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“There is no cure for anaphylaxis, so strict avoidance of triggers is the only way to keep a severe reaction from occurring,” said Anne Muñoz-Furlong, Founder & CEO of FAAN. “For children with severe allergies, even a small exposure can lead to anaphylaxis.” The most common triggers for anaphylaxis are:

* Foods - Any food can trigger an allergic reaction, but the most common are: peanuts, nuts from trees (e.g., walnut, cashew, and Brazil nut), shellfish, fish, milk and eggs. It is important to talk to cafeteria staff and your child about what foods to avoid and not to trade food with other children.
* Stinging Insects - Venom of stinging insects such as yellow jackets, honeybees, paper wasps, hornets and fire ants can cause severe and deadly reactions. Recess exposes children to stinging insects. Teach your child where they are commonly located and how to avoid them.
* Medications - Any medication can trigger a reaction, but the most common drugs that cause anaphylaxis are antibiotics and anti-seizure medications. The school nurse should be aware of what medications your child is allergic to and should have epinephrine available in case of a severe reaction.
* Latex - Products made from natural latex (from the rubber tree) contain allergens that can trigger reactions in sensitive individuals. Inspect the toys in your child’s classroom and inform their teacher about this allergy.
* Exercise - Although rare, exercise can trigger anaphylaxis after eating certain foods before beginning the activity. Inform your child’s physical education teacher of this allergy, and check to see if your child can participate in physical activity before the lunch hour.

“For students, studies show that the most severe allergic reactions, especially to food, occur in the classroom,” said Munoz-Furlong. “Parents, school administrators, teachers, and the school nurse need to develop an action plan before the school year begins to keep these students with allergies safe.”

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AAAAI and FAAN educate about dangers of anaphylaxis

With the upcoming school year approaching, the American Academy of Allergy, Asthma and Immunology (AAAAI) and the Food Allergy & Anaphylaxis Network (FAAN) are asking every parent of a child with food allergies or a known insect sting allergy to alert their child’s school to the condition and have an action plan ready.

A potentially life-threatening allergic reaction, called anaphylaxis, can be triggered by exposure to one or more allergens, including foods, insect stings, drugs, and latex products. Anaphylaxis can affect multiple areas of the body (such as skin, respiratory tract, gastrointestinal tract and the cardiovascular system). Symptoms can include severe headache, nausea and vomiting, sneezing and coughing, hives, swelling of the lips, tongue and throat, itching all over the body, and anxiety. The most dangerous symptoms include difficulty breathing, a drop in blood pressure, and shock - all of which can be fatal.

“All school staff must be made aware of the potentially severe nature of an anaphylactic reaction,” said S. Allan Bock , MD , FAAAAI, and Chair of the AAAAI’s Anaphylaxis Committee. “Parents need to work together with teachers, coaches and school nurses to avoid triggers and act quickly if a reaction occurs.”

To protect your child, and prevent anaphylaxis, the AAAAI and FAAN encourage parents to take the following steps before the school year begins:

* Work with an allergist/immunologist to identify your child’s triggers and reinforce these to your child. If possible, provide your child with a medical bracelet or necklace that identifies his or her specific allergy.
* Tour your child’s school or childcare facility before school starts, and meet with the staff to inquire about policies regarding foods and other potential triggers brought into the classroom.
* Provide staff with information and resources to educate them about your child’s allergy. Have your child’s allergist/immunologist provide clear, written instructions on recognizing a reaction early and administering medication in case of a reaction. Inform staff to call 911 immediately if a reaction occurs.
* Teach staff when and how to properly administer medications such as injectable epinephrine, encouraging them to handle the medication and ask questions. Explain to them that they cannot delay in administering medication to your child, and that they are obligated to assist your child and to include him or her in normal school activities. Children with a history of anaphylaxis should carry epinephrine with them at all times.

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Going back to school for the year also means recess, physical education and sports. These fun activities can take a turn for the worse if the following triggers aren’t avoided.

