Allergy, Asthma, and School Problems Warren Richards

llergic disease is the “number one” chronic illness A of childhood. Nasal allergy, asthma, and other allergies account for one-third of all chronic conditions occurring annually in childhood and affect one of five school children.’ Three million children younger than 15 years of age in the United States have asthma.* As with any chronic illness, these conditions not only have ad- verse medical effects, but often adversely affect the child’s quality of life in other ways such as creating special problems in school, including excessive ab- sences, poor academic performance, or psychological and social maladjustment.

SCHOOL ABSENCES Asthma is the principal cause of school absences due

to chronic disease in childhood accounting for 20% of school days lost in elementary and high schools.’ Addi- tional time also is lost from school because of other allergic or associated problems such as nasal allergy, recurrent ear problems, or skin allergy.

Anderson3 illustrated the scope of this problem in Croyden, England. Of 11.1 Yo of children reported to have a wheezing illness during the previous 12 months, 58% had one or more school absences and 12% of these absences amounted to 30 days. These findings of in- creased absenteeism due to asthma also have been con- firmed in this ~ o u n t r y . ~ School absences due to asthma usually are brief, but this type of absence has been found to be more harmful academically than the oc- casional long absence. Indeed, substantial evidence exists that excessive absences are related to lower stu- dent grades6 and to lower scores in teachers’ assessments of the students’ psychological, social, and educational adjustment . 3 s 7

Several causes contribute to excessive school ab- sences due to allergy and asthma. Obviously, one cause may be the severity of the medical problem itself. Howaver, with the availability of new and remarkably effective treatments, symptoms could be “controlled” most of the time in the majority of patients. Adequate communication among the school, parents, and the student’s physician concerning the child’s condition is essential. When adequate medical care has not been obtained, referral to an appropriate resource in the community is indicated. One preventable cause of excessive absenteeism can be insufficient understanding

Warren Richards, MD, Head, Division of Allergy-Clinical Immun- ology, Childrens Hospital of Los Angeles, and Professor, Clinical Pediatrics. University of Southern California, School of Medicine, Los Artgeles. CA 90054.

by the parent or the school of the medical problem and its ramifications. For example, some children may miss school needlessly as a result of unwarranted fear by their parents that inclement weather might provoke their child’s asthma. Some children also may miss school needlessly based on the erroneous assumption of the parent, teacher, or nurse that the student’s allergic symptoms are those of an infection and are contagious.

POOR SCHOOL PERFORMANCE Asthma and allergies, as well as the treatment

employed for them, have the potential for adversely affecting school performance. Children with these medical conditions frequently are discomforted by their symptoms and tend to fatigue easily from loss of sleep, reducing their attention span and impairing their con- centration. Periodic hearing loss is not an uncommon complication in children with respiratory allergies and can affect academic performances. Unfortunately, medications used to treat allergies and asthma also have the potential for occasionally causing sleepiness, ner- vousness, irritability, and other side effects. The school performance of other classmates also can be affected by annoying mannerisms manifested by the allergic child such as sniffing, clucking, snorting, sneezing, and coughing.

Results of studies attempting to document adverse effects of allergy on learning have been conf l i~ t ing .~- ’~ Havards found allergic children to be rated lower in reading and auditory and visual perception, but Rawls9 was unable to find any differences in achievement, intel- ligence, and visual-motor test performances among allergic children, though they were judged to be less pro- ficient in intellectual, academic, and social areas. In a questionnaire survey of parents of 400 allergic and non- allergic children, no differences were discerned in terms of academic performance or behavior except for patients with hearing problems or those manifesting be- havior problems from medication.

PHYSICAL EDUCATION Exercise can provoke symptoms in most asthmatic

children, depending on factors such as the type and dur- ation of exercise, temperature, air pollution level, presence of airborne allergens, severity of the asthma, and use of medications. Asthma is more likely to follow running and is least likely to follow swimming. How- ever, with some exceptions, most asthmatic children should be able to participate in most regular physical education activities providing there is adequate under- standing of the limitations of the asthmatic patient by

Journal of School Health April 1986, Vol. 56, No. 4 151

the physical education instructor or use of medication prior to exercise. Since it is undesirable that asthmatic children “feel different,” every effort should be made to keep them in regular physical education.

