Oak Hill School | Food Allergy Management 1
Academic Year 2013-2014 Adopted Ju ly 1, 2010 Revised February, 2014 Next Review July 1, 2014
Oak Hill School 4815 Franklin Road
Nashvi l le, Tennessee 37220 (615) 297-6544
Allergy Policy and Emergency Response Plan
Oak Hill School | Food Allergy Management 2
Allergy Policy and Emergency Response Plan Table of Contents Guidel ine Overview & Goals 3 Al lergy and Anaphylaxis Overview 5 Planning and Implementat ion 8 Prevent ion 20 Training 21 Emergency Response Plan 22 State and Federal Laws 23 Appendix A – Food Label Reading & Terms 25 Appendix B – Forms 29 Appendix C – Sample Letter 29 Appendix D – Resources 30
Oak Hill School | Food Allergy Management 3
GUIDELINE OVERVIEW & GOALS Goals of Allergy Management Oak Hil l School is committed to providing a safe and nurturing environment for students. The School understands the increasing prevalence of l i fe threatening al lergies among school populat ions. Recognizing that the r isk of accidenta l exposure to allergens can be reduced in the school sett ing, Oak Hil l School is committed to working in cooperat ion with parents, students, and physicians, to minimize r isks and provide a safe educat ional environment for all students. The focus of allergy management shall be on prevention, education, awareness, communication and emergency response. The goals for allergy management include:
• To def ine a formal process for ident ifying, managing, and ensuring continuity of care for students with l i fe-threatening allergies across al l t ransit ions (PreK-6). This process shal l be out l ined in detai l in the School ’s administrat ive procedures manual.
• To maintain the health and protect the safety of children who have l i fe-threatening al lergies in ways that are developmental ly appropr iate, promote self -advocacy and competence in self -care and provide appropr iate educational opportunit ies.
• To ensure that interventions and individual health care plans for students with l i fe-threatening al lergies are based on medical ly accurate information and evidence-based pract ices and in accordance with applicable law, it is the policy of the School to provide all students, through necessary accommodations where required, the opportunity to part ic ipate in al l school programs and act ivit ies. Accordingly, the Head of School shal l direct all employees to act aff irmatively and work closely with parents to assure that the needs of children with documented al lergies are taken into considerat ion in planning for school programming. The Nurse shall ensure the School ’s management plan is reviewed and updated annual ly.
Food Allergy Prevalence
According to the Centers for Disease Control and Prevention (CDC), among chi ldren aged 0–17 years, the prevalence of food allergies increased f rom 3.4% in 1997–1999 to 5.1% in 2009–2011. The prevalence of skin al lergies increased f rom 7.4% in 1997–1999 to 12.5% in 2009–2011. From 1997 to 2007, the prevalence of reported food al lergy increased 18% among chi ldren under age 18 years. Four out of every 100 chi ldren have a food allergy.
Impact on the school
Studies show that approximately 16 to 18 percent of children with food allergies have had a react ion at school, and react ions also occur among others without a previously diagnosed food allergy.
Oak Hill School | Food Allergy Management 4
Food Allergy Reactions
Allergic reactions to foods vary among students and can range f rom mild to severe l i fe-threatening anaphylact ic reactions. Some students, who are very sensit ive, may react to just touching or inhal ing the allergen. For other students, consumpt ion of as l i t t le as one f ive-thousandth of a teaspoon of an al lergenic food can cause death. Eight foods (milk, eggs, peanut, tree nut, soy, wheat, f ish and shel l f ish) account for 90% of total food al lergies, although any food has the potent ial to cause an al lergic react ion. Most, but not al l chi ldhood al lergies to milk, egg, soy and wheat are outgrown by age 5. Peanuts and tree nuts account for 92% of severe and fatal react ions, and along with f ish and shel lf ish, are of ten considered l i felong al lergies.
