The first time Allison Rohdenberg ate peanut butter, she broke out in hives. Since then, the kindergartner's family has taken pains to prevent her from eating or touching anything that contains peanuts or tree nuts such as pecans.
Teachers and staff at Badger Mountain Elementary School know what foods are dangerous to Allison, and she isn't the only student with a severe food allergy. Many schools in the Tri-Cities already have taken steps to protect children from allergens, from separate lunch tables to making sure other students wash their hands after eating.
And more policies are under consideration, such as the possibility of banning homemade snacks in classrooms of the Richland School District.
Parents of allergic children who talked with the Herald said they generally are pleased with the steps schools and teachers have taken, but said there's still work to do, both in protecting their kids and ensuring they aren't ostracized for their condition.
"That's the most frustrating part, other parents who aren't aware of how bad it can be," said Kennewick resident Brandi McGilton, whose 10-year-old son has a severe peanut allergy.
Four out of 100 children in the United States under the age of 18 have some form of food allergy, according to the Centers for Disease Control and Prevention.
Severity of allergic reactions ranges from a mild tingling in the mouth to vomiting, loss of consciousness and difficulty breathing, which can lead to death.
Eight types of foods - peanuts, tree nuts, milk, eggs, fish, shellfish, soybeans and wheat - account for 90 percent of food-specific allergic reactions.
'ONE BITE AWAY FROM DISASTER'
Many families learn of the allergies by accident.
The Deranleaus of Kennewick learned of their son Beckett's peanut and tree nut allergy a few years ago when his mother, Angie Deranleau, gave him a sample of a fruit and nut bar she bought while out shopping.
Angie and her husband, Nick Deranleau, haven't decided whether Beckett, now almost 4, will attend public school in Kennewick, they said. They're concerned about the school's ability to fully protect him or know what to do if he has a reaction.
"I'm so worried about it that I'm thinking we'll just homeschool him," Nick Deranleau said.
The severity of a child's reaction to a food is dependent on multiple factors, said Dr. John C. Walker of Northwest Allergy and Asthma Center in Richland.
Some kids who could be at risk of a severe reaction if they ate something containing peanuts or dairy can get away with just a few hives or a tingling sensation in their mouth if they realize soon enough what they've eaten and spit it out, Walker said.
However, he does worry about some of his patients' potential to go into anaphylactic shock - a violent allergic reaction - and the burden that risk can place on them and their families.
"You're one bite away from disaster," Walker said.
Allison Rohdenberg carries an autoinjector with her at all times, just in case she touches a table that recently had a peanut butter cookie on it or eats a snack made with pistachios.
She's had only a few severe incidents, the latest when she went into anaphylactic shock in November while visiting a relative. A family member used an autoinjector containing epinephrine to calm her allergic reaction.
"When you use (the autoinjector) for the first time it can be scary," said her mother, Tiffany Rohdenberg. "But it's a very safe drug."
Families remove anything containing their children's allergens from their homes. They research restaurants so they know if anything on the menu includes allergens or ingredients processed in facilities where allergens are present. They also have to be careful with processed foods and snacks.
"Learning to cook was the hardest part," said Laura Holland, whose young son's allergies include eggs, wheat, soy and peanuts.
That heightened level of awareness often contributes to anxiety when their children are ready to attend school.
While food-allergic kids learn early on not to share food with others, that doesn't guarantee a student with a contact allergy won't encounter an allergen while eating in the lunchroom or that staff will know what to do if a child goes into anaphylactic shock.
"When (my son) first started school, I was worried every day," McGilton said.
DIFFERENT SCHOOLS, DIFFERENT APPROACHES
Tri-City school officials say everyone - classroom teachers, nurses, lunchroom workers and administrators - takes steps to protect food-allergic students.
Staff in all three districts are trained to recognize when a student is going into anaphylactic shock.
Some schools maintain separate lunchroom tables to prevent contact with another student's peanut butter and jelly or tuna fish sandwich. The Pasco and Kennewick school districts will make separate hot lunches for food-allergic students if the parents want.
Susie Wells, a nurse at Pasco's Longfellow Elementary School, said she and other school staff follow state guidelines. They have plans in place for both emergency treatment and avoiding exposure.
Walker said the schools he's worked with have been amenable to considering the needs of food-allergic kids. Most parents also said they were more at ease after meeting with staff and learning what schools did to ensure their children's safety.
Rohdenberg said her daughter's teacher and the staff at Badger Mountain have been very cooperative in making sure Allison is safe. Holland said the same for her 7-year-old son Eli, who was a second-grader at William Wiley Elementary School this past school year.
"The first day of school he had lunch there a teacher's aide made sure he was safe," Holland said.
However, there is no consistent approach to food allergies throughout all schools.
While Allison can carry her autoinjector with her at Badger Mountain Elementary in Richland, for example, it's less common for elementary students in Kennewick to carry their own.
That's because a Kennewick policy requires medications be kept in the school office or with a teacher, except for special circumstances.
That policy prevented one kindergartner from attending school much of last year, because her parents wanted her to be able to carry her own autoinjector.
"Factors that would be taken into consideration would be the doctor's orders and indication that the student has demonstrated the ability to properly manage self-administration of the (autoinjector) as ordered and the student's developmental level," said Jeanne Bakker, a registered nurse and Kennewick's nursing department chairwoman, in an email. "By the time students are in high school, most have met the above criteria and are self-carrying."
Policies also vary on whether homemade classroom snacks - which can contain the residue of allergens, even if not an intended part of the treat - can be brought to school.
There's a specific district policy in Pasco governing how teachers and staff seek to prevent the possibility of anaphylactic shock. The Richland and Kennewick school districts do not have a similar policy.
Pasco's Wells noted that even with thorough precautions, non-allergic students bring lunches from home made with peanut butter, fish or milk.
"We can't be completely allergen-free," she said.
ACCOMMODATIONS MORE ROUTINE
Richland administrators have been working on a possible policy change for months that could ban food in classrooms unless it is bought prepackaged and fully lists its ingredients.
The district also is looking into having elementary students go out for recess before lunch, instead of the current format of lunch preceding time on the playground. Research shows students eat more and are better behaved if they have recess first. However, district officials said food-allergic children could benefit from not touching residue from high-risk foods on the monkey bars or swing set.
The changes have their critics. Some staff and parents have said at Richland board meetings that restricting or banning classroom treats is unfair to other students or could limit some lesson plans teachers have used for years.
Parents of food-allergic students said they sometimes still hear parents of non-allergic kids complaining about having to make accommodations. Walker has heard reports from around the nation of food-allergic kids being threatened by bullies, he said.
Health professionals and school officials say the number of food-allergic students will increase in coming years. A May 2013 report from the National Center for Health Statistics shows that from 2009-11, 5.1 percent of children under the age of 17 had a food allergy. That's up from 3.4 percent in the late 1990s. Food allergies also are more prominent among children from higher-income families.
If anything, Kennewick's Bakker said food-allergic students yet to enter school should find thing easier, as "accommodations are more routine and staff are more comfortable with the training of how to handle a severe allergic reaction."
Walker said it's important to increase awareness and understanding about food allergies -- among both the general public and those suffering from food allergies.
"Some kids are so paranoid that if they smell (what they're allergic to) they'll freak out," Walker said, adding it's very rare for someone to suffer a reaction to inhaled allergen particles.
Parents also hope for better acceptance of their children's condition. Many said the high level of cooperation from school staff is a good start. And the future looks promising.
"I definitely notice there's a generational component," Tiffany Rohdenberg said. "Teens and younger kids are more understanding."