Assessing the Risks of Allergens in Schools

This article first appeared in the AllergicChild Newsletter, July, 2007.

If you are a parent of a child with severe food allergies, sending your child back to school can generate more than a little anxiety. In addition to registering your child for the new year and obtaining school supplies, you have to schedule an appointment with your child’s allergist, give the school’s administrators and staff a refresher course on food allergies, and make sure the school has a fresh supply of medications on hand.

Even after ensuring that your child is fully prepared for the new year, you may be concerned about your lack of control and what the other students will bring to school. But just how worried should you be? What are the real risks of allergens left behind on tables in the cafeteria or airborne particles floating through the air. In this article, I attempt to relieve some of your anxiety as I explain the various levels of risk for ingestion, contact, and inhalant reactions.

Ingestion reactions

Ingestion reactions (caused by actually eating the problem food or a food that has been accidentally contaminated) pose the greatest risk, but these are the types of reactions that you and the school have the most control over. Assuming that your child’s teacher and the cafeteria staff know about your child’s allergy and follow the proper precautions, and that your child understands the risks of sharing food, the threat of an accidental ingestion can be minimized, although never totally eliminated.

Contact reactions

Contact reactions occur when a problem food touches the skin. Common examples of this include having milk spilled on you, being touched by someone who has peanut butter on their hands, or being kissed by someone who has just eaten eggs.

Although contact reactions are very common, they’re generally much less severe than reactions you experience when you eat an offending food. The severity of the reaction generally varies according to the type and degree of contact:

  • Minor exposure: Reactions are generally minor if the exposure is minor–a few drops of milk on the skin or hand-to-hand transfer of a miniscule amount of peanut butter.
  • Significant exposure: A reaction to milk is likely to be more severe if an entire glass of milk is spilled on the child rather than a few small drops.
  • Eye contact: The eyes can actually absorb allergens, which is almost like eating the food, because the allergen can then travel to other parts of the body.
  • Hand contact to mouth ingestion: A contact reaction can turn into an ingestion reaction if your child picks up an allergen (from a classmate or a contaminated table in the cafeteria, for example), and then transfers the allergen to his or her mouth.
  • Mouth to mouth ingestion: Kissing someone who has recently eaten a food you’re allergic to can cause a reaction, sometimes severe.

Again, all of these scenarios are certainly possible, but following the proper precautions can virtually eliminate these risks:

  • Keep food out of the classrooms when possible.
  • Have all students wash their hands after eating.
  • Have special eating arrangements for younger students (up to third or fourth grade), such as peanut-free tables.
  • Have tables wiped down thoroughly with a household cleaner prior to each lunch shift.

Aside: I have had a severe peanut allergy since the age of 9 months. We didn’t have peanut-free tables in my high school, and I never experienced a contact reaction. The one severe reaction I had occurred when I ate a chocolate brownie. The cafeteria changed the recipe for the brownies that were one of my favorites to take advantage of a surplus of peanut butter.

Inhalant reactions

Allergens can take flight and cause severe reactions, but just how much of a risk do airborne allergens actually pose? Well, that depends on how sensitive your child is and on the concentration of allergenic food protein in the air. In Food Allergies For Dummies, I discuss the four levels of risk for inhalant reactions, but in schools you rarely see anything higher than a level-one risk:

  • Level one: Level-one risks arise when someone is eating a food next to you that contains the allergen as part of its ingredient; for example, a peanut butter or grilled cheese sandwich. Although your child might be able to smell the ingredient, the odor is not the result of the protein that can trigger a reaction. The risk of a reaction is extremely low.
  • Higher risks: When the allergen becomes airborne, the level of risk rises, but it varies depending on the proximity of the person consuming the problem food, how much “protein dust” they are stirring up, and how confined the space is. In a small bakery, for example, where a lot of wheat dust is stirred up and there’s no place for it to go, you may see a level-three or level-four risk. In an open area, where the dust could dissipate quickly, the risk would be much lower.

Although you should certainly be concerned about how your child’s school deals with food allergies, you can significantly reduce your anxiety by understanding the real levels of risk and making sure that your school has the policies, procedures, and training in place to reduce the most significant of these risks.