Staff Training:

Food Allergies in School

Swampscott Public Schools

This presentation is PUBLIC on our Website/ Anyone can view.

Objectives

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Increase knowledge of food allergies

Recognize and manage anaphylaxis

Understand team approach, involving students, parents school administration and school staff to keep students safe at school

Increase awareness and understanding that can help support students with food allergies

Food Allergy: definitions

A food allergy is an abnormal immune response to a food protein.

The most common allergens are:

milk, egg, peanut, wheat, tree nuts, soy, shellfish, fish

Anaphylaxis is a severe life-threatening allergic reaction.

Epinephrine, a medication, is the 1st line treatment for anaphylaxis.

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Early recognition and treatment can be life saving

Most allergic reactions occur within minutes up to a few hours after exposure. Single or multiple systems can be affected.

Skin and mucous membranes (mouth, tongue, lips, eyes): rash, itching, hives, watery eyes

GI: nausea, vomiting, heartburn

Respiratory (nose, throat, lungs): sneezing, coughing, difficulty swallowing, difficulty breathing, throat swelling, dry cough

Cardiovascular (heart): fainting, dizziness

Neurological (brain) and emotional: sense of doom, confusion, lethargy

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Food allergies have emotional and social Impact

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Fear of adverse events including hospitalization and death

Fear of ridicule, being bullied, teased, harassed

Social isolation

Limitations in activities

Limitations in food choices

Fear of being a burden to others, including financial burden of condition

Misinformation regarding food allergies among peers

Food allergy management in the school setting

• Prevention
• Avoid
• Communicate
• Teach
• Emergency preparedness
• Recognize anaphylaxis
• Epinephrine
• Activate Emergency Medical Systems

Avoid to prevent accidental exposures

Federal/state guidelines

Specific students: Emergency Care Plan, Individual Health Care Plan, 504

Avoid exposure to allergen (most common by ingesting, breathing in or touching)

• Most common location for exposure: Classroom and Cafeteria!

FDA requires all packaged food be clearly labeled for 8 major allergens

• does not include sesame, other seeds and gluten (besides wheat)
• labels “contains” statement is preferred
• avoid labels “produced in a facility”, “manufactured on shared equipment”

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Food allergens found in non food items

Food allergens found in surprising places in schools:

Shaving cream: milk

Finger paint: egg whites, milk

Paste: wheat

Play dough: wheat

Bird feed: nuts, seeds

Bean bags, nuts, seeds, beans

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Avoid to prevent accidental exposure

Cross contact (surface to surface, food to food, by saliva)

Proper cleaning can prevent cross contact

• disposable wipes and rags, avoid dip buckets
• handwashing with soap, water, wipes works. Hand sanitizer does NOT work

Sharing of anything (silverware, water bottles, etc) can become a source of exposure

• younger students explore environment with hands and mouths
• older students better able to self-manage

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Communicate to prevent accidental exposure

• Confidential health information
• Know which students have a food allergy
• Protect the student’s privacy before sharing with volunteers, staff
• Communicate food policy with parents/students beginning of school year
• Encourage supportive environment (avoid language, activities that may isolate/exclude student with food allergy)
• Know how to contact the nurse, school administration, EMS

React to accidental exposure

Recognize anaphylaxis

• Unique to each student and each occurrence
• Symptoms may be mild or involve multiple body systems
• Onset may be sudden or delayed

Recognize the symptoms of allergic reaction

There is not any one symptom that is present in all cases of anaphylaxis

• Coughing, shortness of breath, wheezing, chest tightness, difficulty breathing
• Change in voice, difficulty swallowing/speaking
• Throat tightness, tongue swelling
• Rash, hives, swelling, itchy skin, flushing
• Runny nose, sneezing
• Itchy lips, tongue, ears, throat, mouth
• Red itchy watery eyes
• Dizziness, loss of consciousness
• Irritability, confusion
• Stomach cramps, diarrhea, vomiting

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Treatment: give epinephrine and call 911

Once anaphylaxis is recognized, give epinephrine and activate emergency services- Call 911 - then notify parents/guardians

Epinephrine is stored in secure, accessible location in nurses office

4 brands of epinephrine auto injectors available in US:

• Epi-pen (“blue to the sky, orange to the thigh”)
• Generic epinephrine auto-injector
• Auvi-Q
• Adrenaclick

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Epinephrine administration

Please see you school nurse for demonstration of administration of epinephrine as each auto-injector has important differences and required skills competency.

Epinephrine is administered in the outer thigh

• Needle is designed to go through clothing
• Auto-injector is held in place, needle may or may not retract into device
• Rub site of injection for absorption and comfort

Call 911, request Advanced Life Support

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Employees of SPS take the Quiz

Additional information

Food allergy:

About 5.6 million children under the age of 18 (or 8%) in the US have a food allergy. That’s 1 in 13.

Food allergies are associated with conditions such as asthma, eczema and pollen.

Most food allergens cause reactions even after they have been cooked or digested.

• Some allergens, most often from fruits and vegetables, cause allergic reactions only when eaten raw.
• Food oils, such as soy, corn, peanut, and sesame, may or may not be allergenic (causing allergy), depending on how they are processed.

There is no cure for food allergy. Food allergies are managed by avoiding the problem food(s) and learning to recognize and treat reactions symptoms.

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Food allergy: Labeling

The U.S. Food Allergen Labeling and Consumer Protection Act of 2004 requires food labels to list which of the eight major food allergens are present as ingredients in prepared foods. (Sesame is not included)

• milk, egg, peanut, tree nuts, soy, wheat, fish, and crustacean shellfish

However, the law does not require or suggest wording for warning labels, such as “may contain trace amounts of nuts” or “may be prepared in a facility that also uses nuts.” The inclusion of these warning labels is voluntary.

Teach to prevent accidental exposure

Food allergy awareness to students in health/nutrition class

Food allergy awareness and management to parents through PTA communications, school/class policy, notices around special events

Be aware of other situations: changes in school staff (substitute), field trips, field days, school bus/transportation (no eating on the bus), outside food in schools for celebrations, school sponsored before/after school activities

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Resources

www.schools.allergyhome.org general information, includes lesson plans for students

https://www.foodallergy.org/ general information, including links to epinephrine auto-injectors

Voluntary Guidelines for managing food allergies in schools and early care and educational programs, CDC 2013

Managing life threatening allergies at school, Mass Department of Education, 2002

National Institutes of Health: https://www.niaid.nih.gov/sites/default/files/faguidelinespatient.pdf

Pistner, Michael http://allergyhome.wpengine.netdna-cdn.com/wp-content/uploads/2014/12/Label-Reading-Two-Pager-FAMILY-EDITIONv1.1.pdf

DuToit, et al. Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy. N Engl J Med 2015; 372:803-813

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