Oak Hill School | Food Allergy Management 5
ALLERGY AND ANAPHYLAXIS OVERVIEW
Food Allergies
A food al lergy is def ined as an adverse health effect arising f rom a specif ic immune response that occurs on exposure to a given food. The immune response can be severe and l i fe- threatening. Although the immune system normally protects people f rom germs, in people with food allergies, the immune system mistakenly responds to food as if i t were harmful. One way that the immune system causes food al lergies is by making a protein antibody cal led immunoglobulin E (IgE) to the food. The substance in foods that cause this reaction is cal led the food allergen. When exposed to the food al lergen, the IgE antibodies alert cel ls to release powerful substances, such as histamine, that cause symptoms that can af fect the respiratory system (cough, dif f iculty breathing, wheezing), gastrointest inal tract (vomit ing, diarrhea, abdominal pain), skin ( itching, hives, rash), or cardiovascular system (decreased blood pressure, heartbeat i rregularit ies, shock) and lead to a l i fe- threatening react ion cal led anaphylaxis . Food al lergy is the most common cause of anaphylaxis, but other al lergens such as insect st ings, latex, and medicat ions can also cause l i fe-threatening al lergies. Insect Allergy Stinging Insects commonly include bees, hornets, yel low jackets, wasps, and f ire ants. For most people, complicat ions include pain and redness at the bite site. However, some people have a true allergy to insect st ings that can lead to l i fe-threatening anaphylaxis. In these cases, prompt management of the reaction is needed. Latex Allergy Latex allergy is a reaction to certain proteins in latex rubber found in such products as balloons, gloves, and gym equipment. Two common types of reactions include contact dermatit is and immediate moderate to severe al lergic reactions. Contact dermatit is, a type of local ized allergic react ion to the skin, can occur on any part of the body that has contact with latex products, usually af ter 12-36 hours. Immediate al lergic react ions however, are potential ly the most serious form of allergic react ions to latex products. Anaphylaxis Anaphylaxis is a potential ly l i fe-threatening medical condit ion occurr ing in al lergic individuals af ter exposure to their specif ic allergen and requires immediate medical attention. I f a student is exhibit ing signs of a l i fe- threatening al lergic react ion, epinephr ine must be given immediately. Epinephrine (adrenaline) is a medicat ion that can reverse the severe symptoms of anaphylaxis. I t is given as a “shot” and is avai lable as a self - injector, also known as an epinephrine auto- injector that can be carr ied and used if needed. Epinephrine is a highly ef fect ive medicat ion, but it must be administered promptly during anaphylaxis to be most effect ive.
Oak Hill School | Food Allergy Management 6
Anaphylaxis can occur immediately or up to two hours following allergen exposure. Some reactions are biphasic in nature with an init ial per iod of symptoms, a symptom free period for 2-4 hours, followed by another wave of severe shock-l ike symptoms. Therefore, it is imperative that following the administration of epinephrine, the student be transported by emergency medical services to the nearest hospital emergency department even if symptoms appear to have been resolved. Oak Hil l School has stock epinephr ine at the school. The epinephrine wi l l be used in emergencies for students with unknown al lergies who develop an anaphylact ic response and for those students with known al lergies when on rare occasions when their personal emergency medicat ion is found to be f lawed. Symptoms of Anaphylaxis Anaphylaxis refers to a collection of symptoms affecting multiple systems in the body. Symptoms associated with an allergic reaction include one or more of the following:
• Mucous Membrane Symptoms: red watery eyes or swollen l ips, tongue, or eyes.
• Skin Symptoms: i tchiness, f lushing, rash, or hives.
• Gastrointestinal Symptoms: nausea, pain, cramping, vomit ing, diarrhea, or acid ref lux.
• Upper Respiratory Symptoms: nasal congestion, sneezing, hoarse voice, trouble swal lowing, dry cough, or numbness around mouth.
• Lower Respiratory Symptoms: deep cough, wheezing, shortness of breath or dif f iculty breathing, or chest t ightness.
• Cardiovascular Symptoms: pale or blue skin color, weak pulse, dizziness or faint ing, confusion or shock, hypotension (decrease in blood pressure), or loss of consciousness.
• Mental or Emotional Symptoms: sense of “ impending doom”, irr itabi l i ty, and change in alertness, mood change, or confusion.
Oak Hill School | Food Allergy Management 7
Children with food allergies might communicate their symptoms in the following ways:
▪ I t feels l ike something is poking my tongue.
▪ My tongue (or mouth) is t ingl ing (or burning).
▪ My tongue (or mouth) itches.
▪ My tongue feels l ike there is hair on it .
▪ My mouth feels funny.
▪ There’s a f rog in my throat; there’s something stuck in my throat.
▪ My tongue feels full (or heavy).
▪ My l ips feel t ight.
▪ I t feels l ike there are bugs in there (to describe itchy ears).
▪ I t (my throat) feels thick. ▪ I t feels l ike a bump is on the back of my tongue (throat).
Source: The Food Al lergy & Anaphylaxis Network. Food Al lergy News. 2003.
