Food allergies at school: What students, parents and teachers need to know

An elementary school student eats lunch at a table equipped with plastic barriers to prevent the spread of COVID-19 at a cafeteria in Chuncheon, Gangwon Province, Thursday. Yonhap

By Bahk Eun-ji

For most parents, keeping their children safe from coronavirus exposure is the top priority as more students resumed school as part of a phased process since last week.

The many challenges now faced include having children comply with quarantine and social distancing rules but families with child who have serious allergies to certain foods have an additional layer of concern. The most worrying part is the school lunch system in Korea where students and teachers normally eat the same food, all together.

Back in 2013, a nine-year-old elementary school student in Incheon, west of Seoul, died when he accidently ate curry that contained milk at his school. Born with a severe dairy allergy, he was taught from an early age to be vigilant about everything he ate and drank to prevent going into allergic shock. Although his parents had notified the school authorities about his allergy and asked his homeroom teacher to pay extra attention to food provided at the school, no one thought about the milk in the curry prior to the young boy's resulting death.

The tragic accident raised awareness of the dangers of anaphylaxis and food allergies in Korea, where little was known about their characteristics although they are a serious public health problem that affects children and adults worldwide. Schools began to display information about allergy-triggering foods on bulletin boards, but it is still difficult to know the details of ingredients in school meals.

The prevalence of allergies has increased here with the changes in dietary habits. Despite the low prevalence, it can be fatal for those affected and special attention is needed as the proportion of teenagers or younger children among allergy sufferers is high.

According to data from the Health Insurance Review and Assessment Service (HIRA), 1,185 patients were treated for anaphylaxis (disease code: T780) caused by food allergies in 2019, up 32 percent from 898 in 2015. Among them, the number of children under 10 was 564 in 2019 up from 250 in 2015. The number of youngsters increased more than twofold during the same period, and accounted for 47.6 percent of all cases.

A team led by Lee Won-seok, a professor of pediatrics at CHA Bundang Medical Center analyzed patients under 15 from 2015 to 2017, and found that 58 out of 107, or 52.4 percent visited the hospital with anaphylaxis caused by food. Common causes were nuts and dairy products, according to the research.

Symptoms

Skin reactions such as rashes or itching are the most common early symptoms of anaphylaxis. Respiratory symptoms such as coughing and wheezing are also included and sometimes it can be difficult to swallow or talk. Breathing can become difficult, and blood pressure may drop in severe cases.

Digestive symptoms such as nausea, vomiting, abdominal pain, and diarrhea can also occur, as well as various symptoms such as anxiety and a sudden feeling of intense fear. In mild cases, patients usually recover without complications over time, but without proper treatment, it can lead to long-term damage to the body or even premature death.

Identifying triggers is the most essential step in the diagnosis of anaphylaxis. Doctors ask questions about previous allergic reaction including patient's medical history such as whether he or she has reacted to particular food, medications and insect stings. For accurate analysis, patients may be given a blood test to determine their triggers.

“More children have been experiencing anaphylaxis recently. In the case of children, they should be examined to find the cause if they show skin symptoms such as hives, or feeling chest congestion during exercising or after eating certain foods,” Lee said.

What to do in school

Anaphylaxis can be prevented by avoiding the causative agent that causes symptoms. Korea has been conducting allergic food labeling for packaged food since 2004, and school meals are also required to indicate potential allergens and food additives in the dietary information.

To prevent anaphylaxis or to respond quickly to emergencies, it is necessary to make children learn and remember the ingredients they have to avoid, and make them carry cards or necklaces that indicate the causative agent as well as necessary first aid measures if they have an allergic reaction so that people around them can take immediate potentially life-saving action.

It is also important to inform teachers, including health, physical education, and nutrition teachers at the beginning of the semester about the causes and symptoms of anaphylaxis. Making sure schools are prepared for emergency services in the student sick bay so students can be immediately sent to a nearby hospital for treatment is also vital.

Patients diagnosed with allergies that could result in anaphylaxis can be prescribed a self-injectable dose of epinephrine; it should always be carried with them. And even if the shot is administered and the child's condition temporarily improves, it is important to admit them to hospital for further treatment as a secondary reaction could still occur.

“Some patients with anaphylactic reactions to certain foods have a high chance of experiencing severe symptoms even if they are exposed to a small amount, so make sure to look at food labels carefully to avoid ingredients that could cause an anaphylactic reaction,” Lee said.