(DATE)
To Whom It May Concern:
I have been asked by <child>’s parents to provide medical information regarding <child>’s allergies. I understand that you need specific and current information that will be used to determine whether or not <child> meets the criteria for disability under Section 504 of the Rehabilitation Act of 1973 (ADA and ADAA of 2008). I believe that <child> qualifies for this designation based upon his diagnosis and clinical history of life-threatening (anaphylactic) food allergy.
Anaphylaxis is defined as a systemic allergic reaction which may cause death or permanent disability. At least 150 people die each year in the United States due to anaphylactic reactions to foods, most commonly to peanuts. Below, I briefly describe the body systems affected during anaphylaxis:
Systems and Symptoms:
Skin and subcutaneous tissues: flushing, mouth itching and swelling of the lips, tongue, or mouth, and/or hives.
Gastrointestinal system: nausea, abdominal cramps, vomiting and diarrhea (if severe, can cause intravascular volume depletion and shock).
Respiratory system: sense of tightness/itching in the throat, hoarseness due to edema of the larynx (may close the airway), hacking cough, shortness of breath, and/or wheezing.
Cardiovascular system: “thready” pulse, decreased cardiac function, decrease in blood pressure which may lead to dizziness, loss of consciousness, shock, and possible cardiac arrest.
<child> has required emergent medical care for anaphylaxis on more than one occasion. He has a history of rapidly progressing anaphylaxis involving the skin, respiratory, and cardiovascular systems. Due to this reaction history <child> is at elevated risk for fatal anaphylaxis.
<child> was diagnosed with life-threatening food allergies at <age>, following emergency medical care for (allergen)-induced anaphylaxis. <Child> has a clinical history of reactivity to ingestion of microscopic quantities of allergens, and contact with allergens. Possible anaphylaxis symptoms must be treated as a medical emergency.
For the purposes of a Section 504 designation, I attest that <child>’s medical condition substantially and significantly affects the life functions of caring for herself, normal immune function, and eating. Anaphylaxis can, when active, also substantially and significantly limit the life functions of breathing, talking, walking, normal cardiovascular function, thinking and performing manual tasks, among others.
There is no cure for food anaphylaxis. Unlike other allergies for which treatment options include medications or immunotherapy (allergy shots), presently all such treatments for food allergy are considered investigational and high-risk. There is no such approved treatment or device that can act as a mitigating measure for those who are anaphylactic to foods. Regular maintenance medications do not eliminate the need to practice avoidance, nor does epinephrine or any other rescue medication or device necessarily resolve anaphylaxis or eliminate the need to seek additional emergent care. Death or permanent disability is a possible outcome any time anaphylaxis is triggered. Peanut is of particular concern since triggering doses may be very small and too variable to be reliably determined for an individual. Therefore, total avoidance of allergenic foods is imperative.
Avoidance of all contact with food allergens (allergens here) is the only way to avoid a potentially life-threatening allergic reaction. Such avoidance is a highly complex task requiring excellent judgment and social skills, particularly when needs place a person in conflict with a peer group. This is difficult for adolescents, whose executive skills are not yet mature and who may take unacceptably large risks or even hide/dismiss emergent symptoms in order to gain social acceptance with peers. Adolescents must be strongly encouraged to advocate assertively for their needs as appropriate and guided toward good management decisions as they assume the responsibility for their food allergies.
Successful avoidance requires a comprehensive written accommodation plan in consultation with the patient, parents, and physician. I consider <child>’s parents; <parent>, and <parent>, to be knowledgeable about the successful management of their son’s medical condition.
Sincerely,
Awesome Person, M.D.
{additional fancy qualifications as s/he sees fit}
Topic: Restrictive 504 Vs. regular 504 (Read 6406 times)
