to two that I thought were age-appropriate, educational, informative and at the same time gentle and fun. The two books I chose were Taking Food Allergies To School by Ellen Weiner and Food Allergies and Me by Juniper Skinner. I just posted a book review on the former here. A book review on the latter is written by our very own Get Allergy Wise mom, Irene Chu, which you can read here. Most importantly, these two books portray two well-adapted and conscientious kids who navigate through the food allergy world confidently and successfully. Furthermore, they both illustrate how having food allergies is just one of many elements that makes a person who they are.

2) Discuss the Be A P.A.L. program. If I had only 5 minutes to do a presentation, this would definitely be my go-to topic! I feel that the brochure lays out everything you need to know to make a complete food allergy presentation in a classroom setting. Created by FAAN, the Be A Protect A Life Program "is an educational awareness program designed to help parents and educators teach students what food allergies are and how to help their friends who have food allergies." –FAAN. Need I say more? Even better is the fact that FAAN provides resource materials that you can print out including a poster, P.A.L. HERO awards, and even a Girl Scout Patch Program. I offered the poster to the teacher and printed out one brochure per student and handed them out during this segment. Together we went over the entire brochure which clearly outlines 5 simple steps to keep your classmates with food allergies safe. Many thanks to FAAN for these invaluable teaching tools!

3) Review. If a reaction is going to happen at school let's say at lunchtime, the students are most likely going to be the first witnesses to a reaction. That is why I felt that it was imperative for me to review the signs and symptoms of an allergic reaction so they could learn how to identify a reaction if they ever encounter it. The ensuing discussion led me right into a demonstration of what would happen to Kian's trachea if a peanut entered his body and a reaction took place. Using a cardboard tube taken from inside a paper towel roll (with a rubber band wrapped around it), I showed them that a normal trachea (windpipe) is open much like the hole in that tube. I then took off the rubber band so as to represent a cross-section of the trachea, using my hands, I showed them how it could swell up like a marshmallow all the way around causing the inside of the tube, or airway, to become constricted, or completely closed. Eyes widened and jaws dropped. This demo helped me make my next point clear: never take food allergies lightly. Serious things can happen and that's why we never bully or tease someone for having food allergies. And a simple review wouldn't be complete without reviewing the protocol of what to do in the event that a student witnesses these signs which is to tell an adult immediately. The adult should then retrieve the necessary medications and call 911 in the event of an anaphylactic reaction. 4) Establish a Lunch Buddy system. So my son, Kian, who has multiple food allergies including peanuts would often sit at the peanut-free table at school all by himself, that is until I established lunch buddy system. Frankly, he prefers safety over being included socially, he's just one of those kids, but a mom's going to do what a mom's going to do. I finally asked him if he would like it if someone sat with him at lunch time and his face beamed in delight . He answered, "Yes, mom, I would like that." So I created the Lunch Buddy system where each student volunteers once a month to bring a nut-free lunch and sit with Kian at the peanut-free table. How hard is that? They can volunteer alone or bring along friends. The more the merrier. So I provided the teacher with a sign-up calendar as well as a letter to go home to the parents. Contact us if you'd like to get a copy of the letter and we'll be happy to email it to you. Parental feedback has been nothing but positive. They tell me that their child is excited to have their turn to be Kian's lunch buddy! One mom even called to share with me her personal experience with severe food allergies and how everything will be alright because it's definitely manageable.

5) Honor the teacher. I have to say, I cannot be happier with my son's 2^nd grade teacher. Not only is she amazingly organized and structured, not to mention talented, but she is compassionate to needs of the food allergy community – a huge BONUS! Since the beginning of the year, she has been very attentive to my concerns and has been diligent in having the students get in the habit of washing hands after lunch and snack whether or not they've eaten nut products. What can I say, she just gets it. It is this simple task of handwashing that minimizes the risk of a food allergy reaction due to cross-contamination or second-hand contact, not to mention the added benefit of having good hygiene and preventing the spread of infection. So at the end of my presentation, I asked the teacher to come up to the front of the classroom and said, "I want to thank you for allowing me to come into your classroom to teach the kids about food allergies. By doing this, you've Protected A Life from food allergies. " I then handed her the P.A.L. HERO Award. I also presented her with a Kyle Dine's Food Allergies Rock CD so she could get a preview of Kyle Dine's visit to our school next month (more on that in another post)! Later that day I received an email from her saying, "I'm still at school rocking out to Allergy Rock! Your presentation was not only informative, but also lighthearted and fun! The children could've sat through another 30 minutes or more."

If you're a busy mom like me living in the food allergy world, I would highly recommend doing a classroom presentation on food allergies! The first step would be to approach the teacher. I would emphasize the importance of raising awareness in the classroom and mention that teaching kids how to identify signs of a reaction could help Protect A Life and in doing so, turn the students into heroes.

If we can gain the support of not only the faculty and staff, but also the student body, then we've covered all our bases and the school environment will be that much safer for our children. Best of luck on your presentations! We'd love to hear about them! And don't forget to RSVP to the Food Allergies Rock Event in San Francisco!

Book Reviews: Allie the Allergic Elephant & Cody the Allergic Cow

Cody the Allergic Cow, by Nicole Smith, illustrated by Maggie Nichols

A cow allergic to milk?  Cody is a young cow with a loving family and a passion for soccer, and he happens to have a dairy allergy.  He wears an allergy bracelet, knows to bring his own snacks to games, learns how to identify common milk-based foods, and remembers that having an allergic reaction is no fun.  His mom carries epinephrine in her bag in case of an accidental ingestion.  A simple book for young ones to enjoy and learn from. 

Allie the Allergic Elephant by Nicole Smith, illustrated by Maggie Nichols

Allie is a cute young elephant who is allergic to peanuts!  With simple and engaging language and cartoon-like drawings, little kids will love Allie and her story.  I read it to my boys, 4 and 6, and it prompted a discussion about symptoms of an allergic reaction in a very matter-of-fact way.  I appreciate how the book describes Allie as special and unique because of her allergies.