Managing Food Allergies in School

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1 Managing Food Allergies in School Maria Crain, RN, CPNP Amy Arneson, RN, BSN Food Allergy Center Children s Medical Center Dallas Learning Objectives -Define food allergy and the most common food allergens -List signs/symptoms of an allergic reaction -Describe how to treat an allergic reaction -Describe key parts of an emergency food allergy action plan -List family and school responsibilities for a student with food allergies -Describe recent legislation related to food allergy -List ways food service staff can provide a safe environment Review of Literature Approximately 8% of children have a food allergy From , 18% increase in food allergy Food allergy-induced reactions cause an estimated 30,000 emergency room visits and deaths per year Nut allergies caused most fatalities 80% of children outgrew egg and milk allergy by teenage years Peanut, tree nuts and fish and shellfish tend to persist Gupta et al 2011 Pediatrics Centers for Disease Control 2008 Bock et al 2007 Ross et al 2008 Journal of Clinical Allergy & Immunology Savage et al 2007 Journal of Clinical Allergy & Immunology 1

2 Review of Literature Several studies find schools have inadequate emergency plans In 32% of cases, school personnel did not recognize symptoms of an allergic reaction Children had more reactions in the classroom with school projects that contained food than in the cafeteria Sicherer et al 2001 FOOD INTOLERANCE Does not involve the immune system; Symptoms come on gradually May be able to eat small amounts of the offending food with out trouble. May also be able to pre-treat a reaction. Ex. Lactose Intolerance and Lactaid Is not life-threatening FOOD ALLERGY An abnormal response by the immune system to a food protein; symptoms present within seconds to minutes and progress rapidly. The immune system thinks the food is harmful and releases histamine and other chemicals to attack the enemy May be life threatening Prevalence of Food Allergy in U.S. 1 in 13 children in the U.S. have a food allergy Children Adults Milk 2.2 3% 0.3% Egg % 0.2% Peanut 0.6 2% 0.6% Tree nuts 0.4 1% 0.6% Fish % 0.4% Shellfish % 2% Wheat 0.4% 0.3% Soy 0.4% 0.3% Gupta R, et al. Pediatrics 2011 Boyce JA Immunol

3 Prevalence of Food Allergy in U.S. 1 in 13 children in the U.S. have a food allergy Children Adults Milk 2.2 3% 0.3% Egg % 0.2% Peanut 0.6 2% 0.6% Tree nuts 0.4 1% 0.6% Fish % 0.4% Shellfish % 2% Wheat 0.4% 0.3% Soy 0.4% 0.3% Gupta R, et al. Pediatrics 2011 Boyce JA Immunol Common Food Allergies 90% food reactions caused by 8 foods: Milk, Egg, Wheat, Soybean, Peanuts, Tree nuts, Fish, Shellfish Reactions Reactions usually occur within minutes after a child has eaten and no later than 4 hours Reactions can occur from contact and inhalation but these are rare 3

4 Signs and Symptoms Sneezing Nasal Congestion Runny Nose Hoarse Voice Difficulty Breathing Cough Wheeze Flushing Hives Swelling Nausea Vomiting Stomach Cramping Diarrhea What is Anaphylaxis? Term used to describe a serious allergic reaction that is rapid and may cause death Food Allergy is most common (81%) cause of anaphylaxis in children of choice is Epinephrine Jarvinen et al 2009 Medications Avoidance Education 4

5 Antihistamines (ex. Benadryl) Benadryl (1-1.5 mg/kg by mouth every 4-6 hours as needed) Liquid or fast melts are recommended because quick onset of action Used to treat rash, hives, itching, swelling Epinephrine (Epipen brand or Auvi-Q) Intramuscular injection to the outer mid-thigh Hold for 10 seconds, massage area, call 911 Dose may be repeated in 10 minutes Used for treatment of anaphylaxis or severe reactions affecting multiple organ systems Food-induced Anaphylaxis Fatalities Bock A

6 Important that Epipens are in an unlocked location Should be able to administer emergency medications within minutes of a reaction Safe to use, side effects are minimal, may be used through clothing When in doubt, use the Epipen! *Morbidity has shown to be lower in children who received epinephrine early The AAP, AAAAI and NASN recommend emergency action plans directing therapy of allergic reactions Food Allergy Action Plan Clear plan of action for child with allergies Includes student s name, birth date, picture, allergies and history of asthma Symptom chart that indicates when medications should be administered Food Allergy and Anaphylaxis Network plan is preferred 6

7 Avoidance Avoidance in school Encourage hand-washing Safe school projects Nut free or safe areas in school if feasible Work with families to develop a plan that works for both When Working With Families Be Understanding Listen Carefully Answer questions thoughtfully Keep the communication lines open Safe Food Handling Practices: Be Prepared Provide in-service regarding safe food handling practices Supply written information to staff detailing how to manage a food-allergy students dietary needs. Post a copy of the Food Allergy Action plan in the kitchen with a picture of the student (out of public viewing) 7

8 All Foods Are Not Created Equal All food service employees should know how to read food package labels. Ingredients can change at any time without notice so it s important to read every label every time. Do not rely on safe food lists. All Foods Are NOT Created Equal Institutional-size products often have different ingredients from their regular-size versions Beware of hidden or unexpected ingredients No label or unsure? Don t risk it, find a safe alternative. May Contain = DOES contain Cross-Contamination Thoroughly clean equipment, prep boards, and utensils with hot soapy water before preparation Wash hands thoroughly and put on a fresh pair of gloves before preparing an allergy-friendly meal Never just remove the offending ingredient from a food and serve it to the food-allergic student. Trays should first be cleaned thoroughly with hot, soapy water, not just wiped down 8

9 Legislation Statewide guidelines for Texas public schools U.S. House of Representatives Passes School Access to Emergency Epinephrine Act-July 30, 2013 Section 504 and Written Management Plans Food Allergen Labeling and Consumer Protection Act Resources FARE Children s Medical Center 9

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