Managing Food Allergies Requires a Comprehensive Approach

01/07/2018
WELLNESS
By Sherry Coleman Collins

Food allergy management is a hot topic in many school districts each year, but myths and misinformation can make food allergy management even more of a challenge. 

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Schools should begin the process of food allergy management with a good understanding of the facts about food allergies, so that they can use best practices to develop comprehensive plans. Addressing food allergies should be a team approach, including all school staff with contact and responsibility for student safety and health.

Food Allergy Basics

Approximately six to eight percent% of children have some sort of food allergy with less than 2 percent allergic to peanuts. Many children will outgrow their allergy before they are school-age. Even so, allergies to the Big 8 (milk, egg, peanut, tree nut, fish, shellfish, soy and wheat) can linger a lifetime. Milk and egg are the most common foods to elicit allergic reactions, but more than 150 foods have been implicated.

Symptoms of food allergy reaction can include hives, itching and swelling of the mouth, tongue or throat, vomiting, difficulty breathing, and a drop in blood pressure. Studies have shown that simply being near an allergen does not cause a food allergy reaction. Reactions can be triggered by skin contact, but these are less common and generally mild. Anaphylaxis is caused by ingesting the allergenic food and is the most dangerous type of food allergy reaction, involving more than one organ system, and can happen quickly, even if it has never happened before. The only treatment for anaphylaxis is injectable epinephrine.  Although food allergy deaths are rare, they do happen; so prevention and preparedness are essential.

Accommodating Food Allergic Students

Food allergies may be considered a disability, according to the Americans with Disabilities Act (ADA), if they interfere with one or more activities of daily living. This means that schools must provide reasonable accommodations for food allergic students. Reasonable accommodations could include a variety of measures, such as ensuring access to safe foods, allowing a student to carry their own medication, and creating an allergen-safe table in the cafeteria, among other possibilities. Schools should never agree to provide an accommodation that they are unable to execute. Some students with food allergies may request a section 504 plan, however these are not always necessary.

Keys to Successful Food Allergy Management

Because food is eaten throughout the school campus, on buses, and in extra-curricular settings, it is essential to employ a comprehensive approach. Here are some important keys for success:

  • Provide annual food allergy training to all staff with more detailed training to those with direct contact with the allergic student. Include topics such as identifying a reaction, how to respond to a reaction, preventing accidental ingestion and cross-contact, and proper cleaning.
  • Have a standard system to identify food allergic students at enrollment, and to obtain and distribute appropriate documentation to essential staff (especially to school nurse or student health and food and nutrition services)
  • Include all stakeholders and pertinent staff in planning reasonable accommodations; including students, parents, teachers, administrators, school nurses, child nutrition services, transportation, athletics and after-school staff.
  • Clearly communicate the food allergy management plans with parents, students, and staff at back-to-school training, on the district and school websites, printed and digital menus, and in appropriate locations within the building.
  • Focus on caution and preparedness, not bans; which may result in a false sense of security.
  • Consider allergy-aware areas, such as in classrooms with allergic children, designated cafe tables, and on all buses.
  • Know your state’s laws around epinephrine – most states require or allow schools to have non-student epinephrine on site to treat food allergy reactions, particularly for those who might not even know they have an allergy.

Research

Studies have recently shown what experts have said for years, food bans don’t reduce the risk of anaphylaxis in school. These studies are informative about the role of banning peanuts and tree nuts in particular. One Canadian study showed that schools that claimed to be “peanut free” had almost twice as many food allergy reactions than those that did not restrict peanuts. A second study showed that there was no significant difference between the use of epinephrine in schools that claimed to be “nut free” as compared to those that did not have nut bans. However, having “peanut free” tables in the café did reduce reactions. Many experts agree that food bans create a false sense of security for those with food allergies. Furthermore, bans put the focus on enforcement rather than education. Finally, banning peanuts and tree nuts does not reduce the risk of anaphylaxis due to other potential allergens, such as milk. More research is needed in this area, but these studies support a case for comprehensive management, instead of simply banning peanuts and tree nuts.

Resources for Schools

The Centers for Disease Control and Prevention (CDC) released Voluntary Guidelines for the Management of Food Allergies in Early Care and Education in 2010 to help schools learn to better manage this important issue. This PDF is free from the CDC website. More recently, they have created an accompanying web-based Food Allergy Management Toolkit that includes turn-key resources for training the school community.

The School Nutrition Association has recently launched their Food Allergy Resource Center, a clearinghouse of information for school nutrition professionals. The Resource Center includes links to webinars, guidelines, and food allergy advocacy organizations, as well as an “ask the expert” and frequently asked questions sections. Developed in partnership with the National Peanut Board, visitors are also encouraged to visit PeanutAllergyFacts.org to view videos and get more information about peanut allergies specifically.

Summary

School district leaders and those charged with student health and wellness should begin by assessing their district’s current food allergy policy and develop a plan from there with the input of all stakeholders. Thoughtful consideration should be given to the creation of plans that promote safe, inclusive, and reasonable accommodations. Successfully managing food allergies in schools takes a team approach and should include students, parents, and school staff working together to keep those with food allergies safer.

 

 

Sherry Coleman Collins is a registered dietitian and food allergy expert in the metro-Atlanta area. She is the author of the Academy of Nutrition and Dietetics’ practice paper, The Role of the RDN in the Diagnosis and Management of Food Allergies, and co-creator of the Academy’s food allergy certificate of training, Food Allergies: Cutting Through the Clutter. Sherry is a consultant to the National Peanut Board, a sought-after speaker, and frequent contributor to online and print publications
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