Vacation from Food Allergies … Update on School Action Plan
I have not been able to bring myself to blog for the past two weeks.
Between the egg challenge debacle and the bungled camp/school forms, I’ve been at my wits ends with food allergies. It’s been so all encompassing and upsetting that the last thing I’ve wanted to do is to blog about it. Since I am unable to get a vacation from the constant vigilance required to manage a child’s food allergies on a daily basis, I took what I could — a vacation from blogging about food allergies.
But, at least for the time being, things seem more in control. I’m back.
So, here’s how things resolved at school.
I need to enact a plan that balances the health needs of my daughter with ease of administration and minimal liability for the county. Not an easy task. The county policy is that if an epi-pen is authorized for an allergen and a child is sent to the health clinic for exposure to that allergen — an epi-pen will be given without waiting to see what symptoms manifest. After much hand-wringing about the wisdom of this policy (and worrying how it would be enforced) — I talked to a county nurse who would allow my doctor to authorize benedryl and an epi-pen based on allergen and exposure type (ingestion vs. skin contact or inhalation). While this solultion made me more comfortable, in the abstract, at least — a long talk with the nurse who oversees the clinic illustrated how confusing my plan might be to implement and the myriad of opportunities for confusion it could present in a very busy clinic.
So, I’m back to square one, really. The only thing my daughter’s allergist and I have firmly decided is that we’re not authorizing an epi-pen for allergens that are unlikely to provoke a systemic allergic reaction. Rather: authorize benedryl, callling me and 911 if there are signs of breathing distress or anaphylaxis.
The decision on peanuts and tree nuts is equally clear — better to err on the side of caution by authorizing an epi-pen than not. The only remaining allergen that gives me pause is milk. She had such immediate contact reactions when she was little — and benedryl or zyrtec has always resolved the problem within minutes. It seems clear that benedryl is the right medicine to authorize. But I would feel so much more comfortable if I could also authorize an epi-pen for milk as well, for severe reactions only. I am afraid of her being given an epi-pen as a first response to the allergen to which she is most likely to be exposed to at school. (She is in 1/2 day a.m. kindergarten next year, with no lunch, in a nut-free classroom.)
Part of me is mad at myself for getting all wrapped around the axel about this. My daughter is extremely well-trained not to eat anything that has not been pre-approved by me. She will not eat other’s snacks or partake in their birthday celebration treats. She asks friends to wash their hands if she thinks they may have eaten something to which she’s allergic before she will play with them. I know that the risk of allergen ingestion for her in next year’s environment is small. But I know that accidents happen. And, it’s my job, as a mother, to worry about all the what if’s. And to slowly start to brace myself for the horror of her entering the school cafeteria in first grade. It won’t get any easier next year, right?
July 21st, 2008 at 1:12 pm
My son’s allergist’s office provided me with a preprinted action plan produced by FAAN. It has a list of reactions, increasing in severity, from hives to vomiting to (God forbid) turning blue with the appropriate response as determined by his doctor, either Benadryl or EpiPen then dial 911. (I posted a copy of it on my blog a few weeks ago.) The one time my son had a reaction at school, we weren’t able to determine the allergen until an hour or so later, so this type of plan may be helpful.
Was the school able to give you a copy of their EpiPen policy? I would think that a doctor’s orders should be able to supersede the county’s medical decisions. I understand the allergy blog fatigue, but I hope you’ll share if there are any changes. Good luck!
July 21st, 2008 at 2:38 pm
Libby — Thanks for the great suggestion. We think alike. My allergist and I had submitted the FAAN action plan (which I am very comfortable with) for years to my preschool, without problem. But the public school rejected that form — and will not accept any form except its own. My allergist said that many parents/patients share my frustration — but if it’s the price of keeping medicine stored at school, one must play ball, so to speak.