VanEssendelft's 13-year-old brother, David, also has a peanut allergy and is also frequently bullied.
"Recently, I had a kid in the locker room say, 'I'm going to put peanut butter on the ball and I'm going to serve it to you so you have to set it,'" said David, who added this kid frequently makes peanut butter jokes and wants to see David inject himself with an epinephrine pen to stop a reaction.
"I think a lot of times kids get wrapped up in the experience and they don't think," said Susan Swearer, associate professor of school psychology at the University of Nebraska-Lincoln. "Actually, it's true they don't think — they've done studies, the whole myelination in the brain is not complete."
The best way to tackle the thinking problem in adolescents, Swearer explained, is to repeat conversations. "Say it 500 times: someone can die of a peanut allergy."
Despite an initial reluctance to punish bullying, the VanEssendelfts report that the school began an intensive peanut watch after Sarah had a reaction that landed her in the hospital for four days.
Sarah's mother, Lisa, also applied for a 504 plan — a consideration under the Americans with Disabilities Act — to have the school treat her food-allergic children the same way it treats children with other disabilities.
Now, all of Sarah's classrooms have no-eating policies, she gets a chaperone in charge of her medical issues on field trips, and if she rides a school bus, it must be swept out and cleaned for peanut residue.
"So, now, if kids give Sarah a hard time, it's considered a discrimination against a disability," said Lisa.
However, whether or not adults and teachers recognize a "hard time" may be hard to tell.
The NSSC reports 75 percent of children claim to have been bullied at one time or another during school, yet 49 percent of parents did not recognize bullying as a problem.
Teachers may also have a problem recognizing bullying, especially if the bullying is verbal and not physical.
"Schools do a much worse job of consequating verbal bullying," said Swearer. "Adults will tell us, 'We're not sure if the kids are joking around or not.'"
Yet, verbal abuse, including verbal threats, may be more serious than physical bullying.
"The psychological consequences are the most severe," said Pamela Cantor, a psychology professor in the department of psychiatry at Harvard Medical School.
Cantor noted that verbal taunts with a peanut allergy are essentially physical threats, as well. "That's a physical attack, these kids could die."
Allergists say there are no studies to quantify the mortality risk of a person with a severe food allergy. However, "there is a theme for people who have died: [they've been] teenagers and young adults who have asthma, people who know they are allergic," said Sicherer.
To stop an anaphylaxis reaction (hives, swelling, vomiting and breathing problems) someone must inject an epinephrine pen at the first sign and then go to the emergency room.
"What happens is not predictable," said Dr. Kathy Sheerin, of the Atlanta Allergy and Asthma Clinic. "You can have a near-death experience, and the next time, it may not be as bad — but, if you're standing there thinking of using it [epinephrine pen], you probably should have used it already."