Combined Action Plans for Food Allergy And Asthma?

I like how FAAN’s food allergy action plan stresses that for LUNG symptoms, epinephrine must be given and that inhalers/bronchodilators are not enough.

My daughter has both asthma and food allergy. She has asthma symptoms a lot so I am concerned that schools will think “asthma” not “food allergy” when she has symptoms such as coughing or wheezing. Most of the time they will be right, and I don’t want her over epi’d, but it’s so important to epi if it is a FA reaction.

Is there a way the doctors in the food allergy and asthma community can come up with a version of a standard asthma action plan that takes into account the special needs of those with asthma and FA?

For instance, I requested our pulmonologist to add into her asthma action plan that if asthma meds don’t work in 5 minutes, to consider EpiPen.
However, I think there may be a better way to communicate how schools and such should deal with isolated respiratory symptoms in a child with both asthma and one diagnosed with a potentially life-threatening food allergy.

Just to add, my daughter is entering first grade, so it may not be obvious if she touches her allergen, then puts her hands in her mouth. Plus, her food allergen—sesame–is not required to be clearly labeled on food packages so knowing when she has been exposed to her allergen may be tricky.

Thanks.
A Mom

Dear Mom,

Thank you for your question.

I am also a mother of two children who have both asthma and food allergies. I understand your concern about telling the difference between asthma and food allergy reactions. I have had to make that call sometimes with my own boys, one of whom also has a sesame allergy.

Unfortunately, there really isn’t a clear answer for your question. While asthma symptoms and food allergy symptoms may seem the same, there are some clear distinctions. Therefore, combining the two plans into a single one is not recommended. For example, in a food allergy reaction frequent coughing and feeling the need to the clear throat are obvious signs. When wheezing is present it is more difficult to differentiate. Basically this falls in the “better safe than sorry” realm. You may not be aware that up until around 1985, epi was how asthma attacks were treated {note: it was the active ingredient in Primatene, which is now off the market}. Therefore, if this were not so long ago, we would be administering the same medication, regardless of cause. No harm will come if epi is administered, and it will help either condition. The best course of action will depend on all of the available information at the time.

My advice to you is to meet with the school nurse and whoever else has contact with your child. Explain what to look for in making the distinction. You know your child best. However keep in mind that people with both asthma and food allergies are at higher risk for fatal reactions because their breathing is already compromised, so quick action is key. If there is any doubt the school nurse will use the epi, as she should.

Please feel free to contact us with any further questions.

Harriet Spitzer-Picker A-EC