1

ADDRESSING FOOD ALLERGIES

IN SCHOOLS[PRESENTER, TITLE]

[ORGANIZATION]

[DATE]

2

SESSION OBJECTIVES

1.Develop an awareness of food

allergy basics

2.Learn why schools should address

food allergies

3.Understand the components of

food allergy policy

4.Learn about resources for policy

and practice

3

Food allergy is a potentially serious immune

response to eating or otherwise coming into

contact with certain foods or food additives.

A food allergy occurs when the immune system:

1) identifies a food protein as dangerous and

creates antibodies against it; and

2) tries to protect the body against the danger by

releasing substances, such as histamine, tryptase,

and others, into our blood when that food is

eaten.

4

FOOD ALLERGY VS. FOOD INTOLERANCE

Food allergy is a potentially serious immune

response to eating certain foods.

Food Intolerance is an adverse reaction to food

that does not involve the immune system and is

not life-threatening.

Example

Lactose intolerance

Trouble digesting milk sugar (lactose)

Symptoms

Might include abdominal cramps, bloating and

diarrhea

MD13

Slide 4

MD13 This slide should be in the introduction, possibly following slide 3?CDC, 5/17/2011

5

One or more symptoms:

Can occur within minutes up to hours

Can be mild to life-threatening

Trouble

swallowing

Shortness

of breath

Repetitive

coughing

Voice

change

Nausea &

vomiting

Diarrhea

Abdominal

cramping

Drop in blood

pressure

Loss of

consciousness

Swelling

Hives

Eczema

Itchy red

rash

SYMPTOMS

6

LIFE-THREATENING REACTION:

ANAPHYLAXIS

A serious allergic reaction that is rapid in

onset and may cause death

Food Insect Venom Medications Latex

7

TREATMENT OF ANAPHYLAXIS

• Epinephrine by injection is the treatment for a

serious reaction

• Quick administration is key – a delay can be

deadly

• Follow-up care and observation in the

emergency room for 4-6 hours

• Biphasic reactions occur about 20% of the time

(symptoms improve or disappear, then the 2nd

wave can be worse than the first)

8

WHY SHOULD SCHOOLS BE PREPARED

TO ADDRESS FOOD ALLERGIES?

• Responsibility for health and safety of children at

school

• Food allergy is the most common cause of

anaphylaxis.

• Need for immediate response

• Factor when dealing with other chronic conditions.

• Unique social and emotional challenges

9

WHY IS COMPREHENSIVE

FOOD ALLERGY POLICY NEEDED?

• Increased presence of students with food allergy; 18% increase (children under 18) 1997 –2007

• All students need to be safe and ready to learn– Teens are the highest risk group for fatal allergic reactions

• Emergencies are inevitable– Proactive approach rather than reactive

BZG4

Slide 9

BZG4 What is a digestive allergy? I don't think I've heard that term before.BZG, 4/25/2011

10

LAWS AND LIABILITY

• A life-threatening food allergy can be considered a disability under federal laws

– Rehabilitation Act of 1973, Section 504

– The Individuals with Disabilities Education Act (IDEA)

– The Americans with Disabilities Act (ADA), along with the ADA Amendments of 2008 (ADAA)

• Assure compliance for privacy and confidentiality

– Family Educational Rights and Privacy Act (FERPA) and

– Health Insurance Portability and Accountability Act of 1996 (HIPAA)

• Civil rights claim on behalf of student

– Follow the laws or parents/caregivers can file a claim

11

MANAGING FOOD ALLERGIES

Shared responsibility among schools, students,

families, and healthcare providers

Avoidance of food allergens

Being prepared in case of a reaction

12

Student’s

Safety

Healthcare

Providers

Physicians, Nurses,

Allied Health

Professionals

School

Administrator

Nurse

Food Service

Faculty

Others

Families

including

students

The Partnership

Communication / Education

13

AVOIDANCE OF KNOWN

FOOD ALLERGENS

Eight (8) foods cause ninety (90) percent

of the food allergic reactions in the United

States:

Milk Peanuts

Eggs Tree Nuts

Wheat Fish

Soy Shellfish

14

REVIEW

What Questions

Come to Mind?

15

Comprehensive Policy Guidance:

Management of Life-Threatening Food

Allergies in Schools

SAFE AT SCHOOL AND READY TO LEARN:

10 POLICY COMPONENTS

1. Identification of students with food allergies and provision of

school health services

2. Individual written management plans

3. Medication protocols: storage, access, and administration

4. Healthy school environments: comprehensive and coordinated

approach

5. Communication and confidentiality

6. Emergency response

7. Professional development and training for school personnel

8. Awareness education for students

9. Awareness education and resources for parents/caregivers

10. Monitoring and evaluation

16

17

IDENTIFICATION OF STUDENTS WITH FOOD

ALLERGIES AND PROVISION OF SCHOOL

HEALTH SERVICES

• Identify students with food allergies

• Provisions of appropriate school health

services, including medication

administration

• Follow state and federal privacy and

confidentiality laws

18

INDIVIDUAL WRITTEN MANAGEMENT PLANS

• Individual Healthcare Plan (IHP or IHCP)

