Food Allergy Awareness and Management

University of Wisconsin

Jo Hopphoppj@uwstout.edu

Food Allergy Awareness Agenda

Introduction

Food Allergy Basics

Peanut Allergy Basics

Managing Peanut Allergies at School

Reactions and the Epi-pen

Resources and Information

Food Allergy and Anaphylaxis Network (FAAN)

American Academy of Allergy, Asthma and Immunology

National Institute of Allergy and Infectious Disease

FEAST of Seattle, WA Various websites dedicated to food allergy

advocacy (e.g. peanutallergy.com)

THANK YOU, THANK YOU(we can’t say it enough)

Wakanda Elementary School Administration and Teachers

Menomonie School District

Wisconsin Recipients of 3 Mariel C. Furlong

Awards (2006) Contributions of food allergy awareness,

education and advocacy

What is a Food Allergy? Immunological response to food (allergic

reaction) Body protecting itself – release of histamine Affects multiple body systems:

GI Respiratory Skin Cardiovascular

Exposure can cause serious problems or death

Intolerance vs. Allergy

Intolerance Reaction to the chemicals in food No immune system response No serious (life-threatening) side-

effects Bloating, gas, abdominal discomfort

Public impression Parental interaction

Food Allergy FactsWhat the experts say

Doubling of food allergy over the past 10 years, particularly peanut allergy. Latest statistics show continual increase with

peanut allergy as the leading cause

~12 million Americans affected (4%) ~ ½ are peanut and/or tree nut ~3 million school aged children (~8%) Onset at any age

www.foodallergy.org

Food Allergy FactsWhat the experts say

Food allergy is the leading cause of serious allergic reaction (anaphylaxis) outside the hospital setting.

over 30,000 ER visits per year ~ 175 deaths annually reactions caused most often outside the home

and by products believed to be safe Asthma increases risk of fatal reaction Adolescents and young adults are at the

highest risk

www.foodallergy.orgBock, et. al J Allergy Clinical Immunol 2001

Food Allergy FactsWhat the experts say

Sensitivity to the allergen can vary For some, a speck of allergen can have the

same effect as eating a large quantity For some, skin contact with the allergen is

enough to cause a reaction For some, inhalation of the allergen can cause

discomfort Sensitivity is truly ‘unknown’

Affected systems can vary between individuals AND reactions

Food Allergy FactsWhat the experts say

No Cure Strict avoidance is the only way to prevent allergic

reactions

Food Allergy FactsWhat the experts say

Eight foods account for 90% of all reactions

Peanut Allergy Specific

1/250 of a peanut is enough to trigger a reaction (cutting a peanut in half 125 times!) Hourihane, J. J Allergy Clin Immunol 1997

Severe allergies are typically life-long

High cross-reactivity to tree nuts (almonds, walnuts, etc.)

Peanut Allergy Specific

Peanut allergies tend to cause the most severe reactions

Peanut or tree nut allergies and asthma appear to increase the risk for fatal reactions

A study (2001) of 32 cases of fatal food-allergy induced anaphylaxis showed >90% had peanut and tree nut allergies, most had asthma and emergency medication (epinephrine) was not given or not given soon enough. Bock, et al. J Allergy Clin Immunol 2001

A more recent study (2007) also showed a large majority of fatalities due to peanuts/tree nuts and asthma.

Estimated that at least ½ of deaths are result of peanut/tree nut

Allergic Reactions - facts

Severity of reaction can vary from mild to serious and potentially fatal

Previous reactions DO NOT indicate future reactions An unpredictable physiological change occurs

after each exposure

Within a couple minutes to 2 hours after exposure (and in rare cases longer) Once reaction starts, progression can vary Not just a lunch-time event!

Can be biphasic

What is anaphylaxis?

Most severe allergic reaction

Involves multiple systems at the same time

Potentially fatal, especially if medication is not given promptly (at first signs)

What is anaphylaxis?