* Pollen - microscopic, powdery granules necessary for plant fertilization. The average pollen particle is less than the width of an average human hair. With the start of ragweed season just around the corner, it is important to remember to take your medications 30 minutes before going outside. Also, ask the teacher to close the windows in the classroom to keep the pollen from blowing into the classroom. Review Tips to Remember: Outdoor Allergies for more ideas to protect your child.
* Stinging Insects - severe allergic reactions to insect stings can involve many body organs and may develop rapidly. This reaction is called anaphylaxis. Symptoms of anaphylaxis may include itching and hives over large areas of the body, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramps nausea or diarrhea. Carry injectable epinephrine with you to help control allergic symptoms. Go to Tips to Remember: Stinging Insect Allergy for more information.
* Exercise-Induced Asthma (EIA) - for children with asthma it is common to experience symptoms after about six to eight minutes of physical activity. People with EIA experience coughing, wheezing, tight chest, prolonged and unexpected shortness of breath.

As many as one out of every 10 young athletes has asthma. It should not stop them from enjoying exercise or even high level of competition, but athletes of all levels need to remember to take proper precautions if they have EIA.

Patients with EIA have airways that are overly sensitive to sudden changes in temperature and humidity, especially when breathing colder, drier air. During strenuous activity, people tend to breathe through their mouths, allowing the cold, dry air to reach the lower airways without passing through the warming, humidifying effect of the nose.

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Lunch is a time to take a break from the school books and a time to socialize with new friends, but precautions must be taken to ensure your child’s safety when it comes to allergies.

* Food allergies - have your child bring their own food to school and remind them not to share or trade food with others. Also, your child, the nurse or teacher should have injectable epinephrine and know how to use it.

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Teach your child about allergies in the classroom by using the Classroom Corner as a learning tool. Common allergens in the classroom that can trigger an allergic or asthmatic reaction in children are:

*  Dust Mites - microscopic creatures that thrive in high humidity and in areas where there is dust. The droppings of these mites are the most common trigger of perennial allergy and asthma symptoms. Check if your child’s school is air conditioned, this may help reduce dust mites.
* Chalk Dust - an irritant that can trigger an asthma attack. Students with allergies or asthma should try to stay away from the chalk board and erasers, and wash hands after writing on the board.
* Animal Dander - proteins found in the saliva, dander (dead skin flakes) or urine of furry animals can trigger allergy symptoms such as sneezing, an itchy, runny nose and itchy, swollen eyes. Itchy skin or raised, red rash called hives can also come from touching animals, so children should try to avoid contact, if they are allergic. Make sure the teacher knows that your child has an allergy to animal dander.
* Mold - found in dark, warm, humid places. Mold spores can trigger an allergy or asthma attack. Fortunately, indoor molds and mildew can be easily eliminated with a detergent cleaning solution once discovered. Make sure your child’s school repairs and seals any leaking roofs or pipes.

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Given the amount of time children are away from home when attending school and the incidence of allergies and asthma, it is important that children and their families work together with teachers, coaches and school nurses to avoid asthma and allergy triggers and to deal with symptoms. Use this helpful checklist to find out what can be done before the school year starts to reduce potential allergens that may affect your child.

Schedule a meeting with teachers, coaches and the school nurse to discuss your child’s condition.
Make sure a “School Management Plan” is on file for your child at school. Here is a sample copy of an asthma management plan for your use.

* Inform the school nurse about the free “Allergy and Asthma Tool Kit for School Nurses.”
* Work together with your child’s allergist/immunologist to ensure that their medications are helping.
* Talk to your child and review what triggers allergy or asthma symptoms. Encourage them to ask their teacher for help when symptoms worsen.
* Ask your child’s allergist/immunologist to complete a “Food Allergy Action Plan” if your child has a food allergy.
* Inform school cafeteria staff and teachers of what foods to avoid and suggest safe alternatives. If possible, have your child bring a bag lunch to school, and remind them not to share food with their friends.
* Inform physical education teachers and coaches about asthma and warning signs of an asthma attack.
* Encourage your child’s physician to be an informational resource for the school.
* Make sure your child has his or her medications and peak flow meter with them at school.

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Beginning a new school year is always an exciting time for children and parents. It is also an important time to remember that children with allergies and asthma face challenges in the classroom. These challenges can range from discomfort that makes it hard to concentrate on school work, to symptoms that reduce their ability to participate in recess or physical education class, to life-threatening reactions to food or insect stings.

