Question of the Week

April 22, 2008


On Thursday, April 17, 2008, an eighth grader in Kentucky was removed from school after endangering the life of another student. This time, it wasn't guns or knives that a student brought. There was no known history of trouble between the two students, yet one eighth grader was seen putting a potentially fatal substance into the lunch box of the other: cookies.

"An eighth-grader was charged with wanton endangerment after allegedly putting crumbled peanut butter cookies in the lunchbox of another student with a severe allergy to peanuts. The allergic student, also an eighth-grader, did not eat the cookies and did not suffer a reaction. Fayette County public schools spokeswoman Lisa Deffendall said the incident occurred Thursday on the Morton Middle School running track, where students had gone to eat lunch and enjoy the warm weather. As the students neared the end of their lunchtime, a student was seen putting the crumbled cookies in the allergic student's lunchbox, she said. It was well known the other student suffered from severe peanut allergies, Deffendall said. There was no known history of problems between the two 13-year-old students, she said. After an investigation, the student was arrested on a felony wanton endangerment charge and has been removed from the school, Deffendall said."

Some believe that felony charges for putting cookies in a lunch box seems to be an overreaction. Others emphasize that it truly is a serious offense that was potentially fatal.

"Peanut allergy affects approximately 1.5 million people in the United States. As the most common cause of life-threatening allergic reactions (anaphylaxis), peanut allergies account for 80 percent of fatal or near-fatal allergic reactions each year. You can reduce your risk of having an allergic reaction to peanuts by knowing as much as you can about peanut allergy and how to avoid peanut-containing products."

Those with severe peanut allergies do all they can to avoid this common substance which is "the most common cause of life-threatening allergic reactions." Unfortunately, since it is such a common substance, it can be difficult to avoid peanuts completely.

"Despite your best efforts, you may still come into contact with peanuts and have a severe reaction. In this case, you may need an emergency injection of adrenaline (epinephrine) and a trip to the emergency room. If you're at risk of having a severe reaction, you may need to carry injectable epinephrine with you at all times."

If a reaction does occur, time is of the essence. Injectable epinephrine (Epi-pen®) will help buy time; but, even with the injection, emergency help needs to get to the person having the reaction within 20 minutes.

Peanuts account for "80 percent of fatal or near-fatal allergic reactions each year," but there are other allergens that make up the remaining 20 percent. In the fall of 2007, an unfortunate incident led to the death of a young college freshman.

"The death of IU freshman Kareem Bacchus shocked his friends and family Tuesday morning, when the 17-year-old apparently suffered a brain hemorrhage caused after being treated for an allergic reaction to something he ate on Saturday evening. Police responded to a medical assistance call from Bacchus' roommate Sunday morning in McNutt Quad, IU Police Department Captain Jerry Minger said. 'He had informed his friends that he was having an allergic reaction to something he ate at Malibu Grill,' Minger said. 'When the symptoms became worse very quickly, they called for help.' Bacchus was transported to Bloomington Hospital early Sunday morning, where he remained until he passed away shortly after midnight Tuesday. Monroe County Coroner David Toumey said the official cause of death would not be announced for several weeks. Bacchus' friends confirmed that he had a severe allergy to seafood and lactic acid, a compound found in milk products. Officials and his family, however did not disclose what he ate that caused the reaction."

Many people have allergies, but most people don't have allergies that are potentially fatal. This can make it difficult to understand how contact with a substance that is safe for so many can cause death in others.

"Anaphylaxis is a severe allergic reaction that may occur when you come into contact with something you are allergic to (called an allergen). Symptoms of the reaction usually start within minutes to an hour or two after contact with the allergen. In rare cases, symptoms may occur up to 4 hours later. ... If you have a severe allergy to a substance, contact with that allergen causes your blood vessels to leak fluid into the area around them. As a result, your blood pressure may drop suddenly. Because there is less blood flow, less oxygen reaches your brain and other vital organs. Since these organs do not function properly with a lack of oxygen, your body goes into shock. In addition, your body responds to the allergen by releasing chemicals such as histamines, which cause swelling of the skin, a red rash, and severe itching. Complications of anaphylaxis can include brain damage, kidney failure, and death."

When someone with a severe allergy is in school, the safety of the student is dependent upon the school environment that is created.

"Training school staff, at its optimal, can prevent a student with a peanut allergy from being exposed to allergens. A biannual group training session should include the child's classroom teacher, special area teachers, bus drivers, cafeteria workers, and other staff that are responsible for the student. Parents should be partners in the training process whenever possible. Training ought to include an overview of peanut allergies, the student's history of reactions to peanut exposure,an outline of the student's emergency plan, including, emergency phone numbers, specific instructions for staff to follow, location of emergency medications, how-tos for identifying foods that may contain peanuts or peanut products, practice of the emergency response plan... Accommodations in the school cafeteria might include a 'peanut-free table,' far from trash receptacles, where the student with peanut allergies and students with peanut-free lunches may sit. The table should be washed with a cloth separate from cloths and solutions that have washed other tables. Children with allergies who participate in the free- or reduced-price lunch program must be given the necessary food substitutions."

The teenage years can be the most dangerous for those with severe food allergies. They are often eating more with friends and less in the safe environment their parents have worked so hard to create at home. The teenager's friends and their families may not always understand the severity of the allergy or how to help keep their friend safe.

For more information about peanuts in schools, you can visit "Peanut Butter?" in the Question of the Week Archives from September of 2003.

Questions of the Week:

  • If you know someone with a severe allergy, what do you need to know so that you can help them if a reaction occurs? What can you do to help your friend or classmate avoid a potentially fatal reaction? What do you need to understand and respect about their lifestyle as you make decisions about where to go and what to do? If you see someone else doing something that might create a potentially dangerous situation for someone you know who has a food allergy, what can you do? Who can you tell? Does your friend have an "Allergy Action Plan"? What do you, as a friend or classmate, need to know about this plan?
  • If you have a severe allergy, what have you told your friends and classmates? What do you want them to know and understand? What do they need to know and understand in order to help create an environment where you can be safe? Are there things you don't want them to know? What do you think would be the best way to get this information out your peers and their families?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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