This protocol is to be used for students who are at r isk for anaphylaxis and in circumstances where a previously undiagnosed l ife- threatening al lergic response occurs. When a physic ian assesses that a chi ld’s food al lergy wi l l result in anaphylaxis, the chi ld’s condit ion meets the def ini t ion of “disabi l i ty” and is covered under the Federal Americans with Disabil i ty Act (ADA), Section 504 of the Rehabi l i tat ion Act of 1973, i f the al lergy management af fects the student ’s abi l i ty to make educational progress.
Oak Hill School | Food Allergy Management 8
PLANNING & IMPLEMENTATION Individual Healthcare Plan (IHP) Prior to beginning of every school year, the parent/guardian should contact the school nurse to develop and IHP. I f a student is diagnosed with a l i fe-threatening al lergy during the school year, the parent/guardian should notify the school nurse immediately and develop an IHP. The parent/guardian should work with the school nurse to create a strategy for management of a child’s allergy. (See “Responsibi l i t ies of the Parents” for more detai l) . The parent/guardian shal l provide the following:
• Licensed health care provider documentations of al lergy and order for epinephrine by auto- injector as well as other medications needed. Medicat ion orders must be renewed at least annual ly.
• Parent/guardian’s s igned consent to administer all medicat ions.
• Parent/guardian’s s igned consent to share information with other school
staff .
• At least one up to date EpiPen (More may be necessary based on the student ’s act ivit ies and travel dur ing the school day.)
• Descr ipt ion of the student ’s past al lergic reactions, including tr iggers
and warning signs.
• Assessment for self -administrat ion (I t is important that students take more responsibi l i ty for their food al lergies as they grow older and are developmental ly ready to accept responsibil i ty.)
The school nurse wi l l :
• Init iate an Individual Healthcare Plan (IHP) based on the information
provided by the parents, as well as the nurse’s assessment. The IHP shal l include student information, medical information specifying offending al lergens, and a plan of care which includes interventions, supplies, and expected student outcomes.
• Based on the student’s age, class, etc., identify who wi l l be part of the
mult idiscipl inary team. This team may include but not be l imited to administrat ion, c lassroom teacher, student, food services director, PE teacher, enr ichment teacher, and facil i t ies staff .
• Assess the student for his/her abil i ty to self -administer epinephrine. (I t
is important that students assume more responsibi l i ty for their food al lergies as they grow older and are more developmentally ready.)
Oak Hill School | Food Allergy Management 9
• Determine the appropriateness for student to carry his/her epinephrine.
• Ensure Al lergy Act ion Plan (AAP) has been received f rom parent or physician.
Allergy Action Plan Any student diagnosed with a l i fe-threatening al lergy must have an emergency al lergy act ion plan (AAP) to assist the school nurse and staf f in recognizing and providing appropr iate intervention dur ing a cris is. This form can be obtained f rom the student’s health care provider, school nurse, or the Oak Hil l School parent portal. The AAP is a separate document f rom the IHP. Prior to the beginning of every school year, the school nurse wi l l review the medical history forms submitted by parents in an attempt to identify students with l i fe-threatening al lergies as wel l as updat ing exist ing student health information. To ensure a safe learning environment for the student with a l i fe- threatening al lergy, the parents should not ify the school nurse of their chi ld’s allergy and obtain an AAP signed by their chi ld’s physic ian. The AAP should be given to the school nurse no later than the f irst day of school, preferably the week before so proper teaching and planning can take place. The AAP wil l be distr ibuted to al l appropr iate school staf f needing to be trained to respond to a specif ic student ’s anaphylact ic emergency. The AAP should have a current picture of the student on the plan to aid in identif icat ion. The following act ivit ies are recommended for school staff and parents:
• Parents can obtain an AAP from the Oak Hi l l School parent portal to be reviewed and signed by the student’s health care provider and parent.
• Parents should provide the school with al l medications (EpiPens, Benadryl, etc.) and other necessary suppl ies no later than the f irst day of school.
• Develop a disaster preparedness plan to accommodate students with
AAP in case of emergency ( lockdown, evacuat ion, etc.).
• Establish annual in-service training plan for school staf f on r isk reduction strategies including str ict avoidance prevent ion, recognizing signs and symptoms of anaphylaxis, administrat ion of epinephrine and other emergency medicat ions, and monitoring of students with l i fe-threatening al lergies. This training wi l l be provided by the school nurse and may involve the student and parents as appropriate.
