Back-to-School with Food Allergies – Tips from BJ Lanser, MD

By Adem Lewis / in , , , , , , , , , , , , /

AP: Hi everyone and welcome to our first
Facebook live stream my name is Alyssa Paschke and I’m here with Dr. BJ Lanser.
He is the director of the pediatric food allergy program here at National Jewish
Health. We all know that back-to-school is a super busy time for
parents and kids and there’s some additional challenges for kids that have
food allergies, so today we’re hoping to explore that topic a little bit more, and
answer some of your questions. Hopefully you’re a little bit more
prepared for back-to-school. So if you do have a question, feel free to type it
into the comments section and we’ll answer as many as possible. So to start,
Dr. Lanser, would you mind telling us a little bit more about yourself and your
experience with pediatric food allergies? Dr. Lanser: Yeah so I wanted to become an allergist
ever since I was in high school and I went to go get allergy shots with my mom
and that’s why I got interested in allergy and really came to be interested
in food allergy as I was going through my pediatric residency training,
and seeing kids in the ER, you know, having had reactions and taking care of
patients with food allergies, and that kind of then became my focus – an
area of interest within allergy so I’ve been doing that ever since
that time. AP:Awesome! So to get started with some questions: what should parents do as if a kid has a known food allergy? Who should they contact at their school
and what should they tell them about the allergy? Dr. Lanser:So I think it
starts as so many things do in food allergy, with wanting to just be prepared
and that starts from just kind of the big picture of food allergy,
of having your epinephrine, having your emergency action plan and having that
ready to go to school. Once you’re then going to the school setting, start by talking to the administrators, school nurses,
your child’s teacher, once that is known for the year, and then the
kitchen and food services staff as well. That’s a really important part that for
some parents, they don’t necessarily think about but, getting a tour of the
cafeteria, understanding the flow of the lunch day, really helps prepare the child –
but also can reassure the parents about what’s going on in school. AP: So if we do get into a situation where a
kid comes into contact with or accidentally ingests something that they are allergic to, what should they do next? Dr. Lanser: We always talk with our kids about letting
somebody know, right? Find an adult and let them know what’s happening,
either you’re feeling something that doesn’t seem right, you feel like you might be having a reaction you think you ate
something, or you know you ate something. Alert an adult you know right
away and the schools have their practices and protocols in place to
handle that safely and appropriately. AP: Okay, yeah and that definitely makes
sense. So there might be kids out there that experience their very first
allergic reaction to a food can you talk about some of the symptoms they might
experience and when it might become serious? Dr. Lanser: Yeah, that can
certainly happen at school, or daycare or with another caregiver or at
home so that could be anywhere – and it can be a lot of different things. Reactions to food can start out very mild it can be things like
hives, itching, redness of the skin sometimes folks can feel of course, throat itching, or mouth tingling swelling around the lips so you can kind
of have some of those more superficial or mild signs. Sometimes kids will
vomit, or you know diarrhea can happen but that’s not as common or can occur later, not necessarily in the setting of the reaction. And then what we worry about in the more serious reaction,
which can happen early, or it can develop into a more serious reaction,
or any time there’s respiratory involvement, so if a child is
coughing, or having trouble breathing, feeling like their throat is closing, that’s when epinephrine absolutely is indicated and has to be
given, and what we want to prevent is – we don’t want that
reaction to go so far, and fortunately it doesn’t happen often in kids, but to
what’s called anaphylactic shock so essentially the full body reaction, the
body really kind of fighting off that allergen with all of its available
resources and that of course can be life-threatening.
AP: Okay, and since you brought up epinephrine, I wanted to just talk a
little bit more about that for people that are watching that may not know what
it is and when it should be used. Dr. Lanser: Yeah, absolutely. So epinephrine is also known as adrenaline, so that kind of
describes that adrenaline rush that we feel sometimes and in a frightening
situation. It’s a natural chemical that the body makes on
its own and releases in certain situations so we can use that then to
help treat the reaction. So essentially, while it is a complex medicine
actually, and has a lot of different activities, essentially it
blocks the mediators of the allergic response, and it helps
stop that reaction, and supports the body’s ability to protect itself rather than having a serious or life-threatening reaction. It
should always be used if there’s any respiratory involvement in a reaction as
we talked about before so coughing, wheezing, feeling like your
throat is closing, and any time anybody has loss of consciousness, or if they
pass out and they’re not aware of what’s going on, certainly then you want to give
that as well. The other rule of thumb that folks
will talk about in terms of epinephrine is if it’s two systems, and sometimes
it’s a little hard to get your head around, but what that kind of means is:
If you’ve got you’ve got skin symptoms, you’ve got redness and hives
and you’ve got something else going on, then that says this is a more serious
reaction. So anytime you know it’s more serious, or you’re worried about it
progressing, or things aren’t getting better, it’s it’s good to use epinephrine.
