Wednesday, August 19, 2015

Fostering a Culture of Inclusion in Schools

It's that time again... Back to School!

I, for one, relish the newly found silence in my home in the afternoon. I am also happy in the confidence that my boys are learning and playing and enjoying school again. I like knowing that the sweltering days of summer will soon transition into pleasant autumn evenings.

However, I know that back to school season brings on very different emotions for parents of children with life-threatening food allergies. These feelings range from fear and anxiety at being separated from a child with medical needs, to frustration with the necessary mounds of paperwork that constitute school health forms, and apprehension about what some might term "the little things": Will my child have someone to sit with at lunch? What if someone at the middle school starts a food fight, and throws a PB& J? How will my 5 year old handle it, when at the end of a long day of kindergarten, a classmate shares cupcakes with everyone as a birthday treat (everyone except him)? What will I do if the PTA organizer insists on using an ice cream brand for the open house social that is known to have cross-contamination issues?

In my work as a pediatric allergist, I have come across of a wide variety of ways that children with life-threatening food allergies are excluded in the name of safety. Here are a few examples:

1) A class was rewarded for good behavior by being permitted to eat lunch in the classroom instead of in the lunchroom. When the teacher discovered that a number of children had peanut or tree nuts in their lunches, my patient's desk was pushed into the corner of the room to keep him separated from the allergens. Classmates were rewarded. He was punished.

2) A teacher mentioned to a mom that it might be a good idea if a tree nut-allergic student remain home on the day of the field trip, as there would be walnut trees in the park they were planning to visit, and the teacher couldn't guarantee that a chaperone would be able to monitor the student closely enough for the teacher's comfort.

3) A student with a food allergy was identified by name in a letter that went home to parents stating that only fruits and vegetables could be sent as snacks or treats into the classroom. This resulted in a classmate stating to my patient, "My mom says it's your fault that we can't have any good food for the holiday party, and you should just be home-schooled."

The common thread in these scenarios is that each child was isolated or excluded. Now, don't get all up in a knot saying, "They are going to have to learn how to go without eventually!"

Parents of kids with food allergies understand that their kids will one day have to learn that part of the reality of living with allergy is that you can't always have what other people are having. We start teaching that as soon as they are old enough to understand the concept. As children grow older, this is continually reinforced by families and health care professionals. We teach kids to advocate for themselves.

Young children, however, deserve to learn in an environment that is not only safe, but also as inclusive as possible. Sitting alone at lunch, being the only kid who gets a bag of crackers instead of a cupcake, having to miss out on special activities, leaving the soccer game before the snack, being identified as the reason for other children's "deprivation" - these things add up very quickly in the psyche of a young child and create a profound sense of otherness. It IS worth the extra effort it takes to develop non-food rewards and celebrations. It IS worth the extra thought required to ensure that we aren't just keeping our kids physically healthy, but also emotionally healthy.

It takes a village to raise a child. It takes many arms to envelop children in a circle of safety and acceptance. It takes the strength of many to lift our children up so they can look to the future and envision possibilities beyond the immediate.

So, when you are planning that holiday party, or open house event, or fundraiser, or field trip - please ask yourself, "Am I doing everything I can to ensure that all the children in the school feel equally valued and worthy?"

It may just be something on your task list, but to a kid, it can mean the world.

Wednesday, November 5, 2014

Kids Got Too Much Candy this Halloween? Here Are Some Options!

If your Halloween ended up like hours, a short time spent trick or tricking resulted in a ridiculous quantity of candy. Luckily for me, the risk of finding shellfish in my boys' candy stash is exceedingly low. The same sense of relief does not extend to the families of kids with other food allergies, such as milk, egg, peanut or tree nuts. So, what's a candy-overloaded family to do? Here are a few ideas:

1. Let mom and dad eat it. Just kidding. Not really. :-/

2. Invite the "Switch Witch" over for a visit! She takes the candy, and leaves a cool toy in its place!

3. Send your candy to our troops serving abroad! Your donated candy will be included in care packages. Operation Gratitude does a great job:

4. Ask your local dentist or allergist about Halloween candy buy-backs! Maybe your kids will make a few bucks... see below for a picture of a few of my patients visiting their dentist during a candy buy back event. They look pretty happy too me!

