Martha’s Vineyard schools, along with public school systems across the country, must contend with a rise in the number of students susceptible to life-threatening food allergies. Although parents can create safe, allergen-free environments at home for their children, schools are more limited in their ability to remove potential triggers. The school nurse provides the first line of defense for allergy-vulnerable students.
Food allergies now affect one in every 25 students, an increase of 18 percent from 1997 to 2007, according to the National Association of School Nurses (NASN). In a position statement, NASN said, “Safe and effective management of allergies and anaphylaxis in schools requires a collaborative, multidisciplinary team approach.”
The Times recently sat down with all six Island school nurses in the Martha’s Vineyard Regional High School library to discuss the rise in allergies and what is being done on the Vineyard to safeguard students.
The nurses said they have watched the rise in food allergies. One tangible sign is that many students now carry EpiPens, autoinjector devices that deliver a measured dose of epinephrine, a drug most often used for the treatment of anaphylaxis, a severe allergic reaction characterized by rashes, low blood pressure, and throat swelling, among other symptoms.
“I started nine years ago with four EpiPens, and now I have 20,” high school nurse Linda Leonard said.
“We also see a tremendous amount of asthma,” Chilmark and Charter School nurse Janice Brown said. “So many inhalers, so many EpiPens. Every year there is more.”
NASN said food allergies are responsible for 30 to 50 percent of anaphylactic reactions, 90 percent of which are reactions to eight standard food allergens: milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat.
Some school districts have taken drastic measures that include banning allergens entirely. NASN does not support a complete ban: “Completely banning nuts or other foods is not recommended, as it is not possible to control what other people bring onto the school grounds, and does not provide the allergic student with an environment where he/she can safely learn to navigate a world containing nuts.”
NASN said a complete ban can create a false sense of security.
Policy in place
In 2013, the Martha’s Vineyard Public School system approved a policy for managing life-threatening allergies in schools. Since then, the school nurses have worked together to provide a comprehensive emergency and prevention plan in all Island schools.
In line with NASN recommendations, no Island schools ban nuts or other allergens entirely. Instead, the schools, with the exception of the high school, have designated peanut or nut-free areas, cafeteria tables, cafeteria kitchens, food services, home economics classrooms, or classrooms. Precautions are taken based on student needs. In general, the nurses said, students have really taken to the precautions.
“Our tables, they’re not tables that are sparsely populated, with kids who have allergies as well as kids who do not,” Tisbury nurse Catherine Coogan said. “We have a very small cafeteria, so it kind of lends it to that, but it’s not like the child is sitting all by themselves eating their lunch just because they have an allergy.”
“I think it allows other kids to be educated as to what it is, that there are other students with these allergies, so they’re more aware,” Oak Bluffs nurse Lana Schaefer said.
The Chilmark and Charter Schools do not have cafeterias, so precautions take a different form.
“Because the two schools that I work in do not have a cafeteria, a lot of the students eat in their classrooms at their desk,” Ms. Brown said. “They’re taught to have a barrier between your food, so you don’t have your peanut butter and jelly sandwich on the table — put it on a tray or a plate.”
Students are also taught to wash their hands before and after eating.
“We have a couple of children that have anaphylaxis with contact, and they’re little, so it’s making sure that after snack and lunch, that they’re washing their hands,” West Tisbury nurse Kristine Cammorata said. “Because after that they head out to use playground equipment, so if you have a little bit of that oil, it’s going to be a problem.”
“We wash tables and chairs in a room where you have a 5- or 6-year-old who has had severe anaphylaxis,” Ms. Brown said.
Parents are key
Parents are also educated at the beginning of the year about what healthy foods and nonfoods to send in for celebrations or classroom snacks. Massachusetts passed a state nutrition law in 2012 that included a ban on bake sales in school.
“We had an incident today where a beautiful cake came in with that special frosting — it was an awesome-looking cake,” Edgartown nurse Nicole Barlett said. “So I went into the cafeteria, and I said, ‘Where did this come from?’ And they said it was brought in, but the teacher did not allow it into the classroom, and she took care of it.”
Not all parents agree with the strict rules put in place.
“There’s a handful of people who feel that it’s their civil right to eat what they want,” Ms. Brown said. “Which is why they can, in a protected way, have the right to eat what they want, and we do accommodate that.”
If a student wants to eat nuts, the nurses educate that child on how to do so safely, without compromising the safety of a fellow student.
“Hey, I empathize with these people; I ate peanut butter and jelly four days a week when I was in school; that was my staple,” Ms. Brown said. “If you said to me, You can’t eat that, I would not be happy.”
“But for the most part, people are understanding,” Ms. Schaefer said. “They don’t know how they would feel if it were their child.”
She said they try to keep the rules from being too strict.
“That’s one thing that I always talk about with the parents, is that I want them to be comfortable with what we’re putting out there,” Ms. Schaefer said. “Part of that is why we don’t have nut-free buildings. It could be, ‘My child only eats nuts, how am I going to get around this?’ There has to be some leeway in there.”
“The goal obviously is to avoid the allergen and avoid anaphylaxis, but it’s also to empower the child to realize that the world is not a bubble,” Ms. Barlett said.
Team effort
Ultimately, the nurses said, it’s all about preventing an emergency situation. But, if it comes to that, the nurses are prepared, and can count on assistance. A number of professionals throughout the school are trained by the nurses to prevent and handle food allergy emergencies.
“The No. 1 thing is we’re all registered with the Department of Public Health to be able to delegate EpiPens and teach teachers how to administer,” Ms. Leonard said. “That’s a privilege to have. We all have to register every two years with the department to delegate to unlicensed personnel to administer epinephrine.”
“At the beginning of every year, we do a little in-service training,” Ms. Barlett said. “It’s done a little bit differently at every school, but all staff are educated in the signs and symptoms of anaphylaxis and what to do in case of an emergency.”
It’s not just teachers, either. Bus drivers enforce a no-eating food policy on the buses. Cafeteria workers maintain an allergen-free environment, and prepare allergen-free foods based on a list provided by the school nurses, sometimes with specific names and pictures of students hung in a private place.
The line of defense extends beyond the classroom or cafeteria as well.
“We also have, all of us, strict field trip policies,” Ms. Leonard said. “No one leaves our buildings without us going over the list of students that are leaving and what their alerts are. I have a field trip going next week, and there’s three EpiPens that are needed, so I had to delegate how to do it in case of. When the students leave our buildings, they are safe with whoever they are with.”
“When they mentioned that EpiPen training is done at the beginning of the year, it’s also done before they leave the building on the field trip,” Ms. Barlett said. “The EpiPen as well as the food allergy action plan goes with the delegated teacher.”
Sometimes, anaphylactic emergencies occur in students previously undiagnosed with any known allergy. All the nurses’ offices have extra EpiPens in the event of such an incident.
“That’s very important, because I’ll tell you, just from myself, that’s the only time I’ve ever given epinephrine, was to two unknown allergies,” Ms. Leonard said.
Life-threatening food allergies may be on the rise, but the Island school nurses say they are prepared.
“So in a nutshell …” Ms Leonard joked.
“We keep them safe,” Ms. Brown said. “I haven’t had an anaphylactic reaction for the 20-something years I’ve been working in the school system.”
“Just listening to all of us, we are all very comfortable with this, and we all feel like the kids are safe in Martha’s Vineyard,” Ms. Leonard said.
“That’s what we strive for, keeping kids safe and happy, and being proactive with education, and putting policies in place to prevent emergencies,” Ms. Brown said.
“I’m proud of this group,” Ms. Leonard said.