More specifically, the part of the immune system that is usually involved in fighting foreign organisms forms proteins called IgE antibodies that sit on the surface of specialized mast cells. These cells are filled with chemicals called mediators, such as histamines and leukotrienes, which are released when the allergenic protein reacts with the IgE. The release of these IgE mediators causes smooth-muscle contraction, which can produce wheezing and gastrointestinal symptoms, and vascular dilation that can cause angioedema, urticaria, and a decrease in plasma volume that can lead to shock. (http://www.anaphylaxis.com/pro/6_1_3.cfm)

Anaphylaxis is a “systemic reaction,” which means that various parts of the body are affected that are a distance from the allergen's initial entry site (e.g., a sting site for insects or the stomach for foods). Symptoms of anaphylaxis can vary from mild to severe and are potentially deadly. Here is a list of possible symptoms that may occur alone or in any combination:
• Skin: hives, swelling, itch, warmth, redness, rash
• Breathing: wheezing, shortness of breath, throat tightness, cough, hoarse voice, chest pain/tightness, nasal congestion/hay fever-like symptoms, trouble swallowing
• Stomach: nausea, pain/cramps, vomiting, diarrhea, itchy mouth/throat
• Circulation: pale/blue color, poor pulse, passing-out, dizzy/lightheaded, low blood pressure, shock
• Other: anxiety, feeling of “impending doom,” red/itchy/watery eyes, headache, cramping of the uterus
(©2007, American Academy of Allergy, Asthma and Immunology., http://www.aaaai.org/patients/publicedmat/tips/whatisanaphylaxis.stm)

See also the attached Anaphylaxis Grading Charts attached (one is in plain English).

Peanut and food anaphylaxis
While peanut allergy prevalence has increased in recent decades, the causes are unknown. Possible explanations have included a history of allergies, a family history of peanut allergy, prenatal exposure to peanuts, and exposure to peanut oils (e.g., from diaper creams) upon contact with infant skin.

Peanut allergy is generally recognized as the number one cause of severe or fatal allergic reactions in children and adults in the United States. A life-threatening and sudden event occurs after ingestion of food that initiates the allergic cascade, better known as anaphylaxis.

Peanut allergy is believed to be the leading cause of severe or life-threatening food-induced allergic reactions, causing an estimated 15,000 emergency room visits each year and more than 100 deaths. Certain food allergies may be more likely to have long-lasting or lifelong effects, including peanuts, tree nuts and/or shellfish. Recent data indicates that up to one-fifth of persons allergic to these foods may actually lose their allergic sensitivities over time. (“Food allergies and reactions,” Clifford W. Bassett, MD, FAAAAI, Allergy & Asthma Advocate: Fall 2003).

After tested positive to peanuts and remained in the same Allergy Class (Class 3) in 2005, his doctor, , MD, indicated the peanut allergy would likely be lifelong, since those that do outgrow tend to do so by age six.

What is cross contamination in general?
Cross-contamination is a phenomenon that occurs when a food that does not itself contain any allergens is tainted with an allergen during food preparation, cooking, storage, or serving.

Examples:
Cross-contamination could occur in these and many other settings:
• When food is chopped on a cutting board on which allergens have previously been cut;
• When baked goods are baked on a cookie sheet that hasn't been thoroughly washed after baking cookies containing allergens;
• When foods are cooked on a grill on which foods marinated with allergens are also grilled;
• When spoons on a salad bar are used to serve both allergenic foods and safe foods;
• When knives are used to cut allergenic foods and safe foods without washing in between.
• When remnants of unsafe food protein remain on bowls or mixer beaters.
(Victoria Groce, About.com, July 12, 2007, other){SHOULD HAVE INCLUDED MANUFACTURING LINES}

Incidence of Anaphylaxis
• Anaphylaxis occurs at a rate of 21 per 100,000 people each year in the Northern United States. (Yocum MW, Butterfield JH, Klein JS, et al. Epidemiology of anaphylaxis in Olmstead County: a population-based study. J Allergy Clin Immun. 1999;104:452-457.)

