A Mother’s Worst Nightmare

It started with one simple text from her husband. Then another. Then another. Within minutes, Julie Bowen knew something was terribly wrong.

The star of the hit television sitcom Modern Family looked helplessly at frantic photos her husband was sending to her cell phone that showed the face of her then-only son, 18-month-old Oliver, transforming before her eyes. Within minutes of being stung by a bee while at the same time eating a peanut butter snack, Oliver’s face, eyes, and mouth had swelled at an alarming – and painful – rate.

“As the texts came in, first I was like, ‘Well, don’t worry about the peanut butter. He’s had that before,’ ” she says. “And then the next picture comes in, and I was like, ‘Oh boy, this is serious.’ I was very panicked.”

From miles away on the set of a television show, Bowen tried to coach her husband, attempting to instruct him in what to do even though she had no idea what was happening to her only child. She describes the feeling that was in the pit of her stomach as “a mother’s worst nightmare,” and she says the memory of the incident is still “very emotional” for her to talk about.

Bowen’s husband rushed Oliver to the emergency room, where he was diagnosed with anaphylaxis, a severe, life-threatening allergic reaction resulting from exposure to allergens. To this day, Bowen doesn’t know whether her son’s reaction was in response to the peanut butter, the bee sting, or a combination of both – but it’s certain that the simultaneous pairing of these two powerful allergens is an especially dangerous mix. “I always thought that if you were allergic to something that it was consistent,” Bowen says. “I have since come to learn that it can be progressive.”

Eight foods: 90 percent of allergens

Food-based anaphylactic allergies among children are an increasingly pressing health issue in schools. Approximately 2.2 million school-age children in the United States are at risk for anaphylactic shock, and reactions account for 30,000 emergency room visits and some 200 deaths, many in schools, each year.

Just eight foods—milk, eggs, wheat, peanuts, soy, tree nuts, fish, and shellfish—account for as much as 90 percent of all food-based allergic reactions. Peanut-based food in particular is known by the public as a major anaphylactic trigger; the reported incidence of peanut allergies has doubled in the last decade. Outside of food, bee stings are also one of the top causes of allergic shock.

Julie Bowen first learned about anaphylaxis in college. “There was a girl with a severe peanut butter allergy who ate chili at a local restaurant, and the secret ingredient in the chili was peanut butter,” she says.

“She sadly suffered [an anaphylactic] reaction and died immediately. I thought that it was rare, and that something like that would never, never happen again.”

So when anaphylaxis hit years later, so close to home, Bowen took it upon herself to learn as much about the potentially deadly condition as she could. At the hospital, her son was given a shot of epinephrine, a drug that is extremely effective in counteracting severe allergic reactions. Since then, Bowen has taken the advice of her son’s doctors to have an EpiPen (a pen-shaped device that is pre-loaded with epinephrine and can be injected by the patient or a family member) around at all times, stored in such places as her son’s backpack, with school administrators and teachers nearby.

Bowen admits that her anxiety spikes when her son, who is now in elementary school. is away from her. While Oliver’s school has set up a separate lunchroom table for students with allergies, Bowen still worries that he will come into contact with a potentially dangerous food.
Indeed, accidental ingestion or exposure to allergens by children occurs most often at schools and in daycares, where children often consume two meals as well as snacks during the day. In some cases, a reaction in school may be the first sign of an allergy.

Outside school, Bowen encourages all parents not to prepare and serve food at home without knowing what’s in it. “Don’t make a cake without looking at the ingredients in the cake mix,” Bowen says, albeit noting that “labeling has gotten much better. I know exactly where to look on a label for nut information. It is easy to be educated. I want to get that word out.”

While Bowen has worked hard to take precautions across all areas of Oliver’s life, she also stresses a reasonable approach. “I’m not a nervous Nelly,” she says. “It would be tempting to put your kid in a bubble.” But, she adds, “I know my child would be so unhappy if he couldn’t run around outside, and couldn’t spend the night with his friends, and couldn’t go swimming,” she says.

In fact, Oliver has become his own best advocate. “If he is presented with a food that he has never had before, he will take it to an adult, and say, ‘I not sure if I’m allowed to have this,’ ” Bowen says.

At the end of the day, “It’s just a matter of being prepared,” Bowen says. “My eyes were opened by this experience.”

