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mikeb

Peanut Allergy

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I have to believe this is a common thing, my troop is getting a new scout with peanut allergies. I don't think he's so bad that the smell will do him in, but injestion is bad bad bad. This is a new one for us, so I'd like to hear from others with this situation how they are handling it.

My initial thought is that I really don't like the idea of a peanut ban. Peanut butter, trail mix, energy bars, etc., all staples of scouting. How do we balance keeping our staples while keeping him healthy?

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Unless it is so severe that he can't be around them, most units that I know of simply plan an alternate meal for the Scout. Now even given that, if the boys know, they may choose to plan peanut free meals around him. Something to consider is that peanuts contaminate nearly EAVERTHING that you would commonly use, so be sure to check labels carefully if he is not providing his own food.

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Be careful about who's carrying the food and who's handing things out, as well as what else that person has handled.(This message has been edited by BartHumphries)

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Also pay attention to cooking utensils. For some kids, simply sharing a serving spoon or spatula that has touched the offending item (peanut oil is in a lot of things) can be enough. Talk with the boy, mom, dad, and the Patrol Leader to make sure you all understand this boy's needs.

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From the the BTDT side of the fence....I have several lethal food allergies and my daughter has a lethal peanut allergy.

 

It is imperative that you find out exactly how severe the Scout's peanut allergy is, and what measures are to be taken. Usually, a diagnosed peanut allergy involves the use of Epipen (Epinephrine Auto Injection) to counteract an attack. The patient will usually NOT be able to react quickly enough to inject himself/herself.

 

ALL adults that participate in Troop activities should be trained on the use of the Epipen. It is a trival device to use, however if used improperly it can completely ineffective. Epipen trainers are included in every Rx of the Epipen, so the parents should have them. I would be remiss if I did not say they are not completely accurate, as they do not accurately represent the "kick" from the loaded spring in the real device.

 

As a general rule, it should be assumed that any allergic response to a peanut allergy will be lethal. By that I mean that when people with a peanut allergy have a response, it is almost always anaphylaxis (closing off the airway), the only real variable is how long the response takes to set in. In may be minutes, it may be seconds.

 

As for the level of exposure that is takes for an attack to be triggered, that varies as well. There are degrees of exposure that will trigger the response that vary from person to person AND that trigger level can vary (up AND down) over time. An exposure level that might not trigger a response one time, might cause a full blown response the next.

 

My daughter had a friend with the allergy in elementary school who went into anaphylactic shock 20 seconds after sitting down at a table in the cafeteria. She had brushed her hand across the table to clear some crumbs away and got a film of peanut butter on her hand...she NEVER ingested it...her hand immediately swelled and she hit the floor 10 seconds later.

 

In addition to peanuts, there is a potential that those with peanut allergy also have a tendency to allergies to tree nuts, soy and other beans. Peas are also a common cross-allergy.

 

The obvious peanut sources are easy to spot...it's the hidden ones that you have to watch our for...like...

 

Chinese food.

 

Burger King - they use a peanut oil blend in the deep fryer

 

A big key is to read labels before you buy or use something.

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We've got this situation right now, with a new Scout. Interesting, though -- his dad tells me that he doesn't eat anything new unless his mom is there to approve it, and when I talked to her, his mom wasn't real informative (to questions like "does he have problems being nearby peanuts, like some kids on airplanes?"). His dad thinks he needs to learn it on his own.

 

My concern is a little more practical -- this last summer at camp, patrol cooking, we had a strict vegetarian and a severe dairy-egg allergy; both subsist on peanut butter at camp, and we pretty much had to consider two sets of cooking utensils. Add to this a severe peanut allergy, and it is pretty much beyond me.

 

Guy

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Yah, hi mikeb. Good question, eh?

 

As others have mentioned, there's a range in severity, and yeh have to check with the parents and the doc to find out how sensitive the lad is.

 

Some units handle high-sensitivity cases by buying the lad a small backpack stove and utensil set so he can keep the utensils and the meals peanut-free. Then having a good friend as a tentmate who agrees to keep peanut-free as well rounds out the proactive protection.

 

Slightly lower sensitivity cases can usually be handled just by the PL being alert to it in meal planning and cooking. Lots of peanut allergy kids are pretty good at sensing the presence of nut oils by the time they get to Boy Scout age, as long as they're not masked in some kind of differently-flavored sauce.

 

On da reactive side, it's important that the adults and key youth leaders get trained in appropriate response. When and how to use epi injectors, how to manage follow up field care with antihistamines, etc. It's good to ask the boy's parents to provide extra epi kits for the patrol or troop first aid kits, since lads don't always remember to carry theirs on their person. I recommend requesting the TwinJect variety rather than the standard epi pen, since that provides an available second dose which often becomes necessary in the field with longer evacuation times.

 

Beavah

 

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By the way --

 

Last year, at a different summer camp, the dining hall steward was extremely helpful with the vegetarian (and the camp is completely peanut-free, using "sun butter" for the default).

 

This year, with patrol cooking, the commissary staff couldn't have been nicer. I checked allergens on labels several times, because they do a lot of bulk-food repackaging. They also were able to supply us a steady stream of plain bagels, which the dairy-egg allergy Scout can eat. He can't, however, eat the cinnamon raisin bagel they supplied one morning. They didn't know, but it was an easy correction to make when I talked to them.

 

Just as a side note -- the commissary staff, two women, only worked part-time hours. They'd put together, at the same time, the evening meal coolers, which were delivered by camp commissioners at 4:30pm, and then also breakfast/lunch coolers, which were delivered at 6:30am. I think they only worked between 10am and 2pm. The difficulty, I think is that they had to prep two coolers for every patrol (sometimes multiple patrols/troops per site). That was one big stack of coolers!