It is reported that more than 9 million children under the age of 18 suffer from allergies and asthma. This can account for more than 14 million missed school days and cost millions of dollars in medical bills and lost work days for parents.

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The AAAAI’s How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:

* Are not using medications as prescribed, and this is limiting their ability to control their asthma.
* Have potentially fatal asthma, meaning a prior severe, life threatening episode that included intubation.
* Have persistent asthma, particularly moderate-severe or uncontrolled persistent asthma.
* Need for daily asthma reliever medications.
* Would like to try to minimize their need for medications.

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More than 50 million people in the United States suffer from allergies and/or asthma. Fortunately, there are many effective medications available to treat these conditions. The following information is intended to help asthma and allergy sufferers better understand the most commonly used types of medications. It is not intended as a specific recommendation for your treatment. You should consult your personal physician to choose the best treatment plan for control of your allergies and asthma.

Antihistamines: If you have allergies, your physician may prescribe an antihistamine for treatment of allergic rhinitis (”hay fever”) and other conditions such as hives. Antihistamines help prevent the effects of histamine-a chemical substance released by the body during an allergic reaction. By preventing the action of histamine the symptoms of the allergy can be reduced. Antihistamines are available in liquid, tablet or nasal spray form.

Antihistamines are divided into:

* “First generation, sedating:” these are known to cause drowsiness in some people
* “Second generation, low-sedating or non-sedating:” these have much less chance of causing drowsiness

Potential antihistamine side effects (most often associated with the “first generation” antihistamines):

* Dry mouth
* Difficulty in urination (especially in men with prostate problems)
* Constipation
* Drowsiness
* In some children: nightmares, unusual jumpiness, restlessness, irritability

These symptoms are much less common with the “second generation” antihistamines. Discuss with your doctor the potential benefit of using an antihistamine versus the possible side effects.

Decongestants: Decongestants reduce the nasal congestion and other symptoms associated with allergies. They work by constricting blood vessels, thereby decreasing the amount of fluid that leaks out into the lining of the nose which can cause congestion.

* Available in liquid form, nasal spray and tablets.
* Most of these are available over-the-counter as well as by prescription.
* Very often antihistamines and decongestants are combined so that they may control more symptoms.

Potential side effects of decongestants:

* Nervousness
* Sleeplessness
* Increased blood pressure or heart rate
* “Rebound rhinitis” can occur with the decongestant nasal spray form if used for more than three or four days in a row. This rebound will cause the nasal congestion to become more severe which may lead to becoming “dependent” upon the use of the medication.

“Controller” medications: The disease process underlying the symptoms of allergies and asthma includes swelling and mucous production in the lining of the nose and airways, caused by inflammation. There are three classes of medications that are used to treat allergies and asthma which can help prevent or reduce inflammation:

* Mast Cell Stabilizers: These are non-steroidal medications that help control inflammation by preventing the release of inflammatory chemicals.
- They include cromolyn and nedocromil and are available in various forms to treat allergic disease including rhinitis and asthma.
- Some of these medications are available “over the counter” for treatment of nasal allergies.

* Corticosteroids: These are anti-inflammatory medications. When taken properly, they are very effective for treatment of asthma and allergies. These medications are very different from the anabolic steroids that are misused by some athletes.

- Corticosteroids are available in topical creams or ointments, nasal sprays, inhalers, pills and by injection.
- Corticosteroid use needs to be supervised by a physician.

Oral corticosteroids:

- May be required to control severe asthma not stabilized by other medications.
- Oral corticosteroids are usually considered as short-term medications for asthma flare-ups, marked nasal congestion, and at times for skin conditions such as poison ivy.
- Side effects of short-term use may include weight gain, increased appetite, menstrual irregularities, muscle cramps, heartburn or irritation of the stomach lining. These side effects should go away shortly after stopping the corticosteroids.
- Long-term use (months to years) of oral corticosteroids may be associated with ulcers, weight gain, cataracts, decreased density of the bones, thinner skin and easy bruising, high blood pressure, elevated blood sugar, and potential decreased growth in children.

