Ask a Nurse: My Deadly Sandwich! Peanut Allergies

Pamela is an RN, MSN/Ed.

Pamela is a mother of 6 amazing children ages 11 to 24. She is a nurse educator and loves to travel overseas to work in medical clinics and teach health-related topics to schools and communities. She has been married to her best friend, Steve, for 29 years. She has many different interests including reading, writing (NOT arithmetic!), baking, teaching, and spending time with her family. She lives in central Pennsylvania with her husband and two youngest daughters.

My Deadly Sandwich!

( Peanut Allergies)

My favorite sandwich is a good ol’ PBJ. I like it on double fiber bread with crunchy peanut butter and blackberry jam….mmmm, good!  Unfortunately, this favorite sandwich can cause life-threatening symptoms in those with peanut allergies. Some schools are taking drastic measures, even banning any peanut products on school property. Do you think they are over reacting? Well, let’s look at some statistics.

  • Peanut allergy is one of the “Big 8″ food allergies that account for 90% of those suffered by 21 million Americans.

  • More than 3 million people in the United States report being allergic to peanuts, tree nuts or both.

  • Approximately 1% of the U.S. population has a peanut allergy (Sicherer, SH, “Prevalence of peanut and tree nut allergy in the US…“)

  • Less than 21% of patients with peanut allergy will outgrow it.

  • Peanut Allergy is the most common cause of food related death

  • Four out of every 100 children have a food allergy. (CDC/NCHS Study, “Food Allergy Among U.S. Children…”)

  • From 1997 to 2007, the prevalence of reported food allergy increased 18% among children under age 18 years. (CDC/NCHS Study, “Food Allergy Among U.S. Children…”)

From 2004 to 2006, there were an average of 9,537 hospital discharges per year with a diagnosis related to food allergy among children 0 to 17 years. (CDC/NCHS Study, “Food Allergy Among U.S. Children…”

There are many scary stories about children with peanut allergies almost dying at school even when everything was done to prevent mistakes from happening! One child had a substitute, and even though,  one-she had subbed for his class before, two- there were messages on the board about the allergy and three-there were warnings in the substitute folder, lesson plans, etc., this teacher still gave the child a snack with peanuts in it, with an almost tragic result!

When I worked as a school nurse, we had several food allergies, and one very severe peanut allergy. I was told when I was hired that this child had gone into anaphylactic shock and taken by ambulance twice from very small amounts of peanut residue or dust!
You should always have at a minimum, a food allergy action plan (http://www.decal.ga.gov/documents/attachments/AllergyActionPlan-CCS.pdf), this should be copied and given to every staff member in your child’s school, not just those who will usually care for your child! It is when situations are not usual when tragedies occur most often.  Meet with your school nurse, teachers, cafeteria staff and principal to explain your child’s action plan.


If your school is not peanut free, you can at least have your child’s classroom declared peanut free, and have a peanut free table provided for the cafeteria. There are many sources for free signs, classroom and school education and other help you may need. Here are a few to get you started:
http://www.allergyfreetable.com/peanut-free-classroom-poster.aspx
http://www.allergyfreetable.com/babysitting-forms.aspx
http://www.allergyfreetable.com/food-allergy-videos.aspx
http://www.play2learnprintables.com/Peanutsinlunchnotes.pdf
http://www.allergicchild.com/Alliebook.htm
Have your child wear a bright medical alert bracelet that will attract attention if you child begins to have symptoms. I particularly like the set of 3 that says what the allergy is, to call 911 and to use the epi-pen.
Get your child a kit with at least 2 epi-pens (if she/he requires those), benadryl, and instructions for use. Make sure your child, and all school staff know how to use them, and practice with a trainer pen. If you are lucky, your school nurse will take care of all of that for you, in many states it is required for the school staff to all have training in allergy emergency response.  
Do whatever it takes to protect your child! There are a lot of resources to find great products that are actually cool these days. One child I know used to have a lot of colorful t-shirts that boldly stated he was a peanut free kid. Make sure everyone who will be in contact with your child knows about their allergy, what signs to look for and how to treat it. This will take a lot of work but will be so worth it. Don’t forget daycare, church, temple, friends and relatives.

A last bit of advice; provide peanut free snacks to classrooms, friends for play dates and even Sunday school class. People will feel so much better if you provide what you know is safe!

These tips can be applied to any food allergy. Make sure you ask your Doctor for help when your child is first diagnosed, they should be able to set you up with some good health education. There are many sources of support and supplies online; my list is just a small tip of the iceburg of the information out there.

I hope you found this information helpful! I realize there is a lot more to say on this subject, but I wanted to give you some basic information to help get you started. Chances are, if you don’t have a food allergy in your family, you know someone who does.

As always, please check any health information with your doctor. My intent is not to diagnose or treat, just to give information.

Have a great week!

Be Well,
Nurse Pam

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