April 8, 2005
The threat of severe allergic reactions by children is a danger that is very real and ever present and one that we cannot ignore. While it may seem that severe allergic reactions are becoming more common, the reality may simply be that diagnosis and awareness have increased. It really doesnt matter. The point is that anyone who has children or works with children must become knowledgeable about minimizing risk and reacting quickly and correctly if a crisis occurs.

One of the most lethal allergens is that preschool staple, peanut butter. This seemingly innocuous substance is positively lethal to those who are allergic to it. There are many other common allergies that pose a risk of death and are not likely to be outgrown. They include allergies to tree nuts, shellfish, cow's milk, eggs and fish.

The deadly risk comes from the reaction called anaphylaxis -- difficulty breathing, swelling of the mouth and throat, a drop in blood pressure and loss of consciousness -- sometimes to the point of a coma and death. As little as one-fifth to one-five-thousandth of a teaspoon of the offending substance has caused death.

According to the American Academy of Allergy, Asthma and Immunology, five percent of children have food allergies. One percent of the American population -- three million people -- are allergic to peanuts or tree nuts, the most virulent allergy.

Anaphylaxis doesnt usually occur the first time a person eats a particular food, but after exposure to an allergin to which he or she has been sensitized. Allergic children may break out in hives if they so much as kiss someone who has eaten a peanut or if they merely touch a surface -- like a table or doorknob -- where peanuts or peanut butter have been. Peanut protein survives for six months.

Not only is the peanut protein long-lived, but the peanut allergy can survive death. A man who received a liver and kidney transplant inherited a peanut allergy from the donor, a 22 year-old who had fallen into a coma and died after eating satay sauce.

Several months after the transplant, the recipient suffered a skin rash and difficulty breathing after eating peanuts. Doctors traced the newly developed allergy to blood cells primed to recognize the allergins that were passed along with the liver.

A 1992 Johns Hopkins study involving 13 children, six of whom died and seven of whom nearly died, recommended that epinephrine, a form of adrenaline, be kept available in schools and day care centers. These recommendations have been incorporated in settlement agreements negotiated between child care centers and the Department of Justice under the Americans With Disabilities Act.

As announced in an October 1998 Justice Department press release, staff at La Petite Academy will administer epinephrine to children who experience life-threatening allergic reactions to foods such as peanuts or bee stings.

The agreement with La Petite Academy, which operates more than 750 day care centers (one in D.C., 14 in Maryland, and 35 in Virginia), also contained a provision modeled after an earlier agreement with KinderCare, the nation's largest child care.

Schools, day care centers, churches and private child care workers should be aware of the risk, have epinephrine on hand and train workers and volunteers in its use. Those who fail to do so may face serious legal consequences if a child dies as a result of their failure to do so.