by Nabeeh N. Lahood, M.D. Leonard B. Schultz, M.D.
To appreciate the scope of allergic problems that children may experience during their school years, one must, first of all, realize that approximately one-third of a child’s life (up to eight hours a day) between the ages of six and eighteen is spent in the school environment. It is no wonder, then, that environmental exposures at school can profoundly influence the well-being (or lack thereof) of an allergic child.
Generally speaking, four categories of allergic problems can be distinguished.
Inhalant allergy. Probably the most common category, it can be exemplified by the Bermuda grass school yards common in Tucson and Phoenix. Bermuda pollen represents one of the prime allergenic exposures in both communities and, especially combined with other seasonal pollen exposures such as mulberry, olive tree, ragweed, and tumbleweeds, can wreak havoc on the recess and outdoor P.E. experience in spring and fall. In a somewhat narrower sense, exposure to furry pets during biology class or “show and tell” can have the same effect on a highly sensitive child.
Fortunately, recent advances in allergy treatment, both immunological and pharmacological, have provided physicians with a potent therapeutic armamentarium against the symptoms provoked by such exposure.
Food allergies. Particularly in the lower age groups, foods consumed at school, either by design or inadvertently, can provoke allergic symptoms – sometimes very severe ones, as in the case of a peanut sensitive individual. The school administrative staff should be informed if such a problem is known to exist and appropriate emergency medication such as injectable epinephrine (adrenaline) kept in the nurse’s office.
Exercise-induced bronchospasm (EIB). This is a much more common manifestation of allergy than has been thought in the past, and often goes unrecognized and undiagnosed. It consists of symptoms of coughing, wheezing, and shortness of breath during or after exercise, and it can lead, if untreated, to marked limitation of physical activity, both during recess and, more importantly, during physical education classes. This is all the more unfortunate because this distressing symptom can be both prevented and treated by the appropriate administration of a metered-dose inhaled medication (such as albuterol or cromolyn) prior to the anticipated exertion. Thus, any child with known EIB should have such an inhaler available for use prior to P.E. or recess.
Poor school performance. While both medical experience and common sense would teach that a child with constant nasal congestion, sneezing, and sinus pain could not function optimally in his or her school environment, only recently have physicians begun to recognize that the associated difficulty in sleeping, hearing problems, and general irritability can be significant contributors to poor school performance, emotional problems, and even the so-called Attention Deficit Disorder that seems to be increasing among school children. When allergy evaluation has revealed this possibility, subsequent allergy management has often resulted in significant improvement in these parameters.
Finally, if any or all of the above allergy categories are suspected, a comprehensive allergy evaluation should be considered.
Posted in: School Environment