o Nearly 82,000 episodes of anaphylaxis may occur each year in the United States. (Weiler JM. Anaphylaxis in the general population: a frequent and occasionally fatal disorder that is under-recognized. J Allergy Clin Immunol. 1999;104:271-273.) SHOULD HAVE GOTTEN MORE RECENT STATS—MEANT TO

Speed of potentially-fatal anaphylaxis
• It takes only 1 to 2 minutes for a mild allergic reaction to escalate to anaphylaxis.( The Merck Manual. 16th ed. Merck Research Laboratories; 1992:331.)
• The faster the onset of an anaphylactic reaction, the greater the likelihood that it will be severe. (AAAAI. Anaphylaxis in schools and other child-care settings. Position statement #34. J Allergy Clin Immunol. 1998;102:173-176.)

Why is ’s asthma significant?
Individuals who have asthma in addition to food allergies may be at increased risk for having a life-threatening anaphylactic reaction to food. Asthma, even a mild form, is the single most important factor that increases the risk of death from anaphylaxis (allergic shock), says a new report from Harvard Medical School, What To Do About Allergies. (Asthma Sufferers At Greater Risk For Allergic Shock, Says New Report From Harvard Medical School, Medical News Today, June 13, 2007. (http://www.medicalnewstoday.com/articles/74028.php)

A recent study showed that adolescents with food allergy and asthma appear to be at the highest risk for a reaction, because they are more likely to dine away from home, are less likely to carry medications, and may ignore or not recognize symptoms.(http://www.foodallergy.org/anaphylaxis/index.html). Dr. Scott Sicherer, one of the leading pediatric allergists in the US has written:
“Recent case series of fatalities due to food-induced anaphylaxis indicate that more than 50% of deaths occur in the adolescent age group. Reactions to peanut, tree nuts, seafood and, increasingly, cow's milk account for these deaths. . . It is presumed that teenagers are at higher risk for fatal food anaphylaxis because they may be more apt to eat unsafe foods, deny symptoms/delay treatment or may neglect to carry medications such as self-injectable epinephrine.” (American Academy of Pediatrics News, Vol. 28 No. 6 June 2007, p. 14)

PART B: ’S CONDITION

1. ’s allergies and the ways he reacts to his food allergen
has a life threatening allergy to peanuts. He has experienced ingestion and airborne reactions that we have documented, and miscellaneous hives that may be attributed to contact reactions, after discussing the reactions with his doctor.

2. Other allergies or medical conditions that render eligible to receive protection under Section 504 that need to be included in this plan
In addition to Peanut Allergy, also has asthma and keeps an albuterol inhaler in the nurse’s office.

3. Proof of having the allergy or being regarded as having the allergy
We have letters from all three of ’s allergists from the cities has lived in: Dallas, TX; , TX; and , VA. We also have test results from all three doctors. In addition, at the strong request of City Schools, we have submitted the entirety of ’s records from all three of his allergists, his life threatening food allergy was documented. Please see attached.

4. Documentation from doctor stating the danger of anaphylaxis and the need for your child to have an EpiPen with him at all times
Please see Dr. ’s letter, dated , and Dr. letter dated . Please see attached.

5. Formal test results from the CAP RAST and or the Skin Prick Tests
Both RAST and Skin Prick Test. Please see attached.

6. Why a child with a life threatening food allergy qualifies for a Section 504 Plan
The ED Section 504 regulation, at 34 C.F.R. 104.3(j)(2)(i), defines an "individual with handicaps" as any person who (i) has a physical or mental impairment which substantially limits one or more major life activities, (ii) has a record of such an impairment, or (iii) is regarded as having such an impairment. The regulation further defines a physical or mental impairment as (A) any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological; musculoskeletal; special sense organs; respiratory, including speech organs; cardiovascular; reproductive; digestive; genitourinary; hemic and lymphatic; skin; and endocrine; or (B) any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities. The definition does not set forth a list of specific diseases and conditions that constitute physical or mental impairments because of the difficulty of ensuring the comprehensiveness of any such list.
Major life activities, as defined in the Section 504 regulation at 34 C.F.R. 104.3(j)(2)(ii), include functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, and learning. This list is not exhaustive. Other functions can be major life activities for the purposes of Section 504.

