My 8 year old goes to a school with a roof that has been leaking for many years. The district cannot afford to fix it. There are typically 7 buckets in the hall collecting water. Along with the water is black gunk. My son was on the top floor this year. His asthma has worsened. He missed quite a bit of school. He is now on an inhaled steroid. Is it safe to assume that a big part of his problem is the school environment?
Thank you.
Ohio Mom
Parent Mailbag
Mom Thanks Our Book for Helping Save Daughter’s Life
I am sending you my most sincere thank you for helping me save my daughter’s life. My daughter is 4 years old and has respiratory problems since birth (born with pneumonia). Anytime she had a cold/virus she would have severe asthma symptoms and though numerous tests showed that even when she “appeared” well she still had inflammation. We thought that we were experiencing the worst of it. Last week, we were taking a family bike ride to the park when she began to cough and couldn’t stop. We asked her what was wrong and she was only talking in a whisper and continued to cough horribly. From information that I had read in your book, we knew something wasn’t right so we immediately went home to get her started on a nebulizer treatment….as we did the next coughing fit she turned blue and couldn’t speak to us. We called 911 and emergency treatment was given as she was having a “severe asthma attack.” To be honest, I am not sure that I would have realized what was happening and acted so quickly if I had not read your book. I never dreamed that asthma could “change” so suddenly and happen when she was not sick with a virus. I consider myself to be very educated about pediatric asthma in relation to my daughter but I sadly realized that I could have easily missed this symptom. She has never presented with a continuous cough in the past associated with her asthma just wheezing and retracting with low saturation levels during a cold. I truly would not have been as vigilant to notice this as “something is very wrong” if I had not just read about it in the book! I hope that you don’t mind my sharing this with you but it seemed appropriate that you should know how grateful my family is for this book.–Grateful Mother
Henry Ehrlich replies: What more can we say?
Asthma in Public Schools
I work in an office in a New York City public school. Our students come from low-income, minority homes, and the student body suffers from a high incidence of asthma. Every day I sit at my desk and see mouse droppings on surfaces that were clean when I left the night before. Dead and living cockroaches are fixtures in our classrooms and hallways.
Parents in middle-class, mostly-white schools have been agitating for years now about eliminating children’s exposure to peanuts to curb the risk of dangerous anaphylactic episodes. Some schools have gone peanut-free. No such initiative has been taken to get rid of persistent vermin and pest problems in our urban schools. In fact, our school just fired three maintenance workers due to budget cuts.
Pests in older, badly maintained apartment buildings surely contribute to the high incidence of asthma in our student body, but some of our students spend more time in our building than they do in their homes. I have two questions: What can I do to make my school cleaner and safer? What can be done systemically to make all of our schools cleaner and safer?
Concerned Educator
Dear Educator,
First of all, thank you for your service to New York City children. For years I have tried to do my part for kids in that socio-economic group by going to schools and working directly with them, as part of Project ERASE, a program I founded.
You have your finger on the problem in talking about the difference between food allergies and asthma. Food allergy parents see a daily threat to their own kids and understandably raise hell, although the best solutions in my opinion lie with the students and their families, not with the institution. Asthma is a chronic condition that afflicts large numbers of kids of all classes, but disproportionately poorer ones, and it is much more influenced by environmental conditions than food allergies are.
We have found in our work at the schools, and this is backed by all the research, that relatively simple changes, such as complying with prescriptions and better home cleaning, can reduce serious asthma attacks by 75% or more.
What you are describing is very troubling for many reasons. As you point out, students spend 7 or more hours a day in buildings where they are regularly exposed to allergens they can get rid of at home with conscientious housekeeping.
The possibilities for collective action to rid schools of pests would likely produce good results for large numbers of students. However, their beleaguered parents are not well organized. The squeaky wheel gets the grease—again.
If budget cuts are making the schools dirtier, this will compound problems for your school’s administration as well as in the classroom. For example, each day lost at school costs your school money from New York State, so it will exacerbate your principal’s budget problems.
In the classroom, students whose allergies and asthma are uncontrolled not only suffer academically, they tend to distract other students from their learning. They suffer throughout their lives with lower quality of life and lower achievement. This is a huge social cost.
What can you do?
Very hard question. An NYC principal of our acquaintance says there are no hard standards in the system. From what she says, custodians seem to enjoy far more discretion over how they do their jobs and how hard they work than teachers do in their classrooms.
I am hard pressed in this economic environment to encourage you and your colleagues to do more than you already do. You might ask for an inspection of food service and garbage disposal.
It might be worth your while to raise the issue with your administration and try to figure out how many seriously allergic and asthmatic children are enrolled, and what the effect of these conditions is on their health and attendance. If it is a perceptible problem, I am sure we can arrange to have someone come and discuss it with teachers, staff, parents, and even students about the toll this pernicious problem takes. Maybe you can find a cause that all of you can rally around. Keep up the good work you are doing.