Can occur within minutes of exposure (death can occur within as few as 6 minutes)

Pattern can vary among individuals

Peanut/Tree nut allergies in combination with asthma is the highest risk

Managing Food/Peanut Allergies in Schools

Strict Avoidance

No cure for food allergies

Key is helping children avoid allergens Good attitude Careful handling Cross-contamination Label reading Expecting the Unexpected

Good Attitude

Nothing is 100% safe ‘peanut free’ environment only reduces the

risk of exposure, it does not eliminate risk Even food from home is a risk Food and food consumption IS NOT the only

risk Exposure can occur in non-food items Exposure can occur on surfaces, in

projects, outdoors Vigilance is key

Good Attitude

Setting an example

Teaching Empathy

Good Communication with Families

Careful handling

Allergic children can react through Ingesting Contact Inhaling

Everyone has to be aware, as reactions can occur at varying times after exposure Just because you aren’t around during lunch

doesn’t mean that you won’t be needed for a reaction

Avoiding Cross-Contamination

What to do Require thorough hand washing and teeth

brushing especially if you suspect a student has eaten peanuts/nuts

Clean eating and working areas carefully

Discourage food sharing

Have “safe” snacks and treats from family

Do not allow homemade goodies or home prepared foods (e.g. apples cut at home)

Label Reading

Food Allergen Labeling and Consumer Protection Act (FALCPA) As of January 1, 2006, labels must list

common language for the top 8 allergens

Reading labels carefully can save a child’s life Foods can be analogous to poison

Sta

ndard

Label

“Contains” Statements

“Contains” Statement Policy

Only required for allergens not clearly stated in the ingredient list.

Chef Boyardee Pizza

Warning Labels

May also say “manufactured in a facility that also processes peanuts”

Ingredients: ENRICHED FLOUR (WHEAT FLOUR, NIACIN, REDUCED IRON, THIAMINE MONONITRATE {VITAMIN B1}, RIBOFLAVIN {VITAMIN B2}, FOLIC ACID), SUGAR, PARTIALLY HYDROGENATED SOYBEAN AND/OR LIQUID SOYBEAN OIL AND/OR PARTIALLY HYDROGENATED COTTONSEED OIL, HIGH FRUCTOSE CORN SYRUP, GRAHAM FLOUR, BROWN SUGAR, COCOA (PROCESSED WITH ALKALI), BAKING SODA, CORNSTARCH, SALT, CHOCOLATE, MILK (ENZYME MODIFIED), NATURAL AND ARTIFICIAL FLAVOR, SOY LECITHIN (EMULSIFIER).

What NOT to give

If label is ambiguous as to presence of peanut

If no label present

Homebaked items

Ice cream

Bakery Items

Imported Foods

Expecting the Unexpected

What might contain peanuts/tree nuts?

It’s NOT ONLY in the food!!!

A New School Year…new faces, new information

Your Students and Families

Education and Support is critical to keep ALL children safe at school

Hand out Constant reminders are necessary, especially around

birthdays and holidays

Be consistent in policies Be an advocate and an example – avoid confusion

Engage the students in awareness Likely not understand necessity of peanut-free

environment Educate the students

Teach empathy Take bullying seriously PAL Program

Management in the school and classroom

Nothing is 100% safe

Cross-contamination is a serious threat

Label reading is critical

Peanuts/nuts can be in unusual items (not even food related)

Know the students – know the plan Locations of medication How to recognize reaction How to use medication

Possible Exposures

Ingestion

Contact

Inhalation

Eating, Mucus Membranes, Eczema

Signs of an Allergic Reaction

Hives Difficulty Breathing Vomiting Diarrhea Eczema Flare Lightheadedness Swelling

What a Child May Say

I think I am going to throw up

My mouth/tongue itches

My chest feels tight

I feel itchy

My tongue feels hot/burning/tingling/heavy

There’s something in my throat

My lips feel tight

My tongue feels like there is hair on it

Feels like bugs are in my ears

Food Allergy News, Vol 13, No 2; 2003

What can be done???

GIVE EPINEPHRINE!!! (Epi-pen)

Administering an Epi-pen

Hold 15 seconds

Jab black end into outer thighUse enough force to make a bruiseThis can be done through clothing

Remove grey activation cap

Keep patient lying down

Call 911

After injection, call 911 right away

Tell them that you have a child who is experiencing anaphylaxis, you have administered the epi-pen, and to bring more epinephrine!

Emergency Action Plan

Varies for individual child

Action plan should be in place that is SPECIFIC for each allergic child

Know the plan

Know where the medication is located

THANK YOU

You can make a difference in the life of a food allergic child. Please be an advocate.