AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE & DENTISTRY BY H. BARRY WALDMAN, DDS, MPH, PHD, KRISTIN COMPTON, DMD AND STEVEN P. PERLMAN, DDS, MSCD, DHL (HON)

The ADA legislation can help people with asthma and allergies obtain safer, healthier environments where they
work, shop, eat and go to school.

“I t’s 1 p.m. at Mercer Elementary School in Shaker Heights,
Ohio, and Lena Paskewitz’s kindergarten class is filled
with the happy hum of kids getting ready for their favorite
part of the day: lunch. Caleigh Leiken, 6, is toting a pink Hello Kitty
bag her mom has packed with goodies: strawberry yogurt, string
cheese, some veggies and a cookie. But there’s one childhood staple
missing – a PB&J. Caleigh was diagnosed with a peanut and treenut
allergy when she was just 7 months old. Nuts are a no-no at her
table in the Mercer lunchroom. Her allergy-free friends can sit
there, but only if their lunches have been stored in a special bin and
carefully inspected by the teacher. Home, too, is a nut-free zone for
Caleigh. When she goes trick-or-treating this week, her candy will
be scarier than any costume; she won’t be able to eat any of it for
fear it’s tainted with peanut residue. For Caleigh’s mom, Erika
Friedman – whose other two kids also have allergies – food can
seem like an enemy. ‘We plan everything,’ says Friedman. ‘It’s our
job – actually, everyone’s job – to keep them safe.’” 1
On your last plane flight did you receive a small package with
your drink that boldly stated that the contents were “PEANUTS”
followed by four words, “THIS PACKAGE CONTAINS PEANUTS”? At
first glance it seemed rather ridiculous, but manufactures are not
taking any chances in their attempt to conform to federal legislation
regarding allergen labeling and consumer protection.2 We
have become so aware of the potential threat of food, chemicals,
fabrics, latex and just about anything in our environment that we
have filled virtually every free space, in restaurants, schools, bakeries,
planes and beyond with warning notices.
The reality is that asthma and other allergic reactions affect
almost one-in-five U.S. residents, more than the total number of
individuals with Parkinson’s disease, Alzheimer’s disease, stroke,
cancer, coronary heart disease and diabetes.3 (see Graph)

WHAT ARE ALLERGIES?
An allergic condition is a hypersensitivity disorder in which the immune system reacts to substances in the environment that are normally considered harmless. “Allergies are grouped by the kind of trigger, time of year or where symptoms appear on the body: indoor and outdoor allergies (also called ‘hay fever,’ ‘seasonal,’ ‘perennial’ or ‘nasal’ allergies), food allergies, latex allergies, insect allergies, skin allergies and eye allergies.”4 Allergic conditions
are among the most common medical conditions affecting children in the United States.4 Specifically, food or digestive allergies, skin allergies (such as eczema), and respiratory allergies (such as hay fever) are the most common allergies among children. Allergies can affect a child’s physical and emotional health and can interfere with daily activities, such as sleep, play, and attending school A severe allergic reaction with rapid onset, anaphylaxis, can be life threatening.4,5 In 2013, the Centers for Disease Control and Prevention released information from interviews by the Census Bureau, which indicated that the prevalence of food and skin allergies increased during the 1997 – 1999 to 2009-2011 periods from 3.4 percent to 5.1 percent. Food or digestive allergies, skin allergies (such as eczema), and
respiratory allergies (such as hay fever) are the most common allergies among children.

The most frequently cited food allergens in the United States are milk, soy, eggs, wheat, peanuts, tree nuts, fish and
sea food.6 Foods represent the most common cause of anaphylaxis reaction among children and adolescents. In terms of skin allergies, children tend to more readily outgrow them, but respiratory allergies tend to replace them with a higher prevalence for older children.5 Actually, allergic reactions can occur in any number of unexpected circumstances, e.g. MRI or CT scan contrast dyes (which often contain iodine) can cause allergic reactions to individuals with iodine allergies. Similarly, vaccines frequently are grown in an egg media which can cause allergic reaction to individuals who are allergic to eggs. Early detection and appropriate interventions can help to decrease the negative impact of allergies on the quality of life. There are differences by race/ethnicity and income in the incidence rates of allergic reactions:
• Hispanic children have a lower prevalence of food allergy, skin allergy, and respiratory allergy compared with children of other race or ethnicities.
• Non-Hispanic black children are more likely to have skin allergies and less likely to have respiratory allergies compared with non-Hispanic white children.
• Food and respiratory allergy prevalence increase with income level. Children with family income equal to or greater
than 200 percent of the poverty level have the highest prevalence rates.5

ALLERGIES, DISABILITIES AND FEDERAL LEGISLATION
“Some health conditions, such as asthma, gastrointestinal symptoms, eczema and skin allergies, and migraine
headaches, have been found to be more common among children with developmental disabilities.”3
• 53 percent of children with special health care needs are reported to have allergies, including 38.8 percent with
asthma.7
• Between 1990 and 2000, more than half of all children with meningomyelocele (a form of spina bifida with a
protrusion of the membranes and spinal cord through a defect in the vertebral column) developed an allergy to
latex in childhood. Although the reason for this is unclear, the allergy seems to be more common in children who had frequent surgical procedures.8
• The elimination of the most common allergenic foods may improve ADHD related symptoms.9
• Allergies can trigger aggressive behavior among children with intellectual disabilities who can not communicate
their discomfort.10