5. Donate the candy to a local food pantry, community center, or shelter. Ask first, to see if they are accepting candy donations.

6. Throw it away. There will be more next year, and it's just sugar anyway.

Friday, October 18, 2013

Major Changes to Express Scripts Formulary Will Affect Many Asthma and Allergy Patients

I just received notice that as of January 1, 2014, the Express Scripts formulary will be removing a number of medications from its repertoire of covered drugs. This means that patients under the Express Scripts plan will have NO COVERAGE for these prescriptions, and will be required to pay full price at the pharmacy. The list is long, and heavy on medications commonly used by patients with asthma and allergies:

Asthma medications:

Advair diskus
Advair HFA
Alvesco HFA
Flovent Diskus
Flovent HFA
Maxair Autohaler
Proventil HFA
Xopenex HFA

Allergy medications:

Beconase AQ
Rhinocort Aqua

As insurers continue to seek ways to cut costs and boost the bottom line, they will negotiate with pharmaceutical companies to obtain lower pricing. Those companies that play ball get to keep their drugs on the formulary. Those that don't, get dropped. The losers are the patients who will be required to switch from medications they have been taking successfully.

If you or a loved one are taking any of the medications on the above list, I would encourage you to schedule an appointment with your Board-Certified Allergist to discuss a trial of a covered alternative medication well in advance of January 1st. Your physician may have a sample of the new medicine that you can "try before you buy". You don't want to be in the position of being forced to switch before you've determined which alternative works for you. You may also want to take advantage of 90 day supplies of medication before the year ends and your coverage expires. Some of the soon to be excluded medications currently have manufacturer's coupons that will be valid through the end of the year.

Talk to your doctor -- we're here to help you navigate through the complex state of medical affairs.

Friday, September 20, 2013

Your Chance to Weigh In On Stock Epinehprine Legislation (Courtesy of AANMA)

I am proud to be from Illinois, where we already have excellent guidelines in place for the protection of food allergic children, and also have a stock epinephrine law on the books. I am also so pleased that my state's U.S. Senators have teamed up to co-sponsor a bipartisan bill designed to keep the children of America safe from severe allergic reactions. Read on to learn more!

Your Chance to Weigh In On
Stock Epinephrine Legislation

The School Access to Emergency Epinephrine Act, which would encourage states to require that schools keep lifesaving epinephrine on hand, is now in front of the U.S. Senate, bringing it one step closer to passage. You can make a difference by contacting your Senators today to ask for their support.

S. 1503 was introduced by Sens. Richard Durbin (D-Ill.) and Mark Kirk (R-Ill.) and co-sponsored by 23 other senators. The companion bill, sponsored by Rep. Phil Roe, MD (R-Tenn.) and House Democratic Whip Steny Hoyer (Md.), was approved by the U.S. House of Representatives on July 30.

The School Access to Emergency Epinephrine Act would provide incentives for states to adopt laws requiring schools to have "stock" epinephrine auto-injectors, which is epinephrine that is not prescribed to a specific student but can be used for any student or staff member in an anaphylactic emergency. Between 20-25% of life-threatening allergic reactions happen at school without prior knowledge of allergies.

Now is your chance to help.

Call or email your Senators today. Find contact information here.

Suggested talking points:
  • S. 1503 -- Sponsored by Senators Durbin and Kirk, the bill would encourage epinephrine auto-injectors be stocked in schools.
  • As a [parent of a child at risk of anaphylaxis] [constituent] [school nurse/teacher/other], urge them to cosponsor S. 1503.
Twenty-eight states already have laws or guidelines in place allowing schools to stock undesignated epinephrine auto-injectors. Check AANMA's USAnaphylaxis™ Map ( to see the status of laws in your state.

Questions? Contact Kimberly Turner,

Wednesday, June 19, 2013

Generic Epinephrine Autoinjector Authorized (once again!) - What Does It Mean For You?

