Twice a week, Gabriel Cellerini waits on the sidewalk while his bus driver goes through the ritual. Gia Engel runs antiseptic wipes over every surface the 4-year-old might touch as he enters the bus: the door handle, the hand rail, the front, back and sides of his seat. Of the preschoolers who attend the Early Childhood Special Education class at the Linn-Benton-Lincoln Education Service District headquarters, Gabriel is the first one on Engel's route. To further minimize contamination, she makes sure he sits in the same seat each day.
Gabriel is allergic to eggs, milk, peanuts and tree nuts, including walnuts, pecans and almonds. His allergies are so severe that he can have a reaction just touching the surface of something that someone who has handled the foods also touched.
The ESD class minimizes that risk as much as it can. The classroom door bears signs reminding visitors it's a peanut-free zone. Surfaces are wiped down and everyone who enters must thoroughly wash his hands. Teachers keep careful track of snacks, and Gabriel carries a dose of epinephrine, known as an epi-pen, for emergencies.
Gabriel's mother, Britny Cellerini of Albany, has been happy with the way the ESD has handled her son's medical protocol so far. But she worries about sending him to a public kindergarten in two years, when classes will be bigger and the potential for contamination increased.
"I'm nervous for the other schools, because this is such a small classroom," she said. "I don't know how I'm going to approach that yet."
Schools are learning to cope with increasing numbers of children like Gabriel every year. The federal Centers for Disease Control and Prevention isn't sure why, but the number of children with severe food allergies has gone up sharply in the past decade, prompting new legislation, awareness campaigns and occasional battles over medical protocol as school officials struggle to keep students safe.
A study presented in March to the American Academy of Allergy, Asthma and Immunology indicates 5.9 million children in the United States, about 8 percent, have one or more food allergies. That breaks down to 1 in every 13, or roughly two per classroom.
The CDC found an 18 percent increase in food allergies between 1997 and 2007. Reports of peanut allergies in children during that same decade tripled.
The reason behind the spike isn't clear. Family histories of asthma and allergies appear to play a role, as does the child's age (being younger than 3 seems to be a risk factor) and the presence of certain allergen-specific serum immunoglobulin levels in the bloodstream. Some scientists theorize that children develop allergies because they are exposed to fewer germs than children in other countries, so immune systems mistakenly identify certain foods as harmful.
Legislation around food allergies varies. Nearly all states, including Oregon, have laws allowing students to carry prescribed epinephrine at school for allergic reactions. In Oregon, the Oregon Department of Education maintains a number of links on its website to management guidelines for schools with allergic students. Starting next year, the federal government plans to make similar school guidelines available for all states, if they choose.
Section 504 of the U.S. Rehabilitation Act of 1973 is widely held to apply to children with severe food allergies, considering them "disabled" under federal civil rights laws and entitled to the same accommodations.
Some schools rely strictly on 504 plans for allergic kids, while others go with a more informal individual health plan that contains written information from a doctor outlining the necessary precautions.
In Albany, it is the school district's responsibility to ensure that a written health protocol is in place and to train staff to recognize a reaction and respond appropriately, according to an email from Assistant Superintendent Steve Kunke.
Schools follow medical protocol as far as it needs to be followed, Kunke said. Cafeterias across the district have "nut free" areas that are to be cleaned regularly with specific cleaning products. Alternate drink options are provided for students with milk allergies. Some schools have food preparation areas ventilated separately from the rest of the building.
"The risk of exposure through ingesting or touching food is closely monitored by staff to ensure student safety in all buildings," he wrote.
Corvallis carefully monitors, too, said Sharon Gibson, the Corvallis district's food service manager. Her department lets parents know what's on the menu, even providing ingredient labels and checking with the manufacturer if something changes or information isn't clear.
Peanut butter sandwiches are prepared in a central kitchen and kept separate from all other materials to avoid cross-contamination, Gibson said. They're handed out by a gloved server who makes sure to touch nothing else.
The district also provides soy milk, vegetarian meals and other options, she said. "We do accommodate all students to the best of our ability."
But problems can arise if a family and a school don't agree on how an allergic child's medical protocol should be interpreted.
One Albany parent who asked not to be identified said her child's allergy to coconut oil is so severe that even the fumes from using it to pop popcorn can cause a reaction.
The parent said she led an effort to either replace the treats with air-popped, unflavored corn or end popcorn days altogether at the child's school, a request the principal turned down because, according to the district, there was nothing in the student's medical protocol to indicate the student was in danger if she didn't come into personal contact with the popcorn.
"If we receive new information from the student's doctor saying that popping corn at the school, or serving it to other students, is dangerous to the student in question, we will act accordingly," Kunke said.
While each food-allergy case should be considered individually, most children can be accommodated at school with a few simple changes, according to Maria Acebal, chief executive officer of the nonprofit Food Allergy & Anaphylaxis Network.
"One easy thing to do is not allow food in the classroom. Food doesn't have to be in a classroom," she said. As for food in a lunchroom, wiping clean a particular table or extra hand-washing often is sufficient, she said, although a doctor's signoff might be necessary for something more stringent. Staff training on preventing and responding to allergic reactions is also critical, she said.
In Gabriel's case, Britny Cellerini is thankful not to have to worry about the next level of his education just yet. It's hard enough protecting him from potential contaminants in the rest of the world.
Gabriel was 6 months old and just starting on solid food when his parents discovered his allergies. He ate a few bites of baby-food macaroni and cheese, turned purple and started to struggle for breath.
The Cellerinis rushed him to the hospital, where doctors diagnosed the milk and egg allergies. Allergy scratch tests turned up the reaction to peanuts when he was 2 and to tree nuts just last year.
Gabriel's doctor said it's possible he'll outgrow the allergies, Britny said. In the meantime, she has changed her diet to match his, and his father and sister Hannah, 2, eat allergen-containing foods only when Gabriel won't be around for several hours.
The family is also very careful about where they take Gabriel. "Chuck E. Cheese is a big no," Britny said, of the popular pizza parlor and arcade. "Never been there. Probably never will."
It isn't easy, she added.
"Honestly, I am scared all the time, even letting him stay over at Grandma's," she said, remembering the time Gabriel found milk on the counter there, drank it and had to be rushed to the emergency room.
He's been to the ER, she said, at least yearly: "Too many times to count in his little life."
It's especially hard to be around people who don't understand that in the case of children like Gabriel, "food allergy" doesn't mean "minor intolerance" or "no big deal."
"People just don't realize how serious it is 'til they see it," she said. "Just the touch of something could be life-threatening." PD
—AP newswire report