According to the Office of Civil Rights at the Department of Education, "hidden disabilities" are covered by Section 504.
From the US Department of Education’s Office of Civil Rights website: (http://www.ed.gov/about/offices/list/ocr/docs/hq5269.html)
Section 504 of the Rehabilitation Act of 1973 protects the rights of persons with handicaps in programs and activities that receive Federal financial assistance. Section 504 protects the rights not only of individuals with visible disabilities but also those with disabilities that may not be apparent.

Section 504 provides that: "No otherwise qualified individual with handicaps in the United States . . . shall, solely by reason of her or his handicap, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance...."

The U.S. Department of Education (ED) enforces Section 504 in programs and activities that receive financial assistance from ED. Recipients of this assistance include public school districts, institutions of higher education, and other state and local education agencies. ED maintains an Office for Civil Rights (OCR), with ten regional offices and a headquarters office in Washington, D.C., to enforce Section 504 and other civil rights laws that pertain to recipients of ED funds.

Hidden Disabilities
Hidden disabilities are physical or mental impairments that are not readily apparent to others. They include such conditions and diseases as specific learning disabilities, diabetes, epilepsy, and allergy. A disability such as a limp, paralysis, total blindness or deafness is usually obvious to others. But hidden disabilities such as low vision, poor hearing, heart disease, or chronic illness may not be obvious. A chronic illness involves a recurring and long-term disability such as diabetes, heart disease, kidney and liver disease, high blood pressure, or ulcers.
(http://www.ed.gov/about/offices/list/ocr/docs/hq5269.html)

According to the USDA, students with life threatening food allergies qualify as disabled and qualify for special meals prepared by the school’s food service, at no additional cost, as defined in the USDA’s nondiscriminating regulations, 7 CFR Part 15b.

PART C: ’S QUALIFICATION FOR 504 ELIGIBILITY


1. Physicians’ tests and letters confirm that :
• has ingestion allergy reactions to
o peanut
o food that is cross contaminated with peanut (other nuts)
• has contact allergy reactions to
o peanut, environmental allergies including cats, grasses
• has inhalation allergy reactions to
o peanut, environmental allergies including grasses,
• has asthma which is triggered by airborne
o exposure to peanut, exercise, exposure to cat, stress, environmental allergies
• has seasonal allergies to
o trees, grasses, ragweed, dust mites
2. Basis for the determination of the disability:
• See the physician’s letters dated
o , MD, PhD, letter dated
o , MD, letter dated
o , MD, letter dated
• See the allergy testing results dated
o —
o —
o —

• See the parent descriptions of reactions
Ingestion
o 2005— after eating at in .
o 2002—vomiting and sleepiness from ingestion of chips at Panera cooked in hot pressed peanut oil (typically considered safe for peanut allergic individuals). We reported the reaction to his allergist at the time, , MD.
o 2002—Anaphylaxis. Throat closure from ingestion of peanut and peanut flour at in . We should have administered the EpiPen and called 911 but didn’t. We reported the reaction to his allergist at the time, , MD.
o etc

Airborne
o 2007—spaciness, drop in blood pressure, rapid pulse, falling asleep (this was anaphylaxis and an EpiPen should have been administered) after eating close to children eating peanut butter at school. During recess he experienced a drop in blood pressure, causing him to fall asleep on the playground and later went to the nurse.
o 2005—asthma symptoms at a ballet performance from sitting in a row in front of people eating peanut M&Ms (he did not know they were eating them until after the performance, but I did).
o 2001—hives on his belly during a one-hour “peanut free” Southwest Airlines flight (they served raisins because was on the plane, and we’d taken the first flight of the day, typically considered the safest by SWA). had received a prophylactic dose of Benadryl before the flight. I had wiped down with baby wipes every hard surface and the leather seats (and washed my hands) prior to being seated. His seat was then covered with a crib sheet, and he sat in a car seat. He wore long sleeves and long pants and did not touch the tray table (which I had wiped down).
o 1999-2000—hives on his face several times at his daycare sitting several feet away from children eating peanut butter. We moved to a peanut free daycare eventually.
o 1999—hives on his face when his mother ate peanut butter on a rice cake two feet from him (his first reaction to peanut)
Allergy Immunotherapy Injection
o 2008—Anaphylaxis. Throat itching, throat closing, increased pulse, redness on his neck, cold sensation. Administered the EpiPen