The following message is courtesy of the American Academy of Allergy, Asthma & Immunology. A formerly available epinephrine auto-injector (Adrenaclick) is back on the market, as is an authorized generic for this specific device. It is likely that insurance companies and pharmacies may encourage substitution with this generic product, as a way to decrease expenses for both insurers and patients. Please read the message, and be alert to the possibility of device substitution.

Be Aware of Authorized Generic Epinephrine Autoinjector

Dear Colleagues:
It has come to our attention that Lineage Therapeutics, Inc. recently launched an authorized generic version of Adrenaclick® under the name epinephrine injection, USP auto-injector. This product being marketed as a generic epinephrine autoinjector is an “authorized generic” of the Adrenaclick autoinjector only.
We want to make you aware because the availability of this product may result in substitution for other epinephrine autoinjectors at the pharmacy, which could lead to patient and caregiver confusion.
Epinephrine autoinjectors look and function differently from one another, and they have different instructions for use and require different training. You may have trained your patient for the administration of one type of injector, and the pharmacy may provide another type on which the patient has not been trained. During the stress of an anaphylactic reaction, this may be confusing to a patient and could result in the delay or perhaps an error in the administration of the drug.
When having a prescription filled, patients or caregivers should reinforce with the pharmacist the importance of getting the specific epinephrine autoinjector their physician prescribed and that they are trained to use.
You can view each type of epinephrine autoinjector and the instructions for administration at the respective product websites:
Linda Cox, MD, FAAAAI
AAAAI President


Bottom line? 

As proper use of autoinjectable epinephrine is dependent on training and familiarity with the device, generic substitutions for one device should not replace a prescription for a different device. If cost concerns require you to consider a generic, please first visit your doctor's office to be trained on the device you will be receiving. This will allow you to ensure that you and your family are comfortable with the device to be dispensed.

Friday, February 15, 2013

Be a Star! Submit your video to AANMA's "Why see an Allergist?" campaign!

Allergy & Asthma Network - Mothers of Asthmatics (AANMA) is partnering with the American College of Allergy, Asthma & Immunology (ACAAI) to produce six video vignettes on "Why see an Allergist?" and they need your help! AANMA is looking for people who fit the following criteria and are willing to participate:
  • Newly diagnosed or undiagnosed patients with symptoms of allergy and/or asthma 
  • Patients diagnosed with at least one of the following conditions: 
    • Children with seasonal allergies 
    • Food allergy 
    • Pregnancy and asthma 
    • Teenager with asthma 
    • Pet allergies 
    • Rhinitis 
  • Required to send a homemade, 60-second video of your story to AANMA by March 15, 2013 
  • Willing to participate in a pre-interview via telephone with video production agency 
  • Able and willing to participate in a one-day commercial video shoot in downtown Chicago in April 2013 
The video vignettes will be utilized in social media outlets to raise awareness and educate the public on the role of an allergist in a comprehensive, collaborative care model.

Please contact Tonya Winders at or 703-641-9595 should you have any questions regarding this opportunity.

Thursday, February 14, 2013

Fun With Daisy Scouts!

As a mother of 2 boys, I sometimes feel outnumbered. Therefore, I was delighted to be invited by the local Daisy Scouts to a meeting which focused on being kind and considerate. Using the topic of food allergy as an example, we were able to address the issues of safety, inclusion/exclusion, bullying, how to be a good friend, and more. The girls offered up a whole host of ideas about how to celebrate special events without being food-centric, just in time for Valentine's Day!

In this one group of Daisy Scouts, there were allergies to milk, egg, peanuts, tree nuts and fish! It was lovely to see the girls talk about how they pack special lunches so they can sit with their food-allergic friends and how they don't ever share food. One adorable little one demonstrated, arms outstretched, how she would come between a bully and her food-allergic pal! We did a drill of how to call for help if a friend is experiencing an allergic reaction, and familiarized ourselves with autoinjectable epinephrine.

The girls were great listeners and participants, and they presented me with a lovely card and a copy of the story they read aloud earlier in the meeting. It's called "The Bugabees - Friends with Food Allergies".

Thanks for inviting me, girls!

This story about friends with food allergies was a wonderful companion piece to the meeting about being kind and considerate.

Wednesday, February 13, 2013

My Son, Future Immunologist?