See Appendix B - Forms
Oak Hill School | Food Allergy Management 10
Multi-Disciplinary Team Approach The school nurse, collaborat ing with school administrators and the parent/guardian, shall determine the best way to promote a mult i-discipl inary approach to plan for the care of the student with a l i fe- threatening al lergy. The school nurse may meet individually or as a group with staf f members to assist them in preparing for their responsibil i t ies. The team should discuss the prevent ion and management of l i fe-threatening food allergies prior to the start of each school year and on a cont inual basis as educational needs arise. The team may include but is not l imited to:
• Administrat ion • School Nurse • Classroom teachers and Enrichment teachers • Food Services Director and Staf f • Coaches and physical educat ion teachers • Explorat ions • Facil i t ies Staf f
Roles & Responsibi lit ies Responsibilit ies of the Parent/Guardian Each parent/guardian of their child with a Life-Threatening Al lergy shal l have the following expectat ions:
1. Teach your chi ld to: a. Recognize the f irst symptoms of a food al lergic/anaphylact ic
reaction. b. Communicate with school staff as soon as he/she feels a react ion
is start ing. c. Carry his/her epinephrine auto- injector when appropr iate. d. Not share snacks, lunches, dr inks or utensi ls. e. Understand the importance of hand washing before and af ter
eat ing.
2. Take responsibi l i ty for his/her safety. As chi ldren get older, teach them to: a. Encourage self -advocacy of the ser iousness of the allergy to adults
and peers. b. Communicate symptoms as soon as they appear to the school
nurse and teacher. c. Encourage education on label reading and ingredient safety. d. Administer his/her epinephr ine auto- injector and be able to train
others in its use. e. Develop awareness of their environments, including allergy-
control led zones and to pract ice age appropriate behavior regarding health and safety.
3. Inform the school nurse of your child’s al lergies pr ior to the opening of
school (or as soon as possible af ter diagnosis). All food al lergies must be ver if ied by documentation f rom the chi ld’s physician.
Oak Hill School | Food Allergy Management 11
4. Work with the school team col laborat ively to develop the Individual Healthcare Plan (IHP) for accommodations in the classroom, Dining Hal l, Explorat ions, during school sponsored act ivit ies, and provide an Allergy Action Plan (AAP). Medical information f rom the chi ld’s treat ing physician must be provided in order to create an IHP. (A l icensed physician is def ined as a doctor of medicine, MD).
5. The parent should also promote increasing age-appropriate independence
(ages 8 -13) as the student grows and matures. In determining age-appropr iate independence the student’s level of autonomy and their abi l i ty to funct ion autonomously is considered.
6. Complete and submit al l required forms (AAP) annual ly.
7. A physic ian signature is required on for the AAP. Parent signature
required for school personnel to consult with student ’s physic ian/al lergist and Oak Hi l l School staff .
8. Provide the school with current home, cel l, and work phone numbers and
maintain updated emergency contact numbers and medical information.
9. Provide the school nurse with up-to-date emergency medicat ions ( including Epinephr ine) so they can be placed in al l required locat ions for the current school year. Medicat ions wi l l comply with the Oak Hi l l School ’s medicat ion pol icy of proper labeling and expirat ion. Addit ional Epinephrine Auto-Injectors may be needed.
10. Consider providing a medical alert bracelet for your chi ld. 11. Provide “safe snacks for your student ’s c lassroom so there is always
something your chi ld can choose f rom during an unplanned special event. 12. Encourage chi ld to wash hands before and af ter handl ing food.
Encourage chi ld to identify the al lergy control led zone when eating and to ut i l ize easy access to soap in or near classrooms.
13. Inform the school of any changes in the chi ld’s Life-threatening Food
Al lergy status. 14. Provide the school with the physician’s statement if the student no
longer has food allergies. 15. Decide if addit ional EpiPens wil l be kept in other parts of the school,
aside f rom the one in the nurse’s of f ice, and if so, where. 16. Be wil l ing to go on your chi ld’s f ie ld tr ip i f possible and if requested.
Oak Hill School | Food Allergy Management 12
Responsibilit ies of the Student Each student with a Life-Threatening Allergy shall have the following expectat ions:
1.To develop a relat ionship with the school nurse and/or another trusted adult in the school to assist in identifying issues related to the management of the food allergy in the school.
2.Use proper hand washing before and af ter eating and throughout the
school day.
3.To avoid sharing or trading of foods or eat ing utensils with others. Take responsibi l i ty for avoiding food allergens.
4.To not eat anything with unknown ingredients or known to contain any
al lergen.
5.To avoid putt ing anything in mouth such as writ ing utensi ls, f ingers, or other foreign object.
6.To be proactive in the care and management of their food allergies and
reactions based on their developmental level. Learn to recognize personal symptoms.
7.To notify an adult immediately if they eat something they bel ieve may
contain the food to which they are al lergic.