PSYCHOLOGICAL AND SOCIAL ADJUSTMENT Emotional problems are never the primary cause of

allergies and asthma. However, if children are severely incapacitated by their symptoms, are hospitalized or require frequent emergency room visits and miss a great deal of school, are overprotected and spoiled by parents and made to “feel different,” psychological and social problems can ensue. These problems can result in more symptoms. It is vitally important that allergies and especially asthmatic children receive the highest quality medical care, parents and school personnel be fully edu- cated about these medical problems, every effort be made to ensure these children remain in the mainstream with regards to their education and activities and not be made to feel different; and lines of communication re- main open among the school, physician, and parents.

CONCLUSION Recently, members of the American College of

Allergists (ACA) were surveyed to determine the nature and extent of problems their allergic and asthmatic patients had in school. Eighty percent of respondents felt significant problems existed with:

Unnecessary morbidity due to the unwillingness of some schools to permit students to receive medication;

Unnecessary school absences because school per- sonnel lacked sufficient knowledge about these medical problems;

Asthmatic children were penalized frequently and unjustly or “pushed” beyond their capacity in physical education, or inappropriately transferred to modified physical education; and

School performance of a significant proportion of allergic and asthmatic children was affected adversely by the school’s approach to their medical condition.

Accordingly, the ACA has undertaken the very important task of forging new communication links with schools by developing guidelines which schools will be encouraged to follow in their approach to the allergic child. These guidelines have been endorsed by the Asthma and Allergy Foundation of America, the American Academy of Allergy and Immunology, and

the American Academy of Pediatrics. To facilitate implementation of these guidelines, the ACA has developed standardized forms containing specific in- structions to schools for each patient. These forms will be made available to allergists, pediatricians, and family physicians for distribution to parents of allergic and asthmatic children. A network of qualified allergists also will be established to interpret the guidelines for school health committees.

The ACA also urges that medical information con- cerning asthma and allergies be incorporated into the educational program of school personnel. Increased efforts also are being made to ensure that parents of asthmatic and allergic children are fully educated about their child’s medical problems and that physicians caring for children with these problems are more sensi- tive to the adverse medical, social, psychological, and educational effects of these conditions. Working together in this fashion, all school health professionals undoubtedly can help the allergic child in the school.

Additional information and copies of the guidelines and physician instruction forms are available from: American College of Allergists, 800 E. Northwest Highway, Mount Prospect, IL 60056.0

References 1 . Schiffer CJ, Hunt EE: Illness among children. Washington,

DC, US Dept of Health, Education, and Welfare, Children’s Bureau publication no 405, 1963.

2. US Dept of Health, Education, and Welfare: Asthma and /he other allergic diseases; NIAID. Washington, DC, National Institutes of Health publication no 79-387, 1979, p 7.

3. Anderson HR, Bailey PA, Cooper JS: Morbidity and school absences caused by asthma - Wheezing illnesses. Arch Dis Child 1983;58:771.

4. Parcel GS, Gillman S , Nader PR, et al: A comparison of absentee rates of elementary school children with asthma and non- asthmatic schoolmates. Pediafrics 1979;64:878.

5 . Douglas JWB, Ross JM: The effects of asthma in primary school performance. Journals Brit J Educ Wc Psychol 1965;35:28.

6.0’Neil SL, Barysh N, Setear SJ: Determining school program- ming needs of special population groups: A study of asthmatic children. J Sch Health 1985;55(6):237-239.

7. Rapaport HG, Flint SH: Is there a relationship between allergy and learning disabilities? J Sch Health 1976;46(3):139-141.

8. Havard JG: Relationships between allergic conditions and/or learning disabilities. Dis Abs Intern 1975;35:69.

9. Rawls DJ, Rawls JR, Harrison DW: An investigation of six to 1 I-year-old children with allergic disorders. J Consult and Clin Psychol 1971 ;36: 160.

10. McLoughlin J, Nall M, Isaacs B, et al: The relationship of allergies and allergy treatment to school performance and student behavior. Ann All 1983;51:506.

ASHA Study Committee Seeks Members I Health professionals interested in serving as a member of the ASHA Study Committee

on Health Guidance in Sex Education should submit a resume and letter stating their interest to: Judy C. Drolet, PhD, Dept. of Health Education, Southern Illinois University, Carbondale, IL 62901. The Study Committee on Health Guidance in Sex Education is comprised of individuals from various school health disciplines who serve as a medium for discussion, promote research topics in sex education, and assist and advise ASHA on issues that contribute to favorable sexual health for the school-age population.

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