Dr. Ehrlich
Peanut oil spray: safe or not?
At a restaurant recently with our peanut allergic son, we ordered a slice of pie, but first asked if it contained any nuts. The server said “No”, and went to the kitchen. A minute later she was back. The chef uses a spray peanut oil on the crust to help release the crust from the springform pan. So we ordered something else.
Dear Meg,
It doesn’t take much exposure to peanut introduced into the peanut-allergic person to cause a problem. I have looked at peanut oil in grocery stores, and some has a slightly cloudy look rather than a clear one. That cloudy appearance is surely caused by bits of peanut. While aerosol peanut oil sprays are undoubtedly even more refined so as not to clog up the spray mechanism, I suspect that there may still be traces of the allergenic antigens in some products. In our book we tell the story of a patient of mine who had anaphylaxis from unprotected sex with her boyfriend eight hours after he ate peanut butter. If you think of the filters involved in that process, you’re better off playing it safe with your son.
Dr. Paul Ehrlich
Not many servers or chefs are as cautious as this. Should we be worried about spray peanut oil in baked goods or other foods? Could a slice of that pie have caused a reaction? He has reacted to a very small amount of peanut.
Meg
Measuring Peak Flows: a How-To Manual
Q: My daughter was given a peak flow meter by her GP, along with several prescriptions, but no instructions on how to use it or interpret the results. While away at college, her asthma was bad, and she was disallowed from playing intramural sports. Can you please provide good instructions and tell us what the results mean?
Dr. Chiaramonte answers:
The most important instruction is that SHE MUST DO IT. It is more important to her health day-to-day than brushing her teeth, so one way to remind her to do it is to combine the two tasks; I would like her to do the toothbrush trick—attach her toothbrush with an elastic band to her peak flow meter as a morning reminder.
–The peak flow meter should read zero to start
–Use the peak flow meter while standing up straight
–Take in as deep a breath as possible
–Place the peak flow meter in the mouth, with the tongue under the mouthpiece
–Close the lips tightly around the mouthpiece
–She must refrain from “cheating” which she can do by putting her tongues near the whole which will give a falsely higher number.
–Blow out as hard and fast as possible; do not throw the head forward while blowing out
She should try to blow just a little bit harder than her normal exhalation on three attempts—it’s not like blowing up a balloon or blowing out a lot of birthday candles where you keep going till you feel lightheaded–and take the best reading of three.
Breathe a few normal breaths and then repeat the process two more times. Write down the highest number obtained. Do NOT average the numbers.
WHERE IS THE STARTING LINE? Unlike blood pressure or body temperature, there is no one “normal” measurement with peak flows. The best baseline is her personal best all-time peak flow, but we are initially forced to use her predicted peak flow without the knowledge of her best score until there’s more of a track record.
After that, 80% and up of the baseline would be a green normal zone. She can just take maintenance dosages if her medication.
60-80% of baseline would be a yellow cautionary zone –medication should be increased.
Below 60% of baseline would be a dangerous red zone-she should seek medical attention.
She should also work with her doctor to create an asthma action plan—see the link “Action Plan” in the upper right corner of this page–or click here.
You should also know that maximal peak flow number will go up as children get old and taller. A peak flow of 250 may be fine for an eight year old, but if it is still 250 at ten, that’s no good. Asthma Action Plans must be re-evaluated in children on a frequent basis.
As for intramural sports, David Beckham and many other elite athletes have asthma. Get it under control and go out and play!
Success! A Mom’s Photo Essay on a Peanut Food Challenge
A blogger Mom took her child for a food challenge and they got good news. See it here.
Peanut-Sniffing Dogs: Good Idea or Bad Idea?
Q: What do you think about using a peanut-sniffing dog for a severely peanut-allergic child?
Dr. Ehrlich replies:
This is a new wrinkle in discussion of what to do when children have life-threatening food allergies, which we write about in chapter 14 of Asthma Allergies Children: a parent’s guide. To summarize what we say there:
Cases where children are sensitive to fleeting exposure, not just ingestion, are extremely rare.
These dogs are really expensive, as are their inspiration—drug- and explosive-sniffing dogs–so it’s not for everyone because of basic economics. It’s not a particularly cost-effective use of the family health-care budget.
I have heard talk of a foundation to raise money to support this approach. I’m not one to question people’s philanthropic impulses–I would certainly donate for training seeing-eye dogs. However, peanut allergy is not blindness. I can think of many areas in the field of pediatric food allergy that will produce more bang for the tax-exempt buck, primarily because the dog approach projects a fundamental misunderstanding of the problem. The seminal study of peanut fatalities by Dr. Hugh Sampson shows that they happen when people are exposed to peanuts far from their normal surroundings and are exposed accidentally, such as mountain climbers whose climbing partners carry energy bars that contain peanuts.