Inhaled corticosteroids: Inhaled corticosteroids are considered the most effective medications for long-term control of persistent asthma. They provide good control of asthma with minimal effect on the rest of the body at usual doses.
- Minor side effects from using corticosteroid inhalers can include hoarseness and thrush (a fungal infection of the mouth and throat). Both are less likely if you gargle with water after use.
- Long-term use of inhaled corticosteroids in children could potentially result in transiently reduced growth velocity; however this tends to be minimal (approximately half an inch in the first year of use, generally without ongoing effect). In most cases the benefit of having the asthma controlled is far greater than the potential for any significant side effects.

* Anti-Leukotrienes: Many of the cells involved in causing airway inflammation are known to produce potent chemicals within the body called leukotrienes (lu-ko-try-eens). Leukotrienes are responsible for increasing inflammation causing contraction of the airway muscle and swelling of the lining of the airways.
- These drugs are primarily used to help gain control in patients with mild persistent asthma and in combination with inhaled corticosteroids in more moderate to severe disease.
- One is also approved to treat allergic rhinitis (montelukast).

Bronchodilators: The smooth muscle surrounding the airways can be constricted in people with asthma resulting in difficulty breathing. These medications relax this smooth muscle, helping to improve the air flow and relieve the tight breathing. There are several classes of bronchodilators available to treat asthma.

Beta-agonist bronchodilators relax the smooth muscle surrounding the bronchial tubes.

* Short-acting beta-agonist bronchodilators are use d as quick-relief medications. These are available as inhalations, liquids, injectables and pills. (Albuterol and levalbuterol are two examples.) These agents usually take effect with minutes and last for up to 4-6 hours.
* Long-acting beta-agonists bronchodilators (salmeterol and formoterol) are use d for long-term control of asthma. The effect of these medications may last for up to 12 hours.
* Side effects of this class include nervousness, increased heart rate , restlessness, and insomnia, and rarely headaches.
* The FDA has issued a Public Health Advisory for the long-acting beta agonists that these agents may increase risk of severe, potentially life-threatening asthma flares in some patients. You should not change your medications without consulting your physician. Ask your doctor about the potential benefits and risks of these agents for control of your asthma.

Theophylline has been used for over 30 years to treat asthma.

* These are available as tablets, capsules or intravenously .
* Blood levels should be monitored.
* Side effects can include headaches, elevated heart rate, stomach upset. Severe toxicity at higher than therapeutic blood levels can include seizures.

Anticholinergic agents are available in inhaled form.

* These can be used alone or combined with the beta-agonist bronchodilators.
* Ipratropium may be used for asthma treatment, although its official use is for chronic obstructive pulmonary disease (COPD).
* Cough and headache can be side effects.

Anti-IgE antibody:

Omalizumab was approved in 2003 as a new class of therapy, known as “anti-IgE,” for patients with moderate to severe persistent allergic asthma. It is currently approved only for use in treatment of asthma. IgE, an antibody that we all produce, is responsible for causing symptoms of allergic diseases, including allergic rhinitis (”hay fever”) and asthma in some people. Anti-IgE may reduce allergic reactions by binding free IgE so that the bound IgE cannot produce the allergic reaction.

Use of this medication should currently be limited to those patients with moderate to severe persistent allergic asthma who: 1) are inadequately controlled with appropriate combination therapy; 2) have complications due to inhaled or oral steroid use; 3) have increased urgent care, emergency department or inpatient service needs due to severe asthma exacerbations; 4) have significant problems with activities of daily living; or 5) do not tolerate other medications usually prescribed to treat asthma. Omalizumab needs to be administered every two to four weeks by injection based on body weight and total serum IgE levels.

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Epinephrine is a medication that is used in emergency rooms and doctor’s offices to treat allergic reactions. Anaphylaxis is a severe allergic reaction that involves the entire body. It is most commonly caused by foods, drugs and stinging insects. Administering the epinephrine early in anaphylaxis improves the chances of survival and a quick recovery.

People with a history of anaphylaxis should carry an autoinjectable epinephrine with them at all times. As always go to the Emergency Room after you use it for a follow-up from the physician.

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