• Emergency Care Plan (ECP)

• Develop in collaboration with others

MD12

Slide 18

MD12 Last sentence in the notes section should read ..." A 504 plan is needed or required." CDC, 5/24/2011

19

FOOD ALLERGY ACTION PLAN

20

MEDICATION PROTOCOLS: STORAGE,

ACCESS, AND ADMINISTRATION

• Allow for quick access

• Protect the safety of students and the

medications

• Follow state laws for storage, access, and

administration of medication

21

HEALTHY SCHOOL ENVIRONMENTS:

COMPREHENSIVE AND COORDINATED

APPROACH

Create a plan to manage food allergy

across the school system

• Classrooms

• Cafeteria

• Buses

• Field Trips

• Before/after school programs

• School sponsored events

22

COMMUNICATION AND CONFIDENTIALITY

• Comply with state and federal privacy and

confidentiality laws and accommodate parent

requests, as feasible

• Develop plans with the intent to inform all

personnel involved in the care of a student and

increase and enhance awareness of life-

threatening food allergies

23

EMERGENCY RESPONSE

• Food allergy as part of an “all-hazards

approach”

• Written emergency procedures for dealing with

a life-threatening food allergy reaction

- Assure rapid accessibility to epinephrine to prevent a

delayed response

• Roles and responsibilities

24

PROFESSIONAL DEVELOPMENT AND

TRAINING FOR SCHOOL PERSONNEL

• Check for compliance with policies and

procedures

• Provide annual training:

• District/school policies, procedures, and plans for

managing students with chronic health conditions

• Basic information such as signs, symptoms, and

risks associated with food allergy and anaphylaxis

• Strategies that reduce the risk of exposure to

identified allergens throughout the school day

25

AWARENESS EDUCATION FOR STUDENTS

• Educate all students on food allergy

• Incorporate food allergy awareness as part of

the district’s health education curriculum

• Provide annual education:• Support for classmates with chronic health conditions, such as food

allergy

• Knowledge of potential allergens and the signs, symptoms and

potential of a life-threatening reaction

• Importance of following district health and wellness policies and

relevant guidelines regarding hand washing, food-sharing, allergen-

safe zones, and student conduct.

26

A TOPIC NOT TO BE OVERLOOKED:

BULLYING

• Teasing or taunting for food allergy should never be allowed; bullying could come from students, teachers, staff, or parents

• For staff: Bullying prevention, including responsibility to address any harassment, hazing (e.g., forced consumption of the known allergen), or bullying and enforce consequences

• For students: Bullying prevention, including reporting any harassment, hazing or bullying to appropriate school personnel.

• School’s response to reported bullying should be made clear at the outset, should be followed through, and should be both therapeutic and punitive

27

AWARENESS EDUCATION AND RESOURCES

FOR PARENTS/CAREGIVERS

• Provide awareness education and resources

through use of qualified personnel. Increase

understanding of special needs of students

with food allergies.

• In-person education is desirable, but written

communications can also be effective

28

MONITORING AND EVALUATION

• Creating food allergy policy is a process that can be

modeled after CDC’s 6-Steps Framework

• Assess needs and review data

• Engage stakeholders

• Educate, practice and communicate about

policies and programs

• Focus the evaluation design

• Gather credible evidence and justify conclusions

• Implement needed changes and share lessons

learned

• Review and update policy and practices after an

incident of food allergic reaction and at least

annually

29

MONITORING AND EVALUATION

The guide’s policy component checklist:

• Systematic approach to managing food

allergies

• Gauges areas that need attention and

identifies specific actions for

improvement

• Tracks inclusion and implementation

of each element

30

MONITORING AND EVALUATION

Instructions for the policy component checklist:

• Check “Included” or “Not Included” for whether or

not each element is in the policy

• If the element is included in the policy, check

if the element has been “Implemented” or

“Not Implemented” in practice

• Use notes section to document specific actions for

improvement

Optimal: Each element is both “Included” and

“Implemented” at the district and school levels

31

ElementsIncluded Not

Included

Implemented Not

Implemented

Notes: Specify what is needed for

this element to be included and/or

implemented

1. Collect information on

students with life-

threatening food allergies

2. Coordinate a process to

acquire current student

information from

healthcare providers and

parents

3. Document and keep

current parental consent

for medication

administration

Essential Component A: Identification of students with life-

threatening food allergy and provision of school health servicesDevelop, implement, monitor, and update a school health services plan for students

with food allergies in accordance with privacy/confidentiality laws.

FOOD ALLERGY POLICY COMPONENT CHECKLIST Sample

32

POLICY EXAMPLE

The NSBA Food Allergy

Policy Guide contains

sample policies:

• Liberty School District,

Missouri

• Waukee School District,

Iowa

• Connecticut Association of

Boards of Education

• State of Rhode Island

Excerpt from Liberty School District, MO

Allergy Management Policy

Board Policy JHC

Liberty Public Schools is committed to providing a

safe and nurturing environment for students. The

Liberty Board of Education understands the

increasing prevalence of life threatening allergies

among school populations. Recognizing that the risk

of accidental exposure to allergens can be reduced

in the school setting, Liberty Public Schools is

Committed to working in cooperation with parents,

students, and physicians, to minimize risks and

provide a safe educational environment for all

students. The focus of allergy management shall be

on prevention, education, awareness,

communication and emergency response.