3. “has a physical . . . impairment that substantially limits a major life activity”

is anaphylactically allergic to peanuts. This is a life threatening food allergy, as documented by his doctors, and is a physical impairment that substantially limits several major life activities. This onset of the reaction can be sudden and fatal within minutes. It must be treated immediately.

According to the Virginia School Health Guidelines (2nd Edition), page 243, the handicapping condition need only substantially limit one major life activity in order for the student to be eligible. In this document, we identify four:
• The life system of breathing
• The ability for self care
• Eating
• His social/emotional condition
According to the Virginia School Health Guidelines (2nd Edition), page 243, “A student is eligible so long as he/she meets the definition of qualified handicapped person; i.e., (1) has or (2) has had a physical or mental impairment that substantially limits a major life activity, or (3) is regarded as handicapped by others. It is not required that the handicap adversely affect educational performance or that the student need special education in order to be protected.”

Breathing
The fact that has had two significant anaphylactic reactions indicates that he is at risk for deterioration and even cessation of this major life activity. In both reactions, his throat swelled and began to close, substantially limiting his ability to breathe. ’s asthma compounds the risk. While an EpiPen is used to treat an anaphylactic reaction, the fact that has access to an EpiPen at school is not a mitigating measure, because an EpiPen does not guarantee that a reaction will not be fatal. Noted allergist Scott H. Sicherer, MD stated in a recent article:

"It should be noted, however, that prompt therapy with epinephrine is not fool-proof. This was demonstrated by the death of a 16-year-old girl who purposefully ate an unsafe dessert with the expectation that her injector would save her if symptoms became severe. "(American Academy of Pediatrics News, Vol. 28 No. 6 June 2007, p. 14)

In it was shown that breathing is substantially limited due to the degree of a peanut allergic child’s impairment (i.e., respiratory arrest). Section 504 does not indicate that the impairment must be continuous or that the life function has to be impaired 100% of the time to be qualified under disability just as one qualifying for a Section 504 does not have to be symptomatic. (http://www.hhs.gov/ocr/aids.html).

The Ability for Self-care
is substantially limited in the ability to care for himself because managing his life threatening food allergy introduces additional self-care requirements which he is not able to carry out. This limitation is substantial because failure to carry out the additional self-care requirements could have fatal consequences. ’s life threatening food allergy is a physical impairment which at his age renders him substantially limited in his ability to care for himself and at risk for exposure through casual contact or inadvertent exposure to allergens which impede his breathing.

His ability to care for himself is limited because:
• He is not always able to identify safe food and is at the mercy of food packaging and manufacturing industries. The current labeling laws do not require manufacturers to label for cross-contamination of manufacturing lines or shared lines (with peanut containing foods). Currently his parents call manufacturers to determine the safety of the food he eats.
• He is not always able to reliably recognize the signs of an allergic reaction, especially when the reaction involves “spaciness” or disorientation/lowering of blood pressure as the airborne reaction at school last year did.
• He may not be able to treat himself in the event of an anaphylactic reaction. Even as an adult, may not be able to administer his own life saving medication, because he might be unconscious.
• is approaching the age when fatalities from anaphylaxis due to food allergies markedly increase, and it is critical that he has plans in place around him to keep him safe.
• is an “adult-pleaser.” He follows typical first-child behaviors and is comfortable with adults but wants to please them, especially adults who are authority figures, such as teachers. His ability to self-care is even more limited if adults around him do not understand food allergies; their authority may supersede his efforts to self-advocate and prevent him from caring for himself. Without accommodation (i.e. training for the adults and alterations to the discipline system) the school environment can actually prevent him from caring for himself.

is a normally-developing child with the one exception which singles him out from the general population of ten year olds. He has a life threatening allergy to peanuts as well as asthma and environmental allergies. These allergies don't make him unique but they set him apart in what can be expected of him at this age level. According to the information from his doctors, is in a constant state of risk for exposure to life threatening allergies for which there is no preventive medication, only preemptive cautions and reactive solutions.