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A few years ago we had a new scout with the peanut allergy. The lad's mom showed up for a committee meeting to find out what the troop would be willing to do. The entire troop went on a peanut free regimen for a few years. The boy was equipped with an epi pen and knew how to use it. We burdened the mom with providing us with comprehensive lists of peanut free products. It all worked out well and the rest of the boys learned a lot about food that they never would have learned otherwise.

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You will need to talk to the parents to determine how severe his allergy is, and how careful you have to be about his proximity to peanut products. We had a scout in our troop with a severe nut allergy, and clearly he could not eat any foods containing nuts, but there wasn't a problem with storing peanut butter with the troop staples, or other scouts eating peanut products near him. But, as others have pointed out, the severity of allergies can vary greatly, hence the importance of conferencing with the scout and his parents to determine how to best ensure that scout's safety. In my experience, usually kids with these conditions, and their parents, are very well educated about their needs, and usually willing to discuss the specifics of how to keep themselves safe.

 

Also, these kids typically have been prescribed EpiPens. Some kids choose not to carry them all the time, depending on the severity of their allergy. I would recommend strongly suggesting that the scout keep his EpiPen on him whenever he is camping with the troop, especially if your camping activities take you beyond the reaches of a fast EMS response.

 

And, as far as EpiPens go, ensure that, at a minimum, your adult leaders know how to use one. I would also recommend instructing all of the scouts in your troop on an EpiPen's use, if that's something your comfortable with. Depending on the capabilities of the scout with the peanut allergy, this may be something that he could teach his peers, maybe with some additional input from his parents, or another experienced speaker. Training EpiPens, which are the same thing as real EpiPens, except without the needle and the medication, are available. Consider checking with this scout's family, your local EMS agency, hospital emergency department, or community college or hospital EMS training programs to borrow one. EpiPens are very easy to use, but you have to make sure you use it right the first time, as you usually won't have a second shot at it, which could be tragic.

 

Also, don't hesitate to use an EpiPen at the first indication of trouble. Talk to the scout and his family about the specific procedure to follow, but generally, the procedure is to either verify that the scout has administered his EpiPen, or assist him in using it, at the first sign of wheezing or difficulty breathing. The EpiPen should be used as another person is calling 911 for an ambulance. It is essential to use the EpiPen early, especially in kids with a history of severe reactions, so don't be shy about using it when you have to.

 

Personally, I would disagree with the suggestion about trying to procure additional EpiPens or other forms of Epinephrine for storage in troop or patrol first aid kits. I'd be concerned about long-term storage of that medication, in terms of temperature/humidity and access control, as well as the medication being used incorrectly by untrained persons. In my experience, I've found that encouraging (read: "mandating") the scout to carry his EpiPen on him, and ensuring that several people in the troop are trained to assist him in using it, is more than adequate to ensure the scout's safety, and eliminates most of the potential problems associated with the troop trying to maintain their own stocking of dangerous drugs.(This message has been edited by dScouter15)

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Dang! Because of my dyslexia,I had a Howdy Doody flashback!

 

I'm okay, just give me a minute. :)

 

Stosh

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Okay, and now a point of view from the crumudgeons in the audience:

 

All patrols can, should and do accommodate the dietary requirements or their patrol members. Everything from allergies, to medical restrictions, to cultural customs to just plain ol' "I don't like peanut butter" preferences. That's part of the joy of being part of a group and working together.

 

However, when a scout has such a severe allergy the he may very well die because his patrol mate stirred the soup with a spoon that was used two months ago to serve a dish that was made in a pan stored with another pot that had peanut oil, that's a game changer.

 

As a practical matter and at minimum, the family of the allergic Scout needs to assume the responsibility for making sure the boy is in a clean environment. The unit also needs to be given very broad lattitude to decline to take on a Scout with such severe, life-threatening restrictions.

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Twocubdad - not necessarily disagreeing with anything you're saying, but its important to remember that the majority of peanut allergies are NOT as sensitive as the semi tongue-in-cheek situation you mentioned. Peanut allergies are fairly common, and thousands and families, schools, day care centers, youth groups and Scouting units all find ways to operate their program in a safe way for all participants. I think its a bit premature to talk about the possibility of the Scout troop declining to take on a scout, unless the troop leadership and the parents cannot come to a reasonable agreement on how to handle the situation. Its one thing to err on the side of caution, and perhaps be "over-prepared" for emergencies, but its another thing to "swat a fly with a cannonball," so to speak.(This message has been edited by dScouter15)

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I'm kind of like twocub here. While we do all we can to be accomodating......just like we are not trained psychologists, we are not trained medical professionals either. Any child who has a lethal reaction to something, I'm a little antsy about being responsible for.

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I have thought about this with regard to my grandson, who has allergies to peanuts as well as dairy, wheat and a few other things. Since he has not yet reached his second birthday, his food intake is well-restricted by his parents at this point, but I wonder what kind of life he is going to have once he starts school, becomes eligible to join Scouting, etc. Some of the things he is allergic to (such as dairy) are, I suspect, digestive-problem types of allergies, and I think his wheat allergy has been determined to be a break-out-in-a-really-bad-rash-all-over type of allergy. The peanut allergy is, however, the Epipen-type of allergy, and he does have (well, his parents have) Epipens for him. I don't know where it is on the severity scale, and I'm not sure whether his parents know, either. So as I say, I am concerned about the degree of adjustments that are going to have to be made by his parents and eventually by him as he gets older. I do not think it will become a Cub or Boy Scout issue, however, as my daughter has made it fairly clear that she does not plan to enroll her child in a program that excludes... ok, I don't want to derail the thread and this is in the wrong forum for that. Excludes certain people, let's say.

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