The other day, my 7 year old son came home from school excited to tell me about his day. His second-grade class had just begun a unit in science about the human body. As an introduction to the unit, his teacher asked the students to name organ systems.

One child called out, "the gut", and another, "the lungs".

But not my child. No, my kid offered up "the immune system"!

Here's the book he took from my office to read to his class:

"Our Immune System", by Sara LeBien

Obviously, I'm biased by both genetics and profession. But I couldn't be prouder. :-)

Monday, October 8, 2012

Peanut Allergy "Patch" Study Now Recruiting in Chicago!

A new treatment option for peanut allergy is currently being studied in Chicago!

This treatment modality is commonly referred to as the "peanut patch", and aims to induce tolerance to peanut protein by delivering small amounts of peanut allergen to the immune system through the skin. This is similar in concept to oral and sublingual immunotherapy for foods. However, in the case of the patch, the mode of delivery is hoped to result in fewer reactions during treatment, as the allergen will not be ingested. It is certainly an interesting development, which may hold promise in the treatment of food allergy. This study is recruiting children as young as age 6 years, so it may be an option for those children who are not old enough to qualify for the Food Allergy Herbal Formula study.

Please read the memorandum below for further details:

...I would like to share with you the exciting new peanut allergy clinical trial we will be starting this fall called A DOUBLE-BLIND, PLACEBO-CONTROLLED, RANDOMIZED TRIAL TO STUDY THE VIASKIN® PEANUT’S EFFICACY AND SAFETY FOR TREATING PEANUT ALLERGY IN CHILDREN AND ADULTS (VIPES STUDY). 
The VIPES study is a 12 month, multi-center trial examining Viaskin© Peanut as a potential immunotherapy treatment of peanut allergy in participants aged 6 years and older. Viaskin© Peanut is an allergen extract of peanut administered daily using the Viaskin© epicutaneous delivery system.
The goal for this study is to determine the efficacy of several doses of Viaskin© Peanut to significantly desensitize peanut allergic subjects, and to evaluate the safety of long term epicutaneous immunotherapy with Viaskin© Peanut.
You may always find the most up-to-date information about our food allergy research studies by visiting our website at You may also find a current list of all the Division of Allergy & Immunology’s clinical trials at

The Viaskin Peanut Patch

Monday, September 17, 2012

Neglected Child's Eyes Well Up, AllergistMommy's Priorities Get Shaken Up

It's been a crazy few months...

My micropractice is now a little over a year old, and I've been blessed with a growing patient base. However, with more patients comes MORE WORK! I love the patient care part - could do that all day. However, I could do without some of the paperwork, data entry, inventory, etc. I pretty much stopped sleeping.

So the time came to add someone to my team. The search for someone who can channel my vision for the practice into their everyday activities was not an easy one. Resumes, essay exams (yes, I actually had candidates complete an essay exam!), interviews, math quizzes, background checks... phew! Adding employees also means adding an employee handbook, policies and procedure manual, compliance programs, payroll, worker's insurance. Wait a minute - I thought getting help was supposed to reduce my workload?

So, no one would blame me if I haven't been scrapbooking, right? Wrong. My 4 year old blames me, and rightfully so.

This morning, he sat on the sofa with his brother after breakfast, leafing through my 7 year old's baby scrapbook. You know, the scrapbook I created when I was a wide-eyed, bushy-tailed new mom, delighted by the thought of documenting first smile, first bath, first solid food, first fill-in-the-blank? The scrapbook that is not only a collection of photographs, but also captions describing baby antics and quotations on boyhood and motherhood? My older son loves looking at this book whenever he gets the chance. Who wouldn't love a book where you're the star, and every photo is flattering, embellished with jungle animals and teddy bears?

The tears in my 4 year old's eyes were like a dagger in my heart. "Mommy, where is MY book?"

I didn't have the heart to tell him, "Honey, your photos are in a couple of albums on Facebook."

So, this week, I have added to the top of my task list:

  • Redeem self in eyes of baby boy. Create best baby scrapbook EVER. You have 2 hours.

I will be needing this...

One day, I will sleep. Today is not that day.

Tomorrow isn't looking good, either. :-)