A National Concern

National PTA has recently partnered with Pfizer to launch a new public awareness campaign that aims to empower parents to collaborate with schools in educating school staff, parents and kids about how to prepare for and respond to severe allergic reactions at school and at home.

In particular, National PTA advises states and school districts to consider the risks of food allergies when planning PTA and school-sponsored events. The association has also advocated for school staff members to be trained in recognizing allergy symptoms and knowing reaction-pre- vention techniques, in addition to pushing for the development, funding and implementation of school emergency-response plans that include food allergy guidelines and anaphylactic kits on site.

In 2009, National PTA passed a resolution calling for better food allergy and anaphylaxis management in schools. To raise awareness about anaphylaxis, National PTA has created a dedicated webpage about the condition, located at PTA.org. Search the keyword “anaphylaxis” to find informational videos and webinars that parents and school administrators can use to create anaphylaxis action plans.

The importance of managing food-allergic students has also been recognized by the National Association of School Nurses, the National Association of Elementary School Principals, the National School Boards Association, the American Medical Association, the American Academy of Pediatrics, and the American Academy of Allergy, Asthma and Immunology.

Adding to the support of these national associations, Julie Bowen believes that more grassroots work needs to be done to raise awareness. “I hope that I can be a part of spreading the awareness to air on the side of caution,” she says. “There is never enough education. … There is no reason to have just one or two people in a school trained on anaphylaxis.

Every teacher, every coach and every parent should know what the signs and symptoms are, and should know how or what to do.” Right now, anaphylaxis action plans are instituted on a school-by- school basis. Bowen and others would like national standards of care put into place that include such precautions as nut-free tables; no-food- sharing rules; and teacher, staff and administration training on how to recognize and treat anaphylaxis. Bowen would also like to see more PTA-related parent-awareness campaigns.

‘I’m not being a worrywart’

Reflecting on her own family’s frightening experience with food allergies, Bowen says that there have been times when she has felt like she was “entering the realm of the panicky and the helicopter parent. But I realized that was not true. And God forbid that another parent makes that mistake to the effect of hurting their child’s health. Thank God that my lack of knowledge didn’t lead to a fatality. But I would feel terrible if I didn’t speak out and say something, and help another parent say, ‘Hey maybe I’m not being a worrywart. Maybe it’s not being neurotic and crazy. It’s just what we need to do to look out for our kids, and make sure we are all aware, and know what to do with anaphylaxis.’ ”

There is always going to be an element of concern, and an element of keeping your eyes peeled, Bowen concludes. “But there is a fine line between education and terror. And I don’t want to enter the world of terror. I do not want to enter the world of terror and fear-mongering,” says Bowen, who has since given birth to twin sons. “I have a plan of action. All of my kids are in safe environments.” “But it’s still hard not to be nervous,” Bowen concedes. “As a parent, you never stop worrying.”

10 Things Every Parent Should Know about Anaphylaxis

1. An anaphylactic reaction can occur suddenly and is potentially life-threatening.
2. Check with a doctor if you think that you or a family member may be at risk for anaphylaxis.
3. The signs and symptoms of an anaphylactic reaction may include one or more of the following: sudden hives; dizziness; lip swelling; nausea; and trouble breathing or wheezing.
4. If you or your child has been diagnosed with a severe allergy and has been prescribed an epinephrine auto-injector, you should have the injector accessible at all times.
5. Some places and situations in which you may want to consider having an epinephrine auto-injector available for your child include: at a caregiver or relative’s house; at afterschool activities; in your child’s backpack; in a gym bag; in the school cafeteria; at birthday parties; in the school nurse’s office; at camp; when traveling; and when dining out.
6. While having an epinephrine auto-injector is important, it does not prevent a reaction from occurring. Remaining vigilant is critical.
7. Strict avoidance of all known allergens must be the first line of defense in reducing the risk of anaphylactic reactions.
8. If you or a family member is allergic to something specific, it is important to have an allergy management plan in place.
9. An epinephrine auto-injector is considered to be the first-line treatment of choice. But always seek immediate emergency medical treatment after using an injector.
10. Strict avoidance is the only way to prevent a reaction, because there is no cure for food allergies.

Source: Centers for Disease Control and Prevention