The Americans with Disabilities Act (ADA) is a civil rights law that provides for changes where policies, practices or conditions which exclude disadvantage individuals with disabilities. For example, as of January 26, 1992, public entities and public accommodations must ensure that individuals with disabilities have full access to and equal enjoyment of all facilities, programs, goods and services. The ADA legislation borrows wording from Section 504 of the Rehabilitation Act of 1973, which prohibits discrimination on the basis of disability in employment and education in agencies, programs and services that receive federal money. “The ADA extends many of the rights and duties of Section 504 to public accommodations such as restaurants, hotels, theaters, stores, doctors’ offices, museums, private schools and child care programs. They must be readily accessible to and usable by individuals with disabilities. No one can be excluded or denied services just because he/she is disabled or based on ignorance, attitudes or stereotypes.”3

A person with a disability is described as someone who has a physical or intellectual disability that substantially limits one or more major life activities, or is regarded as having such impairments. Breathing, eating, working and going to school are major life activities. Asthma and allergies are still considered disabilities under the ADA legislation, even if symptoms are controlled by medication. The ADA legislation can help people with asthma and allergies obtain safer, healthier environments where they work, shop, eat and go to school. The ADA also affects employment policies. For example, a private preschool can not refuse to enroll children because giving medication
to or adapting snacks for students with allergies requires special staff training or because insurance rates might go up. Public schools and programs cannot avoid their responsibility by claiming to have limited funds or resources; nor can they impose a “disparate impact” on people with disabilities. A firm can not refuse to hire an otherwise qualified person solely because of the potential time or insurance needs of a family member. Finally, the ADA legislation prohibits retaliation, harassment, or coercion against individuals who exercise their rights or assist others in doing so.3

WHAT’S ALL THE FUSS ABOUT ALLERGIES?
It’s difficult for someone who has no allergies to comprehend the sheer ongoing fear, agony and dangers shared by
children and adults who must deal with the concerns of adverse reactions and the need to forego particular items and situations. The two of the three authors of this article share the worries of allergies, including the effects of tetanus vaccines, shellfish, penicillin, latex, seasonal pollen and cinnamon. The third has never experienced an allergic reaction and is trying figure how an allergy to cinnamon fits into the picture. The concerns regarding allergic reactions are compounded for youngsters (and adults) with disabilities. Whether it is the ongoing use of multiple medications (poly- pharmacy) and their potential to increase in interactive relations which cause added adverse side effects, restricted environments, the complex school settings, feeding errors or just about any other situations faced by the general population must be added to the ongoing requirements for the care and support of the youngsters with disabilities. Maybe the third member of this writing team will eventually understand the concern about an allergy to cinnamon. •

ABOUT THE AUTHORS:
H. Barry Waldman, DDS, MPH, PhD – Distinguished Teaching Professor, Department of General Dentistry at Stony Brook University, NY; E-mail:h.waldman@stonybrook.edu
Kristin Compton, DMD – Director of Dental Services, Orange Grove Center; Adjunct Professor, Chattanooga State Dental Hygiene Program; TN State Clinical Director Special Smiles, Special Olympics.
Steven P. Perlman, DDS, MScD, DHL (Hon) – Global Clinical Director, Special Olympics, Special Smiles and Clinical Professor of Pediatric Dentistry, The Boston University Goldman School of Dental Medicine, Private pediatric dentistry practice – Lynn MA.
References
1. Kalb C. The lunchroom. Newsweek Nov 5, 2007 Web site:http://allergyasthma.wordpress.com/2007/ 11/17/newsweek-coverstory-fear-and-allergies-in-the-lunchroom Accessed July 19, 2014.
2. Food Allergen Labeling and Consumer Protection Act of 2004 (Public Law 108-282, Title II). Web site:
http://www.fda.gov/food/guidanceregulation/guidancedocumentsregulatoryinformation/allergens/ ucm106187.htm Accessed July 15, 2014.
3. Food Allergy Support Group of Tidewater. 50% increase in food allergies over the past decade. Web site:
http://www.fasgot.com/50-percent-increase-food-allergies-over-thelast-decade Accessed July 16, 2014.
4. Asthma and Allergy Foundation of America. Web site:http://www.aafa.org/display.cfm?id=9&sub= 19&cont=255
Accessed July 15, 2014.
5. Jackson KD, Howie LD, Akinbami LJ. Trends in allergic conditions among children: United States, 1997–2011. NCHS Data Brief, No. 121, May 2013. Web site: http://www.cdc.gov/nchs/data/databriefs/db121.pdf Accessed July 16, 2014.
6. Haesler RM, Mills JJ. Nutrition and children with disabilities (p.107-119); in Batshaw ML, Roizen NJ, Lotrecchiano GR. Children with Disabilities; Seventh Edition. Baltimore MD: Paul H. Brooks Publishing Co, 2013.
7. Giardino AP, Turchi RM. Health care delivery systems and financing issues (p705-717); in Batshaw, et al., ibid.
8. Liptak GS. Neural tube defects. (p451-472); in Batshaw, et al., ibid.
9. Glanzman M, Sell N. Attention deficits and hyperactivity. (p369-402); in Batshaw, et al., ibid.
10. Tyler C, Baker S. Intellectual disabilities at your finger tips. (p100) New Lenox, IL: High Tide Press, 2009.