The Rise in Food Allergies is Changing the Work of School Nurses

Oct 25, 2016

Every morning Pat Wilson walks down the hall from her office in the Julia Goldstein Early Childhood Education Center through the gym and into a part of the building not typically associated with a school nurse: the kitchen.

There, she checks a list—posted on the side of the stainless steel refrigerator—of all the students in the school with a food allergy.

“It’s constantly being updated,” Wilson says.

Wilson’s been a school nurse for 20 years. She’s the lead nurse in the University City School District just outside of St. Louis, she’s also president of the Missouri Association of School Nurses. The biggest change she’s seen in her profession, she says, is the rising number of students food allergies.

It’s part of a trend that’s shifting the role of school nurses towards managing the rising number of chronic conditions in children across the county.

Tracking Kids’ Allergies

Through school nurses like Wilson, the state of Missouri has collected an almost unparalleled  inventory of health information on the state’s students for the past decade.  In that time, they’ve documented an almost 250 percent jump in the rate of students with a life-threatening allergy—most of those are food allergies.

Growing awareness could account for some of the rise documented in Missouri, says Marshall Plaut who studies food allergies at the National Institute of Allergy and Infectious Diseases.

“People are reporting food allergies more because they are more aware of food allergy as an issue,” he says. But allergies really are rising around the country and across the western hemisphere.

That’s especially true with peanut allergies, which Plaut says appear to have seen a 200 percent increase in prevalence, although he notes more non-self-reported data—like skin tests and IgE levels—would be needed to determine an exact number.

Still, the rate is increasing and one reason could be something called the ‘hygiene hypothesis’—basically as young children are exposed to fewer infectious agents growing up, their immune systems don’t work as well, leaving them more susceptible to developing allergic diseases.

For schools, all of this means there is growing concern about exposing kids to allergens. Nationally about 8 percent of children could have a food allergy—meaning in every classroom of 30 students, two or three would have one. At the same time, school nurses are seeing a rise in other chronic conditions as well.

Missouri Association of School Nurses president Pat Wilson demonstrates how to use an EpiPen in her office in University City, Mo.
Credit Bram Sable-Smith / KBIA/Side Effects Public Media

“The numbers are quoted quite often,” says Evilia Jankowski, president of the Michigan Association of School Nurses. “Three kids with asthma in every classroom of 30. Two kids with some sort of life-threatening allergies. I think the latest [numbers] I’ve seen for diabetes is like one in 100.”

“Our numbers are increasing,” she adds, and that’s reshaping the role of school nurses.

In addition to triaging the scrapes, aches and illnesses that typically send students to the nurse’s office, school nurses are increasingly taking the lead on coordinating student care between teachers, parents and the school. They’re educating school staff on emergency procedures like using EpiPens, and even coordinating with cafeteria managers to make sure students aren’t exposed to foods that could make them sick.

“We have a huge amount of students with chronic health conditions that we didn’t have 23 years ago,” Jankowski says. “The focus and scope of our work has changed dramatically.”

Keeping Children Safe

For Pat Wilson in University City, that means checking the list of children with food allergies every morning.

One name on the list is Haven Brown, a 4-year-old whose favorite foods include broccoli, carrots and macaroni. But there’s a long list of foods that could trigger Haven’s eczema that she’s learning to stay away from.

“Do you eat fish?” Haven’s father Joshua Brown asks.

“No!” she responds.

“Right, because what happens when you eat fish?”

“I get scratchy.”

Eggs, yeast and some citrus fruits have a similar effect. When she gets into an itching fit, Joshua Brown says, “the learning stops.”

Wilson has put plans in place for students like Haven. She’s trained the teachers on keeping potentially allergic foods out of the classroom—homemade cakes to celebrate birthdays are a ‘no-no’—and on emergency procedures. She’s in frequent contact with schools parents. And every day she checks the list of student allergies against the day’s menu.

“It’s all about keeping the children safe,” Wilson says. “That’s just the bottom line, making sure the students are educated and everyone is safe. That’s my primary focus.”

This story was produced by Side Effects Public Media.