8.To notify an adult i f they are being picked on or threatened by other students as it relates to their food al lergy.
9.To keep emergency epinephrine with the student, in the nurse’s of f ice or in
the classroom. I f the student is author ized to carry the emergency medicat ion with them at all t imes, he/she wi l l demonstrate responsibi l i ty of this pract ice by complet ing the skil l with the school nurse.
10.To develop an awareness of their environment and their al lergy-
control led zones.
11.Should know the overal l Individual Healthcare Plan and the Al lergy Act ion Plan to understand the responsibil i t ies of the plans.
12.To develop greater independence to keep themselves safe f rom
anaphylact ic react ions.
Oak Hill School | Food Allergy Management 13
Responsibilit ies of School Administrator Oak Hil l School Administrators shal l ensure the following:
1.Fol low all applicable federal laws, including ADA, Sect ion 504, and FERPA, as well as al l state laws and Oak Hi l l School polic ies/guidelines that may apply.
2.To make avai lable the appropriate al lergy forms to the parent and explain
that the required forms must be returned and approved by the school nurse pr ior to the chi ld attending school.
3.Meet with parents and l isten to their needs and concerns.
4.Establish a core team comprised of Parent, Administrator, Teacher,
Student, Nurse, Dining Hal l Manager, and other personnel deemed necessary to make decisions about food al lergies.
5.Ensure that an emergency act ion plan for addressing l i fe- threatening food
based al lergic reactions has been created with col laborat ion f rom the school nurse, student’s parent(s)/guardian(s), and physician.
6.Ensure school-wide mandatory in-service training and educat ion on
reducing l i fe-threatening al lergy r isks, recognizing food allergy symptoms, and emergency procedures for appropr iate staf f to include, but not l imited to the following topics:
a. A descr ipt ion/def init ion of severe al lergies and a discussion of the most common foods causing al lergic react ions.
b. The signs and symptoms of anaphylaxis. c. The correct use of an Epinephrine Auto- injector. d. Specif ic steps to follow in the event of an emergency. In addit ion,
parent/staf f severe allergy educat ional meetings may be scheduled as medical personnel are avai lable.
7.Reinforce a no-food and no-utensil trading /sharing best pract ice wi l l be
encouraged.
8.Ensure that the School Nurse, in collaborat ion with the student’s parent(s), prepare an Individual Health Plan for accommodations. The physician wi l l prepare and sign off on the Al lergy Action Plan.
9.Ensure the IHP and AAP are avai lable in the nurse’s of f ice and that al l
teachers who teach a specif ic student with l i fe- threatening al lergies have a copy of that student’s AAP.
10.When appropr iate, ensure students are allowed and encouraged to carry their epinephr ine on them once the student has demonstrated to the school nurse the skil l required to self administer epinephrine by auto-injector.
Oak Hill School | Food Allergy Management 14
11.Ensure that al lergy information is in an organized, prominent and accessible format for a substitute teacher.
12.When appropr iate, famil iar ize teachers with the Individual Health Plan for
accommodat ions of their students and any other staff member who has contact with student on a need-to-know basis.
13.Instruct and reinforce with faci l i t ies personnel to develop cleaning
protocol to ensure that the threat of allergens is minimized.
14.Establish procedures to ensure that al l parents of children assigned to a classroom where one of the students has been identif ied as having a Life-Threatening Al lergy (PreK-6) be notif ied of the specif ic al lergen to avoid. This wil l be carr ied out in accordance with patient conf identiality regulat ions.
15.The school’s emergency protocol on Life-Threatening Al lergies wi l l be
posted in appropr iate locations, i.e. nurse off ice, main of f ice and other areas as designated by the School Nurse.
16.Notify staf f of the locations of Epinephr ine injectors in the school.
17.A cont ingency plan wi l l be in place using designated bui lding staff and
understood by al l staff and students in the event the nurse is not in the off ice or in the bui lding.
18.At Least one “al lergen f ree” table in al l school cafeterias wi l l be
established.
19.Administrators and teachers wi l l encourage non-food related alternatives to celebrate developmental milestones and student accomplishments.
20.Learn about food al lergies by reviewing the information and resources
presented in this guide and discussing effect ive food allergy management with the school nurse.
21.Be able to recognize and support response to signs and symptoms of an anaphylact ic react ion in accordance with the student ’s AAP. This includes knowing when and how to contact the school nurse or EMS.
