Addressing food allergies at school

03/21/2011
Nutrition
HANNAH ROWLEY, RD, LDN

The number of school-aged children with a food allergy is rising, and driving a real need for comprehensive food-allergy management plans within the school setting. According to the Centers for Disease Control (CDC), one in 25 children has a food allergy, and that represents an 18 percent increase among school-aged children from 1997 to 2007. In addition, about one-sixth of food-allergic children experience a potentially life-threatening reaction in school, according to a recent report in the journal Pediatrics. For schools to create management plans focused on safety, and a positive learning experience, more staff education and training are needed. image

The most common food allergies are to egg, fish, milk, peanut, shellfish, soy, tree nut (i.e. almonds) and wheat. A food allergy is a interaction between an individual’s immune system and a protein within the food. Exposure to the food allergen can cause reactions ranging from mild to life-threatening anaphylaxis. The only treatment is strict avoidance of the allergen.

There is a noted difference between a food intolerance and a food allergy, but most people with an intolerance follow a strict avoidance diet, too. A food intolerance does not involve the immune system and is not life-threatening. People with an intolerance may experience similar reactions, but never anaphylaxis.

Anaphylaxis is a severe allergic reaction that occurs rapidly and may be fatal. Food allergy is a common trigger of anaphylaxis for the school-aged child. Initial symptoms include difficulty breathing; wheezing; rapid swelling throughout the body, especially throat and tongue; confusion or light-headedness; hives; nausea; warm flushed or cool blue skin and itching.

Where Schools Are Lacking

Research studies have identified two weaknesses when it comes to schools and food-allergy management plans. The first deficiency is incomplete plans or the absence of a plan. The second is an inability of school staff to recognize and treat anaphylaxis, the most serious and life-threatening allergic reaction.

Not only should comprehensive plans exist for each student with a food allergy, but training programs focused on recognizing and treating anaphylaxis need to be in place. A complete plan is individualized, centered on prevention, and includes a written emergency plan detailing medical treatment in the event of an allergic reaction. All school staff should be educated on recognizing the symptoms of an allergic reaction, and trained on how to administer epinephrine — the recommended treatment for anaphylaxis.

Key Players and Responsibilities

Avoiding the allergen and being prepared if a reaction occurs are the two main objectives of a successful management plan. The implementation of the plan at a minimum includes the following players: parents, student, school nurse, teacher, principal, food service director and counselor. Each member of the team accepts specific responsibilities. The partnership among team members, coupled with open communication and education, minimizes risk and establishes an inviting environment for food-allergic students.

The Food Allergy and Anaphylaxis Network, with support from other medical organizations, has identified a list of responsibilities specific to each team member.

Parent Responsibilities

  • Notify school of child’s food allergy.
  • Work with school to develop a plan.
  • Provide written medical documentation from physician.
  • Educate child about food allergy.
  • Provide emergency contact information.
  • Review policies and procedures with appropriate school staff after a reaction occurs.

School Responsibilities

  • Understand federal, state and district laws regarding food allergy management.
  • Identify a core team of school staff who work on prevention and treatment plans.
  • Review health records of students.
  • Provide basic food allergy training to all school staff.
  • Practice the plan for handling a reaction to evaluate efficiency and effectiveness.
  • Review policies and procedures with appropriate school staff after a reaction occurs.
  • Identify other school-based settings that require food allergy plans or policies, such as school bus, field trips or after-school activities.

Student Responsibilities

  • Do not trade food with others.
  • Only eat foods and beverages that contain safe, known ingredients.
  • Participate in management of food allergy.
  • Immediately notify a member of the school staff if he or she has consumed something believed to contain the food allergen.

Engaging the food-allergic student in the planning process is important. It promotes the development of lifelong skills necessary to managing his or her food allergy outside of home and school.

Other Management Plan Considerations

Schools invest a significant amount of time and energy in developing individualized plans for food-allergic students; however, some lesser-known challenges can be easily overlooked. Identifying these challenges and addressing them guarantees a more complete plan.

Unidentified Food Allergies

Preparation is key to addressing unidentified, life-threatening food allergies. A significant number of anaphylaxis incidents occur in school before a child is diagnosed with a food allergy. After reviewing district and state regulations, it is recommended that schools collaborate with the appropriate school health staff and physicians to establish a general anaphylaxis protocol. A prescription for unassigned epinephrine, for general use, may be prudent.

Reactions Outside Dining Hall

While the dining hall is tagged as the most common place for an allergic reaction to occur, studies indicate they also occur elsewhere. Craft projects, parties in the classroom and food sharing on school buses may pose a greater risk of accidental exposure. All areas and/or activities where food is available, even in non-edible forms like craft projects, must be identified in a food-allergy management plan.

Cleaning of Hands and Surfaces

The majority of allergic reactions are a result of consumption, skin contact or inhalation. However, any exposure to allergens can lead to ingestion, especially in preschool-age or younger children. According to a study in the Journal of Allergy and Clinical Immunology, when it comes to cleaning hands, bar or liquid soap with running water, and commercial wipes, such as Wet Ones®, are effective. Antibacterial hand sanitizers, however, leave traces of allergens. When cleaning table surfaces, common household cleaning agents like Formula 409® or Lysol® sanitizing wipes work, but dishwashing liquid alone leaves allergen residue.

Bullying

Children with food allergies commonly report fear, depression and anxiety. Targets of bullying are more likely than other children to be anxious, depressed and lonely. A 2010 study published in the Annals of Allergy, Asthma and Immunology revealed that more than 30 percent of children with food allergies are repeatedly bullied by other students and teachers. Reported instances of bullying involved contact with the allergen or threats of contact, which poses safety risks. Addressing the correlation between food allergies and bullying is important to any plan.

The goal of a food-allergy management plan is access to a safe and warm learning environment. This goal is achievable through partnerships, open communication and education.

Additional Resources

The Food Allergy and Anaphylaxis Network (FAAN) at www.foodallergy.org is the leading organization on awareness and education of food allergies. You will find a wealth of information including the School Food Allergy Program, example of an emergency treatment plan, overview of school guidelines endorsed by professional organizations, and a training video on how to administer epinephrine.

Centers for Disease Control and Prevention www.cdc.gov/Healthyyouth/foodallergies/index.htm. In addition to providing general food allergy information, this site contains a 90-minute webcast, Food Allergies and Schools: Keeping Students Safe and Ready to Learn.

Hannah Rowley, RD, LDN, is Chief Dietitian for SAGE Dining Services, the nation’s leading provider of campus dining services for independent schools. She can be reached at [email protected].
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