Anyone who expects to encounter peanuts at school or the mall can prepare for it by carrying an epinephrine injector such as Epi-pen or Twinject at far less cost, which they should do even if they have a dog. Epinephrine is safe, even with repeat injections.
A family that expects a dog to create a peanut-free bubble is in for trouble because they will create a false sense of security. It’s not a peanut-free world. I agree with the Food Allergy and Anaphylaxis Network that even schools should not be peanut free. The children should understand their condition, never eat food that mom didn’t give them including birthday cupcakes, and their teachers and nurses ought to be trained to help in the event of anaphylaxis. Their classmates should be taught to respect those who have this condition.
Pollen–a reader responds
This reply was written in response to a recent Weekly Tip item:
Thanks for citing my father-in-law Roger Wodehouse’ 1935 work Pollen Grains (Asthma Allergies Children, page 219). “There is another important point to make about pollen: the nectar producing flowers that are pretty or fragrant attract insects, bats, or birds to inadvertently convey their sticky pollen to other flowers while feeding on their nectar. The inconspicuous flowers of grasses, trees, and ragweed rely on the wind or gravity to move their pollen to female flowers. They produce large quantities of pollen grains of small size, carried by the air to other plants and your nose. It is not the showy yellow goldenrod you can see but rather the unattractive green ragweed you overlook that is making you miserable. That is not to say that if you plunge your face into a peony you won’t sneeze, but you can learn to admire pretty flowers from a distance and not condemn them as allergens.”
–AW
Home Air Filters–What Works Best?
I wanted your advice as I am looking into buying new air purifiers in connection with my son’s asthma/allergies. I have heard that I should NOT purchase one that works with ions (ionic technology). Am I wrong?
The ones I bought about four years ago are a bit noisy. So I am planning to purchase the latest
technology. Before I purchase them, I want to make sure that the ionic ones will not be a
problem. One other advantage is that I will not have to change any filters, which I have been doing every 2-3 months, but just clean the blades regularly; also, they are supposedly very quiet. Since I have a
small apartment, I cannot afford to have something bulky and big. Hence, am thinking of something sleek that does not necessary have to be placed in the middle of room (as per the current ones). Please advise.
–Ms. D
Sorry to disappoint you. All air purifiers must be HEPA (High Efficiency Particle Air filters). The ones about which wrote are sub-standard – easier to care for – but not good products. Call 1-800-ALLERGY. That is the simple fact.
–Dr. Ehrlich
{Note: For more on air filters click here}
Parents mailbag
EF writes: My two-year old son was just diagnosed with peanut and tree nut allergies. Since I am new to this, I have several questions.
1. Is there a different trigger level for the allergy flare up in each individual? Can or will new blood tests show this level?
First of all, good luck. We and our colleagues in the specialty of Allergy and Immunology will do our best for you and your child.
30% of the standard blood tests which are reported as positive are really falsely positive, and, therefore, the true gold standard for testing in allergy becomes the double-blind placebo controlled food challenge, known as DBPCFC for short, although the abbreviation is hard to memorize. What you really want to know is whether we can do a test which will tell us whether we can accurately predict the severity of food allergy, and the answer is “they are working on it”, but as of yet “no.”
2. What is the best way to talk to my child about this allergy, what is the best age to start educating him, and what advice do you have for talking to others about it?
Most parents find that by three years of age the children understand that certain foods are not good for them, and they can learn quite early to ask anyone who offers them food of any sort, “Does it have, (food type) in it?” The broader answer to the question, explain to each child and anyone who cares for her/him the consequences of eating a food to which they are allergic. And don’t sugar coat it. By now, most pre-schools are conditioned to be sensitive to the needs of food allergic children. Closer to home, babysitters and grandparents require special attention in this regard.
For a very sympathetic discussion of these issues, see “Guide to the Worry Years” and the rest of “Food, Glorious Food?” Chapter 5 of Asthma Allergies Children: A Parent’s Guide, and Chapter 14, “Mom and the Rest of the Family.”
3. Show me a detailed/comprehensive list of OK FOODS to eat.
No can do. It all depends on the history and the tests. There may even be a tree nut or two that this child can eat.
4. What research is being done to get closer to a cure?
There’s too much to describe here, but Food Allergy Initiative and Food Allergy and Anaphylaxis Network (FAAN) will keep you up to date. Research on one drug that was considered promising for peanut allergy has been discontinued for economic reasons. In the meantime, teach your son, his caregivers, and your family well.
(Note: These questions were answered by Dr. Larry Chiaramonte)