One thing I teach my patients all the time, a question I ask is, if you think somebody’s reacting, but you happen to be wrong, but you think they’re having an allergic
reaction and you think you need to give epinephrine, if you’re wrong, what’s the
difference, what happens? The side effects of epinephrine are exactly the same. So it’s a safe medicine because it’s a natural thing our body makes,
it’s a safe medicine it’s very quick and short-acting so when we inject
the epinephrine, it circulates in the body, and it’s done its job very quickly.
The side effects are really the same as when we have that adrenaline rush.
So you feel your heart race, those kinds of things that are not dangerous.
It’s a safe medicine, obviously it’s a needle, we don’t want to
give it unnecessarily, but if you think you’re having a reaction or
you’re thinking about giving epinephrine you really should give it. AP: So
better safe than sorry, in that case. I just want to pause
see if we have any questions that have come in from the audience? CM: Yes, we have a
question from Lindsay S. She says, “Hi my son has a severe dairy allergy, including
contact allergy, and will be starting kindergarten. The cafeteria serves milk
at lunchtime. I am super anxious about him being in there, any suggestions so he is not secluded?”
Dr. Lanser: Yeah, so one of the things we talk about with with kids, especially
as they get older, and it has to be developmentally appropriate, but is ways to protect themselves at school and at the lunch table. We want to teach kids that their tray is their tray and they don’t touch
anybody else’s tray, and nobody else should touch their tray. If somebody
does put something on their tray that wasn’t there before, that’s not theirs,
tell somebody and let them know to protect them. Fortunately, in school, it’s not as not as much like day care where where food tends to fly around the day care. Cafeterias are a little more
controlled certainly, we see a lot of kids who will get splashed with
milk and break out in hives. One of the reassuring things, or things to keep in
mind is that those kind of contact reactions don’t tend to be as
serious because the skin normally does its job, and is a
great barrier to protect us from the outside environment. So if we come in
contact with our allergen we can see a local reaction, you know redness, itching
hives, but that that food, especially if we wash it off quickly, there’s really
very very little chance for any amount of absorption that would trigger a
systemic reaction. What we want to prevent is from somebody
licking their arm that’s been splashed with milk or touched peanut butter, if
that’s what they’re allergic to, so wash the area off quickly, clean up any spills
or messes and that sort of thing but I think using that that perimeter or
the barrier of your tray and somebody else’s tray to separate them
is a good starting point. We don’t want to isolate kids, absolutely
that’s something we want to avoid. We want them to be apart of their class, and be with their friends and there are ways to do that safely. I think. CM: Ok, we have another question from Sam R. She is wondering what a good age it is
for kids to start administering their own EpiPens? Dr. Lanser: great question so it’s
important to practice early, and that can give you a good guide of practicing with
the trainers that the devices should come with and so if you practice and
they’re getting the hang of it that’s great, and that varies I’ll say. I
have patients who are surprisingly young and are very competent and capable and
they surprise you and then you have some older kids who just aren’t ready or
comfortable to do it. So talk with your allergist and and practice with
your child another thing you can do is kind of create scenarios and your
allergist can help you with that if it’s kind of hard to come up with sometimes,
of “here’s what might be happening how would you handle it?” and as they can kind of work through those scenarios and they’d be comfortable then
you know they’re getting ready. So it varies from from child to child AP: Awesome!
Well on that note with epinephrine I have recently read in the news there was
a shortage of the EpiPen devices and I was just wondering if there are any
updates on that and are there any alternatives to the EpiPen device? Dr. Lanser: There are a couple of different up an efferent auto-injector products
available on the market, so talk with your allergist about what might be
appropriate, or better, or available. In terms of the
medicine itself, they’re equivalent. It has all the same medicine, they’re
just different devices so they have ways to use them, so different functions
so you need to learn of course how to use your device correctly.