33

REFERENCES

• American Academy of Allergy, Asthma, and Immunology (AAAAI) Board of Directors. (1998). Anaphylaxis in

schools and other child-care settings. Journal of Allergy and Clinical Immunology, 102, 173-176.

• Branum, A. M. & Lukacs, S. L. (2008). Food a llergy among U.S. children: Trends in prevalence and

hospitalizations. NCHS Data Brief (No. 10).

• Branum, A, M. & Lukacs, S.L. (2009). Food allergy among children in the United States. Pediatrics, 124, 1549-55.

• Bock, S.A., Muñoz-Furlong, A., & Sampson, H.A. (2007). Further fatalities due to anaphylactic reactions to food:

2001 to 2006. Journal of Allergy and Clinical Immunology, 119, 1016-1018.

• Centers for Disease Control and Prevention. (2009). Framework for program evaluation in public health. MMWR:

Recommendations and Reports. 48, 1-40. Retrieved from

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm

• Decker, W.W., Campbell, R.L., Manivannan, V., Luke, A., St Sauver, J.L., et a l. (2008). The etiology and incidence of

anaphylaxis in Rochester, Minnesota: A report from the Rochester Epidemiology Project. Journal of Allergy and

Clinical Immunology, 122, 1161-1165.

• Food Al lergy &Anaphylaxis Network (FAAN). (n.d.). Frequently asked questions. Retrieved from

http://www.foodallergy.org/questions.html

• Lieberman, J.A., Weiss, C., Furlong, T.J., Sicherer, M., Sicherer , S.H. (2010). Bullying among pediatric patients

with food allergy. Annals of Allergy, Asthma & Immunology, 105, 282-286.

• Massachusetts Department of Education. (2002). Managing life threatening food allergies in school. Retrieved

from http://www.doe.mass.edu/cnp/allergy.pdf

• National Association of School Nurses (NASN). (2010). Position s tatement: Delegation.

• NASN. (2004). Pos i tion statement: Rescue medications in school.

34

REFERENCES• New York State Department of Health, New York State Education Department, & New York Statewide School

Health Services Center. (2008). Making the difference: Caring for students with life-threatening food allergies.

• One Hundred Eleventh Congress of the United States of America. (2010). H.R. 2751: FDA Food Safety

Modernization Act. Retrieved from http://www.gpo.gov/fdsys/pkg/BILLS-111hr2751enr/pdf/BILLS-

111hr2751enr.pdf

• Rotrosen, D., & Fauci, A. (2008). Ra ising awareness of the personal and research challenges of

food a llergy. Retrieved from http://www3.niaid.nih.gov/news/newsreleases/2008/food_allergy08.htm

• Sheetz , A. H., Goldman, P. G., Mi l lett, K., Franks, J. C., McIntyre, C. L., Carrol l, C. R., et a l.,

(2004). Guidelines for managing life-threatening food allergies in Massachusetts schools. Journal of

School Health, 74, 155-160.

• Sicherer, S.H., Furlong, T.J., DeSimone, J., & Sampson, H.A. (2001). The U.S. peanut and tree

nut a l lergy registry: Characteristics of reactions in schools and child care. Journal of Pediatrics, 138, 560-565.

• Sicherer, S.H., Mahr, T., & the Section on Allergy and Immunology. (2010). Management of

food allergy in the school setting. Pediatrics, 126, 1232-1239.

• U.S. Department of Agriculture Food and Nutrition Service. (2001). Accommodating children with

special dietary needs in the school nutrition programs. Guidance for school food service staff.

Retrieved from http://www.fns.usda.gov/cnd/guidance/special_dietary_needs.pdf

• U.S. Department of Education. (2000). Office of Civil Rights memorandum regarding the prohibition

of disability harassment. Retrieved from http://www.ed.gov/about/offices/list/ocr/docs/disabharassltr.html

• U.S. Department of Education. (2007). Free appropriate public education for students with

disabilities: Requirements under Section 504 of the Rehabilitation Act of 1973. Retrieved from

http://www.ed.gov/about/offices/list/ocr/docs/edlite-FAPE504.html

• Young, M.C., Muñoz-Furlong, A., Sicherer, S.H. (2009). Management of food allergies in schools: A perspective

for a l lergists. Journal of Allergy and Clinical Immunology, 124, 175-182.

35

FOOD ALLERGY RESOURCES:

www.foodallergy.org

www.nasn.org

www.cdc.gov/healthyyouth/

National School Boards Association

Division of Adolescent and School Health (DASH)

www.nsba.org/schoolhealth

www.fns.usda.gov/cnd/guidance/special_dietary_needs.pdf

36

THANK YOU

WHAT QUESTIONS DO YOU

HAVE?

For more information contact:

National School Boards Association, School Health Programs703-838-6722

SchoolHealth@nsba.orgwww.nsba.org/SchoolHealth