Oak Hill School | Food Allergy Management 15
Responsibilit ies of School Nurse The school nurse is the primary coordinator of each student ’s l i fe- threatening al lergy plan. School nurse wi l l have the following responsibi l i t ies:
1. Prior to the beginning of each school year, collaborate with parent(s) of a student with a Life-Threatening Al lergy to develop an Individual Health Plan for accommodations for the student. A meeting may be necessary to f inalize the IHP and AAP.
2. Maintain an updated Individual Health Plan in the school c l inic each school
year, and col laborate with administrat ion, teachers, coaches and facil i t ies staff .
3. Assure that the AAP includes the student ’s name, photo, al lergens,
symptoms of al lergic reactions, and emergency treatment orders f rom the healthcare provider.
4. Assist the Head of School in providing information about students with
Life-Threatening Allergies to staff where there is a need-to-know basis.
5. Provide yearly in-service training and education for staff regarding l i fe-threatening al lergies, signs and symptoms of anaphylaxis, r isk reduction procedures and emergency procedures including demonstrat ion on how to use the Epinephrine. The school nurse shal l retain documentat ion of those personnel who have received training on a yearly basis.
6. Familiar ize teachers and substitutes with the IHP for their students and
any other staf f member who has contact with student on need-to-know basis.
7. Provide the pr incipals, classroom teachers, enrichment teaches, PE
teachers, coaches and dining staff with a copy of the AAP on a need to know basis. The AAP should have a current picture of the student on the plan to aid in identif icat ion.
8. Educate staff on the appropr iate locations for storing the Epinephr ine auto-injector and the possibil i ty of receiving more than one Epinephrine as necessary. Locat ions for storage wi l l fol low the manufacturer ’s guidelines for avoidance of l ight and extreme temperatures.
9. Collaborate with the classroom teacher for all f ie ld tr ips, making sure the
student ’s epinephr ine is sent with the teacher on the f ie ld tr ip.
10. Inform the administrat ion and parent/guardian if any student exper iences an al lergic react ion.
11. Check Epi-Pens every semester for expirat ion dates.
Oak Hill School | Food Allergy Management 16
12. Introduce yourself to the student and show him/her how to get to the school c l inic in order to bui ld rapport and trust with the student.
13. Review the IHP on a semi-annual basis to review ef fect iveness of the plan and make changes as necessary.
14. With parental permission or by parental request, a letter may be sent
home to a grade level or homeroom, informing all parents of a l i fe-threatening food allergy and foods to avoid sending to school. See Appendix C – Sample Letter
Responsibilit ies of Classroom Teachers Each teacher shal l have the following responsibil i t ies:
1. Knowledge of the signs and symptoms of severe al lergic react ion as provided in the student’s health care plan, and be aware of and implement the emergency plan if a reaction is suspected.
2. Review the Individual Health Plan with the nurse and/or parent(s) of any
student in your c lassroom with l i fe-threatening allergies along with relevant staff members.
3. Part ic ipate in in-service training about students with l i fe- threatening
al lergies including demonstrat ion on how to use the Epinephr ine.
4. In col laboration with the nurse and parent(s) of the al lergic chi ld, wi l l set a classroom protocol regarding the management of food in the classroom. This protocol wi l l be communicated by the teacher to the students and parent(s) of the affected class.
5. Part ic ipate in the planning of a student’s re-entry into school af ter an
anaphylact ic react ion.
6. Notify parents by wri t ten communication of any school related act ivity that requires the use of food in advance of the project or act ivity (PreK-6). Learning act ivit ies wil l be controlled as much as possible.
7. Reinforce appropr iate classroom hygiene pract ices/hand washing before
and af ter eat ing.
8. The teacher and/or school nurse wil l educate the classroom students on dif ferent types of allergies and food safety.
9. Teachers wil l be provided a copy of the students Al lergy Action Plan
(AAP). Al l AAP’s wil l be kept in the crisis manual and other accessible areas for substitute teachers.
10. Teachers wil l leave al l information related to al lergies for substitute
teachers.
Oak Hill School | Food Allergy Management 17
11. Prohibit students f rom sharing or trading food or snacks in the classroom or in the dining hall.
12. Encourage parents/guardians to send in “safe” snacks for their chi ld.
13. Read al l food labels thoroughly for food brought in for part ies or used for
projects. Avoid use of foods with known al lergens for projects, celebrat ions or part ies, or other classroom activit ies.
14. Ensure epinephrine injectors and AAP are taken on al l f ield tr ips.
15. Consider eat ing situat ions on f ield tr ips and plan for prevent ion of
exposure to the student’s l i fe-threatening foods.
