Allergies, especially to peanuts, in some students can be life-threatening. In Pinellas schools, nurses keep contact to a minimum.
By MONIQUE FIELDS
© St. Petersburg Times, published December 9, 2001
The student cupped his hands for a squirt of sanitizer and rubbed them together until the gel vanished. He was followed by more students until all 25 pairs of hands were free of germs.
The students at Oakhurst Elementary School in Largo seemed to perform the ritual without thinking. But it was one of the most thoughtful gestures they could make.
The fourth-graders were washing their hands for the safety of Conrad Nguyen, who has a life-threatening allergy to peanuts. A subtle touch, a quick taste, or even a light scent of peanuts on someone's breath could send him into shock and kill him. The 10-year-old also is allergic to milk, eggs, shellfish, tree nuts, citrus fruits, monosodium glutamate, nitrates and sulfites. And he suffers from asthma.
The school district has provided Conrad and five other children with severe allergies with certified nursing assistants to make sure they have absolutely no contact with peanuts.
The move was applauded by Dr. Sami Bahna, a clinical professor of pediatrics at the University of California at San Francisco and chairman of the International Committee on Food Allergy at the American College of Allergy, Asthma and Immunology in Arlington Heights, Ill.
Bahna said it is unrealistic for schools to try to ban the food. Even if the cafeteria doesn't make or serve anything with peanuts, it is likely students will bring food from home with peanuts or peanut oil in them, Bahna said.
So the life-and-death matter requires serious monitoring in Pinellas schools.
Since 1997, the number of students with allergies has doubled in Pinellas County schools. And the number of students with asthma has risen at almost precisely the same rate.
There were 3,835 students who had allergies in 1997 compared to 7,486 last year.
Four years ago, 3,872 had asthma compared to 7,320 last year.
Most don't have allergies so severe they could lead to death, but 179 students in Pinellas elementary, middle and high schools have allergies that warrant schools keep epinephrine on hand to treat them in case of emergencies.
Those with severe allergies aren't allowed to eat in the cafeteria, and a nurse checks other students' lunches and snacks to make sure there is no contamination. Students with allergies often eat lunch in the classroom with students whose parents have packed a peanut-free meal for them.
Parents are relieved that Pinellas schools receive federal and state funds to provide nurses for their children.
"She's the eyes and ears looking out for wherever he might go," said Conrad's mother, Theresa Nguyen. "He could be perfectly fine one minute and the next minute, crash and be gone."
Ella Swinton's 10-year-old daughter, Ariel Littleton, is allergic to peanuts, fish, citrus, dairy products, chocolate and some vegetables. She, too, suffers from asthma. Having a nurse in her classroom takes a lot of the burden off of her mother, who once quit her job to make sure her daughter received the proper care at school.
"It takes a lot of stress off of you to know someone is there in the medical field, someone who is trained," Swinton said.
About a million people in the United States suffer from peanut or tree nut allergies, according to the Food Allergy & Anaphylaxis Network, a national nonprofit organization established to increase public awareness about food allergies and anaphylaxis.
Allergies in general have increased, but peanut allergies have drawn attention because they can be fatal.
The peanut and its cousin, peanut butter, have long been considered a childhood favorite. Some form of the peanut is found in a variety of foods, including cakes, candies and pastries. The protein found in the peanut is a very potent allergen, leading to hives, wheezing, abdominal pain or obstruction of the airway in those allergic to it, Bahna said.
Unlike other foods, the peanut is not easily denatured by heat, so a roasted peanut also contains a very potent amount allergen.
"Because peanut protein is very potent, small quantities can stimulate the immune system even by touch or by inhalation," Bahna said.
All this comes at a time when there are fewer and fewer nurses in public schools, leaving front office workers to administer medication to students.
"It's dangerous," said Diana Dameron, supervisor of school health services for Pinellas schools. "What is it going to take for the legislature to recognize we need nurses in schools? Is it going to take a public outcry, losing a child on campus?"
For now, the district does what it can with 63 nurses, nursing assistants and vision and hearing specialists who serve more than 111,000 students. Plus, the students don't mind taking up some of the slack and helping their fellow classmates.
At Curtis Fundamental Elementary School, Ariel is "the most popular girl in school" because other students and teachers know she has allergies. She sits with just a few students at lunchtime, and her classmates wash their hands after lunch.
"Everybody wants to eat with Ariel," said Swinton, her mother. "They really sacrifice something they like for her."
Students in Conrad's class also like to eat with him. It's loud in the lunchroom, they say. And with just a few students, they have more privacy when they sit with Conrad.
Signs posted outside the class read: "Stop Severe Peanut Allergy Alert."
"We know we have to be really careful. We just try to make him feel normal," said Anthony Watson, 9.
Both Ariel and Conrad know what can happen to them if they are exposed to peanuts, and both say they don't mind that a nurse goes to school with them every day.
"She's there for my health," Ariel said. "She's there to help me."
As for Conrad, "She teaches me how to do it myself, how to watch out for peanuts and how to read food labels."
The two of them also have developed lasting relationships with their nurses.
Barb Cole, a certified nursing assistant, is a friend to Ariel. She helps Ariel with school work and brings presents on Ariel's birthday and at Christmas.
"If I get a bad grade on a test or quiz, she tells me, "You'll do better next time.' "
Cole said she has gotten attached to Ariel over the last four years and is a giving person.
Conrad and his nurse Cindy Lou Hoisington have developed their own sign language in the five years they have been together.
If Hoisington needs him to take his hands out of his mouth, she holds her hand up and wiggles her fingers. If she needs him to back away from students, she puts her hands together and then pulls them apart.
The sign language allows him to have some independence while she sits in the class with him, she said.
Everyone -- parents, nurses and their patients -- has to be constantly prepared for an inadvertent exposure to peanuts.
Theresa Nguyen said she doesn't live her life in fear, but she wished a cure would be developed.
"Even in the best of situations, accidents do happen," she said.
The possibility of exposure or death always rests in the back of Ariel's mother's mind. Swinton was told her daughter would die before age 3. When she didn't, she was told the girl would die at age 9. Now, 10, Ariel considers herself blessed to have lived this long.
"God blessed me," she said. "He helped me. I'm a living witness."