Do I Have to Sit at the Peanut-Free Table? - Sherry Coleman Collins, MS, RDN, LD Shenae Rowe, RDN Caitlin Merlo, MPH, RDN - School Nutrition ...
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Do I Have to Sit at the Peanut-Free Table? Sherry Coleman Collins, MS, RDN, LD Shenae Rowe, RDN Caitlin Merlo, MPH, RDN
Affiliation or Financial Disclosure • Sherry Coleman Collins, MS, RDN, LD – Consultant, National Peanut Board
Food Allergy Fast Facts
• Prevalence is between 6-8% in children and up to
10.8% in adults
• Costly in terms of finances, healthcare use, and
psychosocial measures
• Societal Confusion over true allergy vs other adverse
reactions to food
– Overestimation of prevalence based on self-diagnosis
– Myths and misperceptions increase fear and anxiety
– School site-wide bans are not medically necessary and
create a false sense of security
The Big 9
Preventing and management of
food allergic reactions in schools
1. Implement training for teachers and other personnel in the prevention, recognition, and treatment of
allergic reactions to food.
2. Require all parents of students with diagnosed food allergy to provide an up-to-date allergy action
plan.
3. Implement site-wide protocols for the management of suspected allergic reactions to food in
individuals with no allergy action plans on file.
4. Use epinephrine only when they suspect that someone is experiencing anaphylaxis, rather than use
epinephrine as the first universal treatment for all suspected allergic reactions. For special
circumstances, see the full guidelines.
5. Do not preemptively administer epinephrine in cases when no signs or symptoms of an allergic
reaction have developed, even if a student has eaten a food to which they have a known allergy or
history of anaphylaxis. For special circumstances, see the full guidelines.
6. When laws permit, stock unassigned epinephrine autoinjectors on site, instead of requiring students
with allergy to submit personal autoinjectors to be stored on site for designated at-school use. For
special circumstances, see the full guidelines.
7. Do not prohibit specific foods site-wide.
8. Do not establish allergen-restricted zones, except in the special circumstances identified in the full
guidelines.
Best Practices – Training to Prevent Reactions – Communication About Allergens – Reasonable Accommodations – Preparing for Reactions
Training • Annual training is recommended • Should include everyone who might be with a student when they have a reaction • Foodservice staff should be trained to identify allergens, separate in storage and preparation, prevent cross contact, and respond to suspected food allergy reactions
Communicating About Allergens
• Internal communication
– Within foodservice (daily "jump starts")
– To school staff (emails, morning announcements)
– To student customers (emails, morning
announcements, at the point of sale)
• External communication
– To parents (emails, website)
– To wider community (website)Reasonable Accommodations • Always offering a safe option • Washing hands before and after meals and snacks • No food-sharing policy • Allergen-safe areas (such as classrooms for very young students or shared computer labs) • Separate tables in cafeteria or classroom • Non-food rewards & celebrations policy
Emergency Anaphylaxis Action Plan
Keys to More Effective Communication
• Empathetic
• Clear and Concise
• Frequency
• Listen More Than
You Talk
This Photo by Unknown
author is licensed under
CC BY-SA.Preparing for Reactions • Know signs and symptoms • Emergency Anaphylaxis Action Plans • Epinephrine is the only approved treatment for anaphylaxis
Takeaway • Use evidence-based recommendations to help reduce the risk of food allergy reactions. • Create a comprehensive food allergy management plan. • Focus on training, communications, and preparation to keep students with food allergy safer.
Affiliation or Financial Disclosure • Shenae M. Rowe, RDN – Warrick County School Corporation, IN – Food & Nutrition Director – Nothing to Disclose
The Food Allergy Epidemic
Back to School with Food Allergies:
What’s all the Fuss?
20% of food allergies reactions will occur in school settings
79% of school reactions occur in the classroom
25% of 1st time peanut reactions occur in school
Every 3 minutes, a food allergy reaction
sends someone to the ER.
200,000 people visit the ER annually in US.
2021 Food Allergy Research & Education
www.cdc.gov/healthyyouth/foodallergies/How much is TOO much? • Varies from person to person. • Varies from day to day • Fatal reactions can be induced by as little as one milligram.
How much is 1 milligram?