16. Consider ways to wash hands before and af ter eat ing (hand wipes, etc.) on f ield tr ips.
17. Carry red safety sack on all f ield tr ips with cr is is manual including parent
contact information, AAP, and epinephr ine auto- injectors.
18. Eating food on the f ield tr ip bus wi l l be prohibited unless the food has been cleared or prepared by the school.
Responsibilit ies of Dining Services The Dining Services department shal l:
1. Provide in-service to nutr it ional service employees regarding safe food handl ing pract ices to avoid cross contamination with potential food al lergens.
2. Food service employees wil l wear non-latex gloves. Gloved hands wil l be
washed or changed during extended use to avoid cross contamination with potent ial food al lergens.
3. Maintain a l ist of students with food al lergies within the food service area
with a photo of the student wherever possible (not for publ ic viewing).
4. Read al l food labels and recheck routinely for potential food allergens.
5. Provide al lergen-safe zones at schools where students with appl icable food allergies are identif ied.
6. Part ic ipate in al l in-service training related to students with l i fe-
threatening al lergies including demonstrat ion of Epinephrine use.
7. Respond appropr iately to all complaints/concerns f rom any student with a l i fe-threatening al lergy, including allowing student to see school nurse if complaining of any potential symptoms. A response to complaints/concerns would also include any type of inappropriate behavior on the part of other students.
Oak Hill School | Food Allergy Management 18
8. Maintain contact information for manufactures of food products.
9. Str ict ly following cleaning and sanitat ion protocol to avoid cross-
contamination.
10. Assure that thoroughly c leaning of all tables is being done af ter each lunch session.
11. Provide menu in advance to parents/guardian and notif icat ion if menu
has changed.
12. Have readily accessible epinephrine injector. Responsibilit ies of Coaches, Physical Education (PE) Teachers, Explorations and Under the Oaks Staff
1. Keep a copy of the students Al lergy Action Plan (AAP) readi ly avai lable in case of emergency. A copy of al l AAP’s should also be kept in the cris is manual and other accessible areas for substitute teachers.
2. Al l coaches should have access to the student ’s epinephr ine injector at
al l pract ices and games.
3. Make certain that an emergency communicat ion device (e.g. walkie-talk ie, intercom, cell phone) is always available.
4. Part ic ipate in training to administer epinephrine auto- injectors.
5. Communicate with the school nurse regarding any concerns about the student.
6. Learn about food al lergies by reviewing the information and resources presented in this guide and discussing effect ive food allergy management with the school nurse.
7. Be able to recognize and support response to signs and symptoms of an anaphylact ic react ion in accordance with the student ’s AAP. This includes knowing when and how to contact the school nurse or EMS.
8. Notify administrat ion, parents, and school nurse of any symptoms of al lergic react ion and act ion taken to support student.
Oak Hill School | Food Allergy Management 19
Facilit ies Staff
1. Ensure that cleaners are proper ly labeled and storage areas for cleaning supplies are identif ied.
2. Tables should also be washed with an appropriate cleaner in the morning if an af ter-school event has been held in the cafeteria the night before.
3. Work with administrat ion, teachers and the school nurse to create
cleaning plan for students’ with l i fe-threatening allergies.
4. Avoid cross-contamination of foods by wiping down eat ing surfaces with an appropriate cleaner before and af ter eat ing.
Oak Hill School | Food Allergy Management 20
PREVENTION Most (but not al l) anaphylact ic react ions in schools are caused by accidental exposure to food al lergens. Schools are a high r isk sett ing due to the large number of students and staf f , increased exposure to offending allergens, and possible cross-contamination. Our goal is to maximize inclusiveness to the greatest extent possible without sacr if icing safety. High r isk areas and act ivit ies for the student with food al lergies include: the cafeteria; craf t , art , and science projects; party and hol iday celebrat ions; advisory meet ings; f ield tr ips; and cross-contamination when food is being served in the classroom. Ingestion of the food allergen is the principal route of exposure, but touching and inhal ing the al lergen can also be l i fe threatening. Success in managing food allergen depends on al lergen avoidance techniques. Met iculous ingredient and label interpretat ion on every item brought into the school is vital to prevent accidental exposure. Unfortunately, this is dif f icult due to manufacturing processes. Accidental exposure occurs due to cross contamination of equipment, omission of ingredients f rom ingredient statement, substitut ion of ingredients, nonspecif ic food terminology, or the use of scientif ic or technical terminology (e.g., sodium caseinate for milk protein). See Appendix A Procedures wi l l be in place at school to address food al lergy issues in the classroom and gym, food services/dining hal l, for enrichment classes, explorat ions and under the oaks, and f ield tr ips. (See “Responsibi lit ies Section” and IHP’s of individual students) Multi-disciplinary Team Prevention Approach
• Conduct team meetings to discuss prevention strategies and approach for student with l i fe-threatening al lergies.
