Having food allergy is a stressful thing, as is having any potentially life threatening disease. What can make it even more stressful is when your peer group and community don’t take you seriously. Shinga from BreathSpa for Kids and Allergic Girl from Please Don’t Pass the Nuts brought my attention to a recent article by Jean Warner in the April 19, 2007 New York Times titled “Mean Grown Ups” (full text on Please Don’t Pass the Nuts) about conflict between the parents of the food allergic kids and non-allergic kids, here’s an excerpt:
“There’s an absolutely horrifying article in the current issue of Child Magazine about the food fight now raging between parents of children with life-threatening food allergies and parents of the allergy-free. The latter, apparently, have started to push back against “peanut-free” school regulations to assert their children’s natural right to eat whatever they darn well please.
The stories are downright chilling: One parent joked on a message board about having his daughter dress as “the Death Peanut” on Halloween. A North Carolina father at a parent-teacher organization meeting said he’d continue to send his child to school with peanut butter sandwiches and “tell his child to ‘smear’ the peanut butter along the hallway walls.” Another father sent his child to school with a “disguised” sandwich that had peanut butter hidden in the middle of the bread.”
All I can recommend is “Education, Education, Education”. As far as I know, there is no amendment in the constitution that states that any child has a right to a PB&J sandwich in school, particularly if it might cause the death of his or her classmate. This was the same issue that came up when they stopped serving the little peanut packets on airplanes. The airlines realized that it was cheaper and easier to switch to pretzels instead of having to make emergency landings whenever a patient anaphylaxed. Of course, the “mean grown ups” in the article might have said that peanut allergic people shouldn’t fly on planes because it restricts their right to eat peanuts while flying.
I have posted an excerpt from my chapter in the upcoming 4th edition of Food Allergy (Blackwell Science) which I hope will shed some more light on the matter, and I refer you to the excellent Food Allergy and Anaphylaxis Network which has a School Food Allergy Program to increase food allergy awareness in schools, pre-schools, camps, and daycare centers and a Kids site to help children deal with their situation.
Psychological Support of Patients and Families with Food Allergy
The first and most important step in the management of food allergic patients is obtaining an accurate diagnosis. Once the diagnosis is established, education of the patient and their family regarding avoidance of the allergic food and treatment of anaphylactic reactions can be conducted . However, avoidance measures and vigilance required have been shown to diminish quality of life and increase stress levels, particularly for families of children with food allergy [2,3]. This may also be a factor in decreased compliance with proscribed measures and precautions and result in increased risk-taking behaviour, particularly in teens and young adults . Recognition of these issues are often overlooked in the evaluation and management of these patients. Use of disease specific quality of life measures, such as the Food Allergy Quality of Life –Parental Burden , increases understanding of these factors and may aid in the development of improved treatment strategies.
Use of self-management support and education, similar to the model used in the management of chronic illnesses such as diabetes, may offer insight into how we can improve quality of life and compliance in food allergic patients. Patient education provides knowledge-based instructions in the hope that this will lead to behavioural changes and improved clinical outcomes. Self-management support is directed towards improving the patient’s ability to deal with their medical condition, including physical and social consequences and lifestyle changes. It goes beyond patient education to include processes that develop patient problem-solving skills, improve self-efficacy, and support implementation of knowledge in real-life situations .
1. Munoz- Furlong A. Daily coping strategies for patients and their families. Pediatrics. 2003 Jun;111 (6 pt 3):1654-61.
2. Primeau MN, Kagan R, Joseph L, Lim H, Dufresne C, Duffy C, Prhcal D, Clarke A. The psychological burden of peanut allergy as perceived by adults with peanut allergy and parents of peanut allergic children. Clin Exp Allergy. 2000 Aug; 30(8):1135-43.
3. Bollinger ME, Dahlquist LM, Mudd K, Sonntag C, Dillinger L, McKenna K. The impact of food allergy on the daily activities of children and their families. Ann Allergy Asthma Immunol. 2006 Mar; 96(3):415-21.
4. Sampson MA, Munoz-Furlong A, Sicherer SH. Risk-taking and coping strategies of adolescents and young adults with food allergy. J Allergy Clin Immunol. 2006 Jun;117 (6):1440-5.
5. Cohen BL, Noone S, Munoz-Furlong A, Sicherer SH. Development of a questionnaire to measure quality of life in families with a child with food allergy. J Allergy Clin Immunol. 2004 Nov;114(5):1159-63.
6. Coleman MT, Newton KS. Supporting self-management in patients with chronic illness. Am Fam Physician 2005;72: 1503-10.
From: de Asis L, Simon R. Psychological Considerations of Food Allergy chapter, Food Allergy and Adverse Reactions 4th ed. Blackwell Science (in press)