= 25 grams
= 1 grams
1 mg = 1/600th peanut
1/1000 gram = 1 milligramAllergic Reactions: Do you have to "eat" the food? Touching the skin (although very rare) Touching the lips (young children) Eye exposure Inhalation of vapors- (opening packages) Exercise Induced Anaphylaxis - Reactions by any way other than ingestion “SHOULD” be listed on the Food Allergy Action Plan. ** There reactions are typically very mild and do not cause anaphylaxis.
Is There a Cure? * There is no cure for food allergies.* • STRICT AVOIDANCE of the food. – Reading EVERY label. • Constant vigilance. • Just one little bite can hurt or kill.
Be Aware: Allergens can be found in places you would never expect!
Gray areas ➢ You may see children that can tolerate cooked milk or cooked eggs, but not raw or undercooked. Need a physician approval to allow to eat the protein- otherwise avoid all forms of protein. Action plan needed (70-80% can tolerate cooked dairy). ➢ Heat changes the protein structure of the amino acid sequences and may help the body to not “recognize” the protein in some children. How much heat and for how long? Which proteins and which children are the questions.
Cross-Contamination vs Cross-Contact ▪ Cross-contamination is what happens usually before the food is served. Whether this is at the processing plant, when it’s in the field, or on the cutting board, cross-contamination happens when bacteria from one food product transfers to another. So, generally, it happens when foods are raw. ▪ Cross-contact can happen at any time in the course of preparation. From its initial harvest in the fields, to setting it on a serving plate, cross-contact is always a danger at anytime for anyone with any kind of food allergy. While cross-contamination refers to the transference of bacteria, cross-contact is the transference of proteins. Sadly, you can’t cook off a protein.
1) Identify the students with food allergies ◦ Understand their allergy and it’s severity ◦ Know their “unsafe” foods 2) Understand the symptoms of a reaction 3) Know how to react!
➢ Never guess or make assumptions about whether a food is safe for a student with a food allergy. ➢ Refer all questions to the dietitian, café manager or person trained to answer questions about ingredients and cross contact. ➢ Report preparation inconsistencies. Remember you can’t just scrape off mayo.!! Remake the food. No blame policy -just redo it! In case of a reaction, get help immediately!
Ethan Rowe 6/8/0 Have an up-to-date
Peanuts, Tree Nuts 8 FAAP (yearly) if
possible
Fortunately, many
children outgrow
Click to add text their food allergy
80% outgrow milk,
egg, wheat and soy
Only 20% will
outgrow peanut and
tree nut, fish and
shellfishX
X
Dr. McLaughlin Shenae Rowe
1/5/21 1/5/21X X 6 X
Common Food Allergy Symptoms Children might communicate their symptoms in the following ways: It feels like something is poking my tongue. My tongue (or mouth) is tingling (or burning). My tongue (or mouth) itches. My tongue feels like there is hair on it. There’s a frog in my throat; there’s something stuck in my throat. My tongue feels full (or heavy). My lips feel tight. It feels like there are bugs in my ears (itchy ears) My chest hurts. I can’t breathe. I can’t stop coughing.
Hives and Swelling
Hives are common but not
always present in anaphylaxis
(10-20% have no skin symptoms)Why do people die of anaphylaxis?
• The difference between fatal and near-fatal events?
• How quickly medication was given
• How quickly professional medical help became available
– Don’t be afraid to treat these children
• Treat early and move them quickly to appropriate medical
supervision
• Epinephrine in the schools—federal law states children may
carry with permission- please check your state and local laws
– School owned epinephrine- Make sure your school participates
(www.epipen4schools.com)
(https://kaleo.com/who-we-are/kaleo-cares/)How To Treat Anaphylaxis
Epinephrine, or
adrenaline, is the
medication of
choice for handling
an anaphylactic
reaction.
Can cost up to $600 per pack!!• Advisable to have 2 self-injectable doses available – check
expiration dates
• Keep away from temperature extremes.
• Keep readily available- with child
• Don’t be afraid to use it - don’t wait
• Teach caregivers to always call 911 after givingHow to Use an EpiPen®
How to Hold
• Form a fist around the
center of the unit
• Pull off blue activation cap
How to Use
• Hold orange tip near outer thigh
(always apply to thigh)
• Goes through clothes
Count to 10
• Inject into outer thigh.
