Judy is to start regular kindergarten. When she was two years old, she was diagnosed with a peanut food allergy after many episodes of asthma and hives. Her health has improved as a preschooler with avoidance of peanuts in all forms. The family has carefully watched what she eats. However, at age 4, she had an episode of breathing difficulty that required an emergency-room visit. This incident makes the family quite concerned about Judy’s eating at school. She is generally not allowed to go to friends’ homes to play; friends come to her house so the family can watch out for her. She has been instructed not to take any food from anyone. She has not been in day care or preschool, so starting school is a big step for the family.

Interventions: A meeting was held at the school after receiving the physician’s statement and diagnosis. Judy’s mother met with the school staff to discuss plans for Judy at school to avoid exposure to peanuts in any form. The family did not want to participate in the school lunch program. Her mother proposed to pack Judy a lunch from home, although most children eat food provided at school. With the school staff, Judy’s mother discussed snack time for Judy and her eating at the cafeteria, which periodically serves food cooked in peanut oil, or food containing peanuts. The snack at kindergarten was discussed, as it is provided by parents based on a rotation schedule. It is usually milk or juice with cookies or fruit.

Monitoring Recommendations: A plan was put in place for the teacher to check the snack foods and offer a replacement snack provided by Judy’s mother if she is unsure whether that day’s snack contains peanuts. The school working group had written out a 504 accommodation plan for Judy’s peanut allergy. It included making sure that tables where children eat peanut-containing foods are washed well, with signs in the cafeteria with Judy’s picture to make sure she does not inadvertently get peanut-containing food from another child or in a food activity.

After Judy has been in school for one month, the family meets with the school group. In that month, two episodes resulted in what may have been hives, and her family is worried that Judy is not adjusting well. At snack time Judy did not recognize some of the foods; she refused to eat a snack most days. She appeared hungry at home after school. Her mother says she would like to send to school a snack that she knows her daughter will eat, and she wants to attend school during snack time to make sure Judy is not being teased.

What are the chances that Judy will outgrow the peanut allergy by next year?