Managing moderate-to-severe asthma and food allergies at school during normal times can be challenging, and COVID-19 is making it more so for school nurses, teachers and parents.
About one in four U.S. schools does not have a school nurse on site. Even in schools that do, space and resources are often limited. Cramped quarters inside school nurse offices make it difficult to separate kids with tummy aches and headaches from children who need their asthma inhalers, peak flow meters and nebulizer treatments, said experts during a presentation on schools at the virtual American College of Allergy, Asthma & Immunology (ACAAI) 2020 Annual Scientific Meeting.
Many schools don’t have the necessary personal protective equipment (PPE), such as masks, goggles and disposable gowns, that should be worn when administering asthma treatments, explained Dr. Sujani Kakumanu, a clinical associate professor of allergy and immunology at the University of Wisconsin in Madison.
She cited a survey from this spring by the National Association of School Nurses, which found that only 78 percent had sufficient surgical masks, 28 percent had N95 masks, 20 percent had face shields, 33 percent had goggles, and 25 percent had disposable gowns.
Nebulizers and Virus Risk
Nebulizers aerosolize asthma medication as a mist that a child breathes in through a face mask. Since mist travels in the air, that may pose coronavirus risks in tight, enclosed spaces. “School nurse offices often house multiple children at the same time,” Kakumanu said. “In Madison, oftentimes schools nurses will be treating six to eight children at a time. Traditionally, our school nurses have not had space to physically separate students.”
When possible, she said children should use asthma inhalers instead of nebulizers to minimize aerosols. Children able to self-carry inhalers should be allowed to do so, so they have easy access to the medication when needed, such as prior to exercise, and to avoid them having to go to the nurse’s office.
Another concern is that kids may potentially be exposed to more cleaning fluids and disinfecting chemicals, which can trigger asthma symptoms. Kakumanu noted that rooms should be well-ventilated, both for infection prevention and to reduce exposure to chemicals.
About 9 percent of school-aged children have asthma. Children with asthma are three times more likely than other children to miss school.
Food Allergy Risks & Upsides
The pandemic is also potentially posing risks for kids with food, environmental or insect sting allergies. In warmer weather, eating lunch outside exposes kids to more pollen and potentially, insect stings, said Dr. Julie Wang, a pediatric allergist at Mount Sinai Hospital’s Jaffe Food Allergy Institute in New York City.
Kids being spaced further apart in the cafeteria or having students eat in more places in the school may mean school staff will have a harder time keeping tabs on what’s going on during lunch.
However, some COVID-19 school policies may actually be safer for kids with food allergies. Frequent handwashing removes food proteins, as does washing down tables and other surfaces between uses. Soap and water removes food proteins better than hand sanitizers, Wang noted.
Children may cough when experiencing an allergic reaction or anaphylaxis, so school staff should also wear PPE when helping such a child, Wang noted.
During COVID-19, it’s more important than ever for parents and allergists to work closely with school staff to keep kids safe and healthy, said Dr. Michael Pistiner, director of food allergy advocacy, education and prevention for the MassGeneral Hospital for Children Food Allergy Center in Boston.
Knowing who is at risk of asthma or food allergy reactions is essential, so that school staff can take respond quickly to emergencies. Parents should work with allergists to make sure that kids have individualized health plans (IHPs) and food allergy and asthma emergency action plans. Allergists should also advocate for additional PPE for school nurses and staff.
Pistiner also raised concerns that many children with food allergies are learning at home without adult supervision while their parents are at work. Children may be being left at home alone at younger ages than they would during non-pandemic times, so they will need to be trained for emergencies is important.
“We need to reinforce practical home management strategies for these patients, and have these discussions with them and their parents,” Pistiner said.
Also From the ACAAI 2020 Meeting:
Study Finds Parents Are Bullied About Food Allergies Too
Avoiding Overuse of Prednisone Pills in Severe Asthma