Allergies Galore!
Managing Allergies Is More Than a Call to 911

by Cassandra Piper, M.A., and Helen Rebull, B.S.M., R.N., N.C.S.N.

In the summer of 2001, Congressional Camp found itself hip deep in allergies. Of the 490 campers on our campus, 222 had identified allergies. This fact left us limp and sweaty with concern . . . and it wasn't because of the humid Virginia summers.

We knew that food allergies never take a break, never rest, never leave well enough alone, and never forgive a tiny transgression - "just this one time." The worry about an exquisitely allergic child is continuous - for the parents and for our director and staff.

A million questions swarmed like mosquitoes around our heads. How would we manage? Could we trust the counselors we hired to maintain the necessary precautions? How could we possibly avoid milk and peanut butter? After all, peanut butter crackers and ice cream are the staples of summer. Would allergic kids let us know if they felt bad or accidentally contacted something? Could we keep the medications organized and available, yet safe?

We realized that educating our staff was a big priority. The camp nurse was consulted and laid out some things for us to think about.

1. True allergies are not food whimsies of a child.
2. Food allergies are not necessarily based on religion nor self-imposed as voluntary food restriction.
3. Food allergies come in a variety of degrees of seriousness.
4. Food allergies can kill.

We consulted a leading authority in the field of food allergy, the Food Allergy & Anaphylaxis Network. Camp directors can find enthusiastic encouragement from the Food Allergy & Anaphylaxis Network. No one understands how important vigilant attention to detail is like this group - an organization that knows of many children who have perished from accidental exposure to a common food.

The Network shared a story of a fourteen-year-old camper who went on an all-day canoe trip. When the group stopped for lunch, the counselors pulled out the previously set aside jelly sandwich for the food allergic canoeist. They then proceeded to make peanut butter sandwiches for the rest of the party. They realized that the girl's jelly sandwich was not cut, so they carefully wiped the knife and cut the sandwich. Everyone began to eat. In a very few minutes the counselors knew they were in serious trouble.

The trace amount of peanut butter on the knife was sufficient to precipitate an allergic response in the girl. The counselors realized too late that no one had thought ahead to bring the girl's emergency medication - No one had thought to bring a cell phone to be able to call for help. No one could do anything to stop this young girl's body from collapse. Within minutes she was dead.

Taking Steps

After reading some literature, viewing the nurse's videos, and talking over our mutual experiences, we felt it was best to start by talking with the parents and campers. Our camp director and nurse invited each parent to come for a visit and to give us the details of his or her child's allergies.

Learning from Parents and Campers
It is from the parent that a clearer picture of the extent of the allergic sensitivity can be determined. For instance, could a peanut allergic child be in the same room with others eating peanut butter or would the camper need to be isolated? The parent is the person best able to explain what has happened during previous contacts. Did the child have to go to the emergency room or was an oral antihistamine sufficient to stop the allergy in its tracks?

We created an Emergency Allergy Form so that the parent could formally authorize the camp officials and the nurse to give medications and proceed with emergency care in an orderly way. We use our own form, but an excellent form is available on the Food Allergy & Anaphylaxis Network Web site.

We were also able to talk with the camper and determine if the child had sufficient maturity to be able to cooperate. Could this child be trusted not to eat food offered from a best friend's lunch? If the child began to feel bad or realized that he/she accidentally ate something that was forbidden, would they feel it was important to report it to an adult? This is a fine-line judgment call, and we recognized that in every case nothing substitutes for proper supervision.

Educating Staff
To increase and maintain an adequate level of staff awareness on the serious nature of severe food allergies, camp directors and camp nurses need to remind, reeducate, reinforce, and restructure, as necessary, the issues surrounding food preparation procedures, serving techniques, impromptu snacks, and "care" package inspection.

Our next step was to share as much about food allergies as we could with our staff. We had to teach them how to read a food label and to look for hidden ingredients lurking in unexpected places. For instance, who knew that hot dogs contain a binder made of milk? We learned that some Fig Newton cookies have ground peanuts inside. We taught everyone that they had to read every label every time. Recipes change and new warnings on labels are posted all the time.

The staff that we hired was indeed very conscientious, but in the heat of a late, lazy summer afternoon one of our campers asked, "Can I eat this?" Forgetting that those words are code for "I am one of your super allergic kids," the counselor muttered, "Sure."

The label that was glanced over showed cholesterol, calories, fat, vitamins, but on the underneath side - the ingredients held the real message - "May Contain Peanut Particles." The counselor turned about in time and saw that the child was very pale, starting to cough, and was showing signs of distress. The nurse was notified, and our emergency planning went into full swing.

After a wild afternoon of medications and concerned parents flying through compacted traffic, we went home grateful that all was well.

Continuous Vigilance
Even though a child may not have had an allergic response in a long time, camp cannot function as an experimental venue "to see if he is still allergic." All experimentation of that kind must be done with a physician and parent in attendance in a hospital where extensive rescue equipment is available. We have irritated some parents when we wouldn't let their allergic child go on a field trip and "eat the foods the others are eating 'cause he wants to so bad." We can't accept that level of risk.

The child, teenager, or anyone with food allergy requires special planning, separate foods, emergency plans, AND huge doses of acceptance, inclusion, camaraderie, and fun that only the camp experience can bring.

Cassandra Piper has been the director of Early Childhood/Great Adventures Programs at Congressional Schools and Camp for five years. She has a B.A. in psychology and an M.A. in child development. She has accumulated sixteen years of experience teaching and administering programs serving young children.

Helen Rebull, B.S.N., R.N., and N.C.S.N. has been the camp nurse at Congressional Schools and Camp for two years. She is a member of the Association of Camp Nurses. Rebull has ten years of experience as a school nurse and thirty years experience managing allergies in children as a parent.

Greg Cronin, Congressional's camp director, served as consultant on this project.

Originally published in the 2002 July/August issue of Camping Magazine.