The school has acknowledged that needs an IHP, which would deal with the burden of self care. This emphasizes the reality that is unable to successfully care for him self in the school environment. Even once an IHP is in place, it is not a mitigating measure.

Eating
In Fraser v. Goodale, 342 F.3 1032 the Ninth Circuit held that "broadly speaking, eating is a major life activity. However, eating specific types of foods, or eating specific amounts of food, might or might not be a major life activity. If a person is impaired only from eating chocolate cake, he is not limited in a major life activity because eating chocolate cake is not a major life activity. On the other hand, peanut allergies might present a unique situation because so many seemingly innocent goods contain trace amounts of peanuts that could cause severely adverse reactions."

can eat in the literal sense that he can chew and swallow and digest without difficulty; it is the type of food which limits this major activity. He lives with the constant awareness that unsafe food, should he eat it, could kill him. He can’t eat in the same environment where other children are consuming his allergen, because that would put him at risk. Food of any kind not provided by his parents is a potential danger, not a source of pleasure and nutrition. For most people, food is a sign of hospitality and welcome; for a child with life threatening food allergies, it is frequently a cause for isolation and fear.

Food is frequently used in the classroom, whether for celebrations or as a learning manipulative. If the food isn’t safe, ’s life is at risk.

His Social/Emotional Condition
suffers emotionally and socially because of his life threatening food allergy. Having a life threatening food allergy is a constant source of stress and fear. It impacts one’s ability to interact with peers normally, as socialization around food is so prominent in our society. For to be safe at <>, a peanut free table has been established, and it is physically separated from the other tables. Other children may sit with him, but if everyone is eating peanut butter on a given day or if no one wants to sit away from other peers and join at the peanut free table, he may sit by himself (and has).

His everyday life is affected in class. For example, when the class has a food-related celebration to bid a student teacher good-bye or when another child brings cupcakes to celebrate her birthday, is constantly reminded how different he is from the other students. He cannot eat that food that his peers eat if it is brought from home or from a bakery; he must eat food brought from his home, food that is guaranteed to be safe for him and not cause a life threatening reaction.

It is very easy for him to feel excluded and not a part of his peer group. He gets few invitations to birthday parties of his classmates. His parents assume it is because other parents are not comfortable in dealing with this allergy. His experiences are not unique. Others who suffer from life threatening food allergies experience the emotional stress and social alienation that does.

In a recent article, Scott H. Sicherer, MD wrote this about food allergies and social isolation (and related it to an increase in fatalities among adolescents with food allergies):
“Indeed, surveys of food-allergic teenagers reveal that risk-taking (eating foods that may contain an allergen, not carrying medications) was common and associated with feeling socially isolated because of the food allergy. . . When asked about the 'worst part' of having a food allergy, 94% cite "social isolation." (American Academy of Pediatrics News, Vol. 28 No. 6 June 2007, p. 14)

Dr. Sicherer, in his book Understanding and Managing Your Child’s Food Allergens, states the following.
• “Because of peer pressure at school, your child may be tempted to eat unsafe food.” (p. 220)

• “Living with a food allergy can be like living in a field of land mines. Living and managing this situation can lead to fear, anxiety, sadness, depression, anger frustration, guilt, rivalry among siblings, and stress between spouses and other family members.” (p. 238)

• “Living with food allergy is a significant challenge. The illness affects every aspect of life for the allergic child and family. Whether it is shopping, being with relatives and friends, at school or camp, or maintaining diligence at every meal, food allergies affect life.” (Page 229)


Because these four major life activities are substantially limited, qualifies for accommodations under Section 504 of the Rehabilitation Act of 1973, and we request that the 504 Committee grant him eligibility of a 504 Plan, in accordance with the Virginia School Health Guidelines (2nd Edition).