Figure out what prescription you have, what might be available. Certainly the
shortage has continued in different parts of the country, we have seen different
kind of varying rates of how hard it is to get that. Here in the Denver area, we haven’t had much trouble, our pharmacy certainly has the devices
available. I’ve heard from some of my patients up in the mountains that
they’ve had more trouble up there getting them, and different parts of the
country have had more trouble than others unfortunately so that shortage
really does continue and can be an issue for some patients. If that’s the case
certainly talk with your allergist because may be a different brand or
different product would be available. In terms of alternatives to
epinephrine, there aren’t any. So that’s why we talked about before, epinephrine is the the treatment of choice for anaphylaxis the only medicine
we have that’s effective and really needs to be used. You really do
need to have epinephrine available and work with your allergist to figure
figure out what to do if there is a shortage. AP: So definitely work on filling those prescriptions prior to starting school, so right now if your child is starting school in August. Dr. Lanser: It’s a good time to get those prescriptions refilled and also to renew your action
plan. Make sure that food allergy and anaphylaxis action plan
is up to date, and ready for the start of school. AP: Great so we did talk a little bit
about some kids might be feeling excluded from different school activities, and as
we know in school, there’s birthdays, holidays, tons of different food-related
events and things that go on so what do you recommend other parents do or maybe
even educators do to make kids that have allergies feel included? Dr. Lanser: Great
question. There’s a couple different things and one, some
schools have started to say we’re just not gonna have food at these parties we
can do pencils and other safe things, you can do crafts, it doesn’t
necessarily need to be food. Some schools have moved that way and I think
that certainly for some schools it is probably the right
decision. Others want to keep that kind of the treat situation going and
that’s understandable too. Food is a huge part of who we are and it’s a big
cultural – you know it’s culturally important for us, so you know some
schools will say avoid certain allergens so if your child falls into
that category of allergens then you should be safe. Otherwise, I
think it’s always a good idea regardless of either of those scenarios to have a box of snacks that you can send to school for your child that’s safe for
your child that you know doesn’t have their allergens that they
regularly eat so that they can have something when everybody else is having
something else, if that’s the case. A little bit
of a case-by-case basis you know craft projects or the other
thing that’s an important thing to consider, is sometimes
allergens will be used in different art projects and we want to
avoid that as well, so that’s where it’s good to talk to the teacher
early and and think of those kinds of things. Whether that’s,
we’re not gonna use egg cartons, or not going to use dairy-based products of whatever kind or maybe we don’t use
certain grains for some of the art projects. Certainly peanut
butter pinecones with seeds are popular bird feeders in the past, and that probably
isn’t the best thing we should be doing. So maybe let’s find a replacement
for those. So sometimes thinking ahead and planning for those maybe more
hidden or less commonly thought of allergens will help avoid a problem down the road. AP: That’s really
good I didn’t even think of art projects as something that could have allergens,
so that totally makes sense. Along those same lines you know some kids might have a little bit of anxiety or worry about starting school with their food
allergies and what can parents do to help them make feel a little bit more
comfortable and confident for going to school? Dr. Lanser: I think if we
can all remember back to the days when we were we were nervous about starting
with a new teacher, and a new school, and a new classroom, and new friends and
so you know there’s a lot certainly to think about just right you know just to
go back to school, let alone to have to worry about food allergies and so that’s
where again, I say it many times and I say it every day, preparation is really important and so you can kind of start that
conversation early in the year as you start early in the summer as you start
to talk about going back. Talk with your allergist, there are, for kids
who have pretty significant anxiety or more worried there are ways we can help
them and work with behavioral health specialists therapists that can really be
helpful, just as a sounding board and somebody to talk to you and and help
them learn some coping skills and tools that they can use to help work on that
anxiety. For some kids talking through scenarios is helpful to
say, “let’s pretend you this is what happens at the lunch
table what do you do?” And just having that idea of, “now I know, I’ve
thought this through, I have an idea of what to do” can be really helpful to
reduce those fears. Getting into the school early can be helpful too so if
they can see the cafeteria, see their classroom, talk with their teacher that’s
helpful. A lot of times I think there’s a misconception or a thought or fear that
that folks will know nothing about food allergies and in
today’s world that’s just not true. Everybody might have a little bit different knowledge and a little bit
different approach for management but that’s okay as long as you
have those conversations early, and talk about it. AP: Great! Any other questions? All right so I think we’re gonna wrap it
up for today. Thanks to Dr. Lanser and everyone who joined our broadcast
this afternoon. Like our National Jewish health Facebook page so
that you can see future broadcasts where we’ll talk about other trending health
topics. If you would like more information from National Jewish health
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and have a great afternoon.

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