• Hold in place and count to 10How to use Auvi-Q
The Future of Food Allergy Management? Food Challenge Oral Immunotherapy (peanut)- Palforzia Allergen powder- increase dose over time Supposed to dose after school but… 1% chance of anaphylactic reaction Better label laws- sesame added by 1/2023
The Emotional Impact of Living with Food Allergies
Are you feeling
OVERWHELMED
yet??
Imagine how the parents
of these children feel
every day…Parental Goals School Goals • Keep their child safe • Keep students safe • Form a partnership • Form a partnership • Help the child have as • Provide safe learning normal a school and environment childhood experience as possible • Address teasing/bullying
Coordinated Approach
School
Nurse’s Office
Nutrition Dept
Effective
Management
of Food
Child with Allergies Allergist or
Food Allergy Licensed
and Parent PhysicianThe Emotional Impact of Living with
Food Allergies
• Children can feel…
– Angry
– Sad
– Left out
– Embarrassed
– Different
– Scared
– Bullied (Nearly 1 in 3)
Children are learning about food allergies at such a
young age now. Most food allergy students have
very supportive friends.Practical Suggestions
• Host a “Before” School Year Meeting:
– Individualize avoidance strategies
– Go over emergency plan
– Involve school nurse, counselor, parent, teachers, cafeteria staff
– Have student come to café to meet staff and identify where to pick up
his/her safe meal
– Provide detailed meal preparation instructions for staff
• Suggest one person at each site be responsible for special diets
EDUCATE! EDUCATE! EDUCATE!Practical Suggestions
Have a plan for:
• Who receives copies of FAAP • Classroom food rewards
• Field trips • Class pets
• Classroom Parties • Class projects/art class
• PTA functions • After school activities
• Foods sold in school to students • Storage location of Epi
• Substitute teachers • Bus
• Classroom food rewards • Cleaning lunch tables
Cleaning processes– use fresh rags, wipes for surfaces. Bleach and alcohol
(like in hand sanitizer) don’t “kill” proteins. Soap and water and removal
(friction, wiping)We’re All In This Together!
▪ Education is key to managing food-allergic children
▪ Remember there is no cure
▪ Learn from mistakes, avoid repeating them
▪ No blaming
▪ There’s no such thing as asking
too many questionsAffiliation or Financial Disclosure • Caitlin Merlo, MPH, RDN – Health Scientist, CDC Healthy Schools – Nothing to Disclose
CDC’s Voluntary Guidelines
1: Schools & Early Care & Education Programs
2: School Boards & District Staff
3: School Administrators & Staff
4: Early Care & Education Administrators & Staff
5: Federal Laws & Regulations
6: Food Allergy Resources
www.cdc.gov/healthyschools/foodallergies/index.htmFood Allergy Management Plan
Professional Create safe
Daily management
development environments
Educate students
Plan & prepare
& familiesActions for School Nutrition Directors
• Help develop and promote the food allergy
prevention plan
• Train food service staff
• Coordinate food substitutions
• Share information with parents and students
• Help enforce policiesActions for School Nutrition Managers & Staff
• Learn about food allergies and school policies and
procedures
• Know how to respond to a food allergy emergency
• Be ready to administer an epinephrine auto-injector
if you are delegated and trained to do so
• Follow policies and proceduresActions for School Administrators • Lead school’s planning process • Ensure implementation of the food allergy plan • Set up communication systems • Support professional development for staff • Create and maintain healthy environments
Actions for School Nurses
• Supervise daily management of food
allergies for students
• Develop instructions for responding
• Train staff
• Educate students and family members
• Assess school to identify allergens
• Develop strategies to help students avoid
allergensCDC Food Allergy Toolkit
Tip Sheets https://www.cdc.gov/healthyschools/foodallergies/toolkit.htm
PowerPoint Presentations https://www.cdc.gov/healthyschools/foodallergies/toolkit.htm
Podcasts
Managing Food Allergies at School: School Nutrition Professionals
https://www.cdc.gov/healthyschools/foodallergies/toolkit.htmSNA Food Allergy Resource Center
https://schoolnutrition.org/learning-center/food-allergy/Thank you! Sherry Coleman Collins, MS, RDN, LD sccollins@nationalpeanutboard.org Shenae Rowe, RDN srowe@warrick.k12.in.us Caitlin Merlo, MPH, RDN ihb7@cdc.gov
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