• Review the Individual Healthcare Plan (IHP) and Al lergy Action Plan (AAP)
• Reduce allergens in the school sett ing – Strategies wi l l be implemented to help avoid exposure to al lergens and minimize the r isk of the student having an al lergic react ion.
• Provide educat ion about allergies to students, parents, and school staf f to prevent and avoid allergic react ions.
• Address f ield tr ip and transportat ion plan with team.
Protecting a student from exposure to offending allergens is the most important way to prevent life-threatening anaphylaxis. Most anaphylactic reactions occur when a child is accidently exposed to a substance to which he/she is allergic, such as foods, insects, latex, or medicines.
Oak Hill School | Food Allergy Management 21
TRAINING Oak Hil l School wil l have annual training and education for al l staff , including coaches, Explorat ions, and Under the Oaks Staff before each school year by the school nurse regarding l i fe-threatening allergies, anaphylaxis, and epinephrine administrat ion. Al l staf f wil l be educated on how to follow the students Individual Healthcare Plan (IHP) and the Al lergy Action Plan (AAP). Education and Training components include:
• Avoidance strategies for the ident if ied al lergen(s).
• Most common food allergens
• Recognit ion of signs and symptoms of allergic react ion and what to do if the student is exposed to the allergen or exposure is suspected.
• Demonstrat ion and hands on instruct ion for the administrat ion of epinephrine. Epi-Pen trainers wi l l be avai lable for training anyt ime throughout the school year.
• Instruct ion on the administrat ion of oral medicat ions as ordered.
• Review procedures for cal l ing the school nurse, 911 (EMS), parents, and school administrators
• Pert inent blood borne pathogen training information training with emphasis on safe handl ing of contaminated sharps (af ter an Epinephrine auto-injector is used the needle is exposed).
• Recording of the incident, including medicat ion administered, the amount of medication administered, t ime, and by whom
• Conf idential ity of healthcare information
• Identif icat ion of harassment or teasing in situat ions that may result in a student being exposed to the allergen. Al l students should be taught that bul lying, harassing, or int imidat ing wil l not be tolerated.
• As needed training and education throughout the school year for new employees, newly diagnosed student allergies, or changes to a student ’s condit ion.
• Annual pract ice of Emergency Al lergy Action Plan Procedures There is a natural reluctance to wait to administer epinephrine unti l symptoms worsen and you are sure the student is experiencing an anaphylactic react ion. There is the same reluctance to cal l 911. Many fatalit ies occur because the epinephrine was not administered in a t imely manner. Pract icing implementat ion of the AAP can be the most effect ive strategy to overcome the tendency to delay and to decrease the l ikel ihood of a student fatality.
Oak Hill School | Food Allergy Management 22
Emergency Response Plan Emergency Response to Allergic Reaction Any staf f member who becomes aware that a student is having an allergic reaction must:
1. Stay with the student.
2. Notify the school nurse immediately.
3. Obtain and quickly review the student ’s Al lergy Action Plan (AAP) in order to follow doctor’s orders.
4. I f the school nurse or trained staf f member determines that the al lergic react ion is potent ially l i fe-threatening and the administrat ion of epinephrine is indicated per the AAP , immediately give the epinephrine auto-injector and call 911 (EMS).
5. Notify the parents/guardian.
6. I f possible, remove other student ’s f rom the area and restr ict crowd and traff ic through the area.
7. Provide f irst responders with information about the student ’s al lergy, symptoms presented with reaction, and act ions already taken including t ime of epinephrine inject ion.
8. Notify school administrat ion.
9. I f parents are unable to arr ive at school before EMS transports student to hospital, the school nurse or staf f member wi l l accompany the student to the hospital.
I f a student has no history of allergic reaction but is showing signs of an al lergic react ion (per Tennessee Code Annotated Section 49-5-415(f), AMEND Senate Bi l l No. 1146*) the school nurse or trained staf f member may administer the stock epinephr ine at Oak Hil l School per a standing physician order by the school medical director. Follow-up after exposure incident Following an exposure and react ion incident, administrat ion, staff involved in the incident and the school nurse should gather as much information as avai lable about the exposure and the response f rom staff members who were involved. This information should include:
• Identify the source of exposure. I f the allergy is to a food product, determine where the food originated (ex: school food services, class party or celebrat ion, school project, etc.) and review ingredients.
• Review