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Children With Asthma And Allergies Need To Take Special Precautions At School

A new survey by the American Academy of Allergy, Asthma and Immunology (AAAAI) of allergists, immunologists and school nurses showed that children with asthma and allergies often have reactions to triggers in the classroom. An AAAAI survey of children with asthma and allergies conducted by the American Academy of Allergy, Asthma and Immunology (AAAAI), 41 percent of respondents said they had as many as three asthma attacks per month at school.

"Parents with children suffering from allergies or asthma should be concerned," said Michael Zacharisen, M.D., Fellow of the AAAAI. "Parents of allergic and asthmatic children need to take special steps to help prepare their child and their child's teachers for the new school year."

Asthma and allergies are among the most common, chronic conditions in the United States. Nearly five million children in the United States have asthma and millions more have allergic rhinitis, or hay fever. Children miss about two million school days each year because of allergy symptoms and 10 million school days because of asthma symptoms.

Triggers and symptoms in the classroom

Allergies and asthma can be triggered by allergens, ordinarily harmless substances like pollen, dust mites and mold spores. Allergens at school that can cause an allergic or asthmatic reaction include dust mites, chalk dust, animal dander from class pets or pet hair on student's clothing, exercise and pollen and molds.

Children with allergies may experience congestion, a runny nose or itchy, water eyes when they are exposed to the allergens to which they are sensitive. When children with asthma come in contact with their triggers, they may experience coughing, wheezing, shortness of breath, or chest tightness.

"The key to reducing the severity of symptoms a child experiences at school is avoidance," Zacharisen said. "Parents need to make school personnel aware of their child's asthma or allergy triggers so they can help the child avoid them."

Appropriate treatment is key

Allergy and asthma symptoms sparked by triggers in the classroom can interfere with participation in sports, school trips, physical education and play activities. Asthma and allergies can also interfere with a child's energy level, concentration, attention, peer relations, physical activities and cognitive functioning.

"If you or your child's teacher notices your child is having difficulty concentrating in school or isn't able to participate in physical activities, it may be a sign of improper treatment," Zacharisen said. "Children with well-controlled allergies and asthma can fully participate in all school activities. Just because a child has asthma or allergies doesn't mean they have to suffer with them."

Access to medication at school

Students with asthma frequently have a sudden onset of symptoms from a variety of causes. In most cases, these asthma episodes can be prevented or treated by inhaled medications. For students to be able to function normally at school, it is critical that prescribed medications be available to them at all times during the school day.

It is the position of the AAAAI that children be allowed to carry their inhaled asthma medications with them at school. The AAAAI position statement says, "Students whose parents and physician judge that they have sufficient maturity to control the use of these inhaled medications should be allowed to retain these inhalers in their possession. School policies that require inhalers to be kept in school officials' or nurses' offices resulting in an interference in the medical needs of the patient and may seriously delay treatment."

Communication is critical

"The key to a healthy school year is communication," Zacharisen said. "It is critical to a child's health and success at school that parents explain their child's condition to teachers and school officials."

Students with asthma and allergies should have a School Management Plan on file at school, Zacharisen said. This plan, developed with the child's allergist/immunologits or pediatrician, should contain detailed information about the child's condition, including triggers, medications and what to do in an emergency.

Food allergy

Food allergies are a special concern for many parents. Up to two million children in the United States have food allergies. The most common symptom of an allergic reaction to food is hives. Food allergic individuals can also experience asthma-like symptoms, eczema and other gastrointestinal symptoms such as vomiting, diarrhea and abdominal cramping. The most severe reaction to food is anaphylaxis, a systemic reaction that can sometimes be fatal.

Some of the most common foods that can trigger an allergic reaction are milk, eggs, peanuts, wheat, soy, fish, shellfish and tree nuts. Strict avoidance of the foods to which a child is sensitive is the only proven therapy for food allergy, but it is difficult to achieve complete avoidance of all allergenic foods. Traces of problem foods can be hidden or accidentally ingested, however, it is possible to reduce student's exposure to allergenic foods within the school setting.

"Staff members involved with the child's care should be instructed about which foods the child needs to avoid, the potentially severe nature of food allergy and proper treatment of allergic reactions," Zacharisen said. "If prescribed, food allergic students should have an epinephrine auto-injector device clearly labeled with the child's name and classroom number. School personnel should also be instructed about the location of the medication and how to administer it if an allergic reaction should occur."

Treating allergies and asthma

The best person to treat allergies and asthma is an allergist/immunologist. Allergy/immunology specialists are pediatric or internal medicine physicians who have completed an additional two years of training to become specialized in the treatment of asthma, allergy and immunologic disease. allergists, immunologists are the best qualified physicians to recognize the sometimes subtle symptoms of allergies and asthma and recommend appropriate treatment. To be referred to a local allergist/immunologist, contact the AAAAI's toll-free Physician Referral and Information Line at 800-822-2762 or on the web at

Ten tips for parents:

The following are ten tips for parents to help their allergic or asthmatic children stay healthy during the school year:

  • 1. Make sure a "School Management Plan" is on file for your child at school.

  • 2. Schedule a meeting with teachers and the school nurse to discuss your child's condition. Review the School Management Plan and help them understand your child's condition.

  • 3. Encourage children to take their maintenance medications as prescribed.

  • 4. Review your child's triggers with them and encourage them to get help from a teacher when symptoms worsen.

  • 5. Make sure your child has their medications and peak flow meter with them at school.

  • 6. If your child is allergic to certain foods, inform cafeteria staff of foods to avoid and suggest safe alternatives. Be sure epinephrine is available and staff know how to administer it.

  • 7. Inform physical education teachers and coaches about asthma and warning signs of an attack. Make sure they have a copy of the School Management Plan.

  • 8. Work with your child's school system to address their concerns about your child's medical needs.

  • 9. Encourage your child's physician to be an information resource for the school.

  • 10. See a physician if your child is having difficulty with learning, alertness or endurance. These symptoms may be due to side effects of the child's condition or medications and may be eliminated with a change in medication.

The AAAAI is the largest professional medical specialty organization in the United States representing allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Established in 1943, the Academy has more than 6,000 members in the US, Canada and 70 other countries. The Academy serves as an advocate to the public by providing educational information through its toll-free line at 800-822-2762 and its Web site at

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Editor: Susan K. Boyer, RN
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