100 teachers surveyed with responses to questions regarding their knowledge of food allergies and allergic asthma. Teachers responded with minimal experience and knowledge of allergic asthma and food allergies. Many have not been trained to identify anaphylactic events and how to intervene in case of an emergency. Teachers did respond positively to enhancing their skills through professional development in their individual districts. The knowledge gap identified in the study underscores the need for administrators to strategize on how their professional faculty will receive this critical information to ensure the health of students.
Food Allergy Basics
Simply stated a food allergy is a “response of the immune system to a component of food, usually a protein that the immune system recognizes as foreign to the body” (Kagan et al 2003). Allergies to certain foods can cause a severe allergic reaction, causing the body to release chemicals that can cause symptoms including: breathing difficulties, swelling of the lips and throat, extreme hives, nausea, vomiting and abdominal cramps, drop in blood pressure, and headaches. As many a 7 million Americans (or 2.5% of the population) have food allergies 9sapien, 2007). The following eight foods are the most commonly responsible for severe allergic reactions: peanuts, tree nuts, shellfish, fish, milk, wheat, soy, and eggs (Rhim & McMorris, 2001). In fact, the above foods account for 95% of all food-allergic reactions. Anaphylaxis is an extreme allergic reaction that is more common then most people think. Up to 32 million American, this includes both children and adults may be at-risk for this life threatening emergency (CDC, 2000).
Food allergies are most common in young children (Rhim & McMorris, 2001). Many infants become sensitive to foods, such as cow’s milk, soy and eggs during their first years of life. Fortunately, most infants will outgrow these sensitivities in a year or two (Jaffe, 2003). However, children with an allergy to peanut or shelf fish will not outgrow it. In fact, the symptoms may become more severe each time the child is exposed. Food allergies can be very serious for many children. A smell of fish can make a highly sensitive person feel ill, while just a tiny bite of a cookie can cause a life threatening emergency for some children. Allergies to peanuts are responsible for nearly 100 deaths and 15,000 visits to the emergency room each year (FAAN). This number includes both adults and children.
These are extreme reactions, so it is no wonder many schools worry about food allergies. In order to avoid these substances known to cause severe allergic reactions, schools have taken steps to avoid these substances and situations. The most common form of prevention in schools is not to let children come into contact with even the tiniest amount of that food. According to the National Institute of Allergy and Infectious disease, approximately 2%-3% of all children in the U.S. suffer from true immunological food allergies. In a school of 500 children, that means 15 students may have some form of food allergies which is life threatening. A 0.8% prevalence rate for peanut allergies is noted (NIAID, 2006).
However, within schools peanut allergies appear to be on the rise and are gaining massive amounts of attention in the media and by parents and school health officials (Sedwick, 1996). Under section 504 of Vocational Rehabilitation Act children with peanut allergies are entitled to accommodations. Because of the potential for serious reactions from exposure to peanuts, the Food and Allergen Labeling and Consumer Protection Act were passed in 2004, making foods that contain peanuts more easily identifiable (FAAN, 2006).
Allergic Asthma another Life Threatening Disease
Allergic asthma on the other hand is a chronic inflammation of the airways. Asthma, like food related allergies can be a life-threatening disease if not properly managed. Asthma, unlike peanut and food related allergies causes breathing problems that usually happen in “episodes”, the inflammation underlying asthma is continuous. An asthma episode is a series of events that result in narrowed airways. These include swelling of the lining, tightening of the muscles, and increased secretion of mucus in the airway. The narrowed airway is responsible for the difficulty in breathing with the familiar “wheeze”.
Asthma is the leading chronic illness among children and youth in the United States. Nearly one in 13 school-aged children in America has asthma. Among children 0–17 years old in the US: 12.2% (8.9 million) had been told by a health professional at some point in their lives that they had asthma; 2) 8.3% (6.1 million) were reported to currently have asthma; and 3) 5.8% (4.2 million) had an asthma attack in the last 12 months (National Center for Health Stats, 2004). Allergic asthma is the third leading cause of hospitalization among children under 15. In 2000, 728,000 pediatric emergency room visits were due to asthma and 214,000 children were hospitalized due to asthma (Hall and DeFrances, 2001). Allergic asthma resulted in 4.6 million visits to the doctor’s office and hospital outpatient departments (Mannino et al., 2002). The estimated cost of treating asthma in those under 18 is $3.2 billion per year. The harsh truth about asthma is the condition kills and estimated 15 people everyday with the United States (Weiss, Sullivan, and Lytle, 2000).
Allergic asthma accounts for 14.6 million lost school days, and is the leading cause of school absenteeism attributed to chronic conditions (Mannino et al., 2002). Allergic asthma directly affects the educational performance in children (Whalen, et al 2004). For instance, children and teens whose nighttime sleep is disrupted by asthma symptoms can have a greater difficulty with schoolwork. Missed sleep due to nighttime asthma can cause children to have poor memory recall, lack of concentration, and mood swings. In fact some asthma medications used to treat the condition have side effects which may interfere with a student’s ability to concentrate or participate in school activities.
The Connection between Allergic Asthma and Food Allergies
When teachers enter schools within the US the expectation and focus is typically on curriculum, methods, behavior management and content knowledge. Teachers typically do not expect to be responsible for issues of health and safety. The occasional mention of urban health issues center on problems of drug and alcohol abuse. The topic of bad health of inner city children and an obsession with the consequences of addiction, crime victimization, and/or the dangers of sexual abuse are the focus of health issues among teacher involved in urban education. Issues like low birthrate, infant mortality, lead paint poisoning, diet, and the dangers of transportation may often arise as well. As stated above, schools are paying very close attention to health issues, particularly allergic reactions caused by food, but how much attention is paid to issues relating to allergic asthma? Teachers who teach in urban setting must become well versed in the identification and treatment of both the symptoms and prevention of asthma that are endemic to the city environment. The impact of illness and deaths due to asthma is disproportionately higher among low-income populations, minorities, and children in inner cities than in the general population (National Institute of Health).
Schools are simply dangerous places for the millions of children who have asthma. Too many schools deny students access to lifesaving asthma medication, lack of full-time nurses, and contain symptom-causing allergens and irritants. A deadly asthma attack can occur anywhere — playgrounds, lunchrooms, school buses, or classrooms. Yet only 18 states have passed legislation giving students the right to carry and self-administer lifesaving inhalers at school. Approximately 56,000 nurses serve the country’s 47 million public school students (CDC). But the reality is that many school nurses shuttle between three or four schools each week, leaving many children without a full-time nurse to manage asthma emergencies.
In regards to food/peanut allergies, many schools are turning “peanut free” zones as a primary form of prevention. No longer are children allowed to share and trade food, and students are encouraged to wash their hands before and after eating. Many schools have even taken the important step to educate their staffs and put emergency plans in place. One allergist found, out of 23 people who thought that they had a food allergy, only 4 actually did (Hefle and Taylor, 2004). Unfortunately, because of a lack of good information about severe food allergies, many children are being restricted unnecessarily.
Schools simply remain unsafe for children with conditions such as peanut/food allergies and allergic asthma. Some experts assert that a ban on peanuts in schools may cause a false sense of security (Mays, Ponce, Washington and Cochran, 2003). “For some people, as little as one-one thousandth of a peanut can trigger a deadly reaction and/or anaphylactic shock” (Connecticut Post, 2003). Are public school staffs more aware of peanut/food related allergies than health issues pertaining to allergic asthma. Children spend at least six hours a day in schools filled with mold, dust, pesticides, pets, and other chemical that may trigger an asthmatic episode. Breathing these allergens is unsafe and unhealthy for everyone, but for a child with asthma- schools can place children in life threatening positions. This question was put to the test. One hundred teachers were randomly surveyed.
A total of 100 surveys were randomly distributed to teachers within the Central New Jersey area. A seventy-one percent response rate was obtained. Of the respondents, eighty-five percent of the samples were female and 15 percent were male. The majority of the sample, eighty-five percent indicated being Caucasian, while the remaining part of the sample indicated either being African American, Asian, and/or Hispanic. Seventy-two percent of the respondents indicated at that they were currently employed as full time teachers. Eighty-seven percent of those surveyed currently have taught between one to five years. The majority of the respondents (53%) indicated have earned at least a bachelor degree in Education and were currently working towards a more advanced degree.
Ten items on the survey consisted of ten true/false questions pertaining to children with peanut allergies. The respondents indicated that they had “some” knowledge of peanut allergies. Forty-nine percent of the respondents responded incorrectly that new research existed that children with peanut allergies can never outgrow peanut allergies. The average score for this section of the survey was an eighty-nine percent, which indicates a high knowledge and overall awareness of peanut allergies. Interestingly, 71% of those surveyed indicated never having attended a workshop/training, and 93% indicated that they have had a child with peanut allergies in their classroom. Seventy-five percent of those surveyed indicated either not knowing or indicating a non-awareness to district policy regarding peanut or food allergies. The majority of respondents indicated never witnessing an allergic episode by peanuts, as well as indicating never administering an Epi-pen.
Ten items on the survey consisted on ten true/false questions pertaining to children with allergic asthma. Again the respondents indicated that they had “some” knowledge of allergic asthma. However, sixty-one percent of the respondents answered incorrectly that children outgrow asthma. Sixty-six percent of the respondents answered incorrectly that children with allergic asthma were not protected under federal legislation. Nearly a quarter of the sample indicated incorrectly that asthma related deaths have doubled in the past 15 years, ad that more school aged children have allergic asthma than school aged children with peanut/food allergies. A quarter of the respondents responded incorrectly that allergic asthma resulted in over 1.4 million missed school days. An overwhelming majority of those surveyed responded to not having ever had a child with allergic asthma in their classroom or witnessing an allergic asthma. In addition, the respondents indicated having limited experience and exposure to allergic asthma. Eighty-eight percent replied that they have never attended a workshop/training session on allergic asthma, while 81% indicated not knowing if their district had a policy on allergic asthma. An overwhelming eighty-six percent indicated never having administered medication to an asthmatic child. Despite, the respondents limited knowledge and exposure to children with allergic asthma, the respondent’s average score on this section of the survey pertaining to allergic asthma was a seventy eight percent.
The marked increase of children diagnosed with allergic asthma and identified food allergies underscores a significant need in supporting educators, parents and children in coping with and managing these allergies. The data reflects that educators are woefully unprepared to manage potential anaphylactic events in children with these allergies. All instructional staff must be afforded proper training and at the minimum in the use of the Epi-pen. With each passing school year, school districts will see more and more students with the above aforementioned conditions. Now is the time to begin to develop, pilot, and implement educational programming and protocol within schools for dealing with this situation. Long-term planning rather than ineffective quickfixes to these serious and escalating health issues with schools is truly needed.
Professionals in educational settings must understand both the risk of under-identified or non- identified children with these allergies and the health risks they pose. Moreover, the substantial number of respondents who have not received any form of training, relative to these allergies, emphasizes the necessity of re-examining district and school policy ensuring that professionals directly in contact with students are able to intervene when a health care provider is not present. Likewise, policy must be improved in those states where children are not permitted to carry an inhaler so they may administer medication on their own behalf in the case of an allergic event. Rapid intervention when an allergic reaction is either occurring, or is about to occur, bespeaks the critical nature of permitting students to manage their health when others are unprepared to do so. Above all, school districts must expand and enhance their professional development for administration and pedagogical staff in an effort to secure the health needs of these vulnerable populations of students.
Districts and schools are mandated in terms of the educational identification of students who are in need of special education services. In line with this federal legislation protects children with these debilitating allergies. Accordingly, a “child-find” procedure for children with allergic asthma and food allergies must be promulgated and is necessitated by the increasing numbers of children with these allergies.
Children who reside in urban settings and are prone to food allergic reactions or allergic asthma appear particularly vulnerable because the respondent sample reflects teachers who have less than five years of experience. This teacher inexperience combined with the socio-economic needs of these school communities can exacerbate a disproportionate effect on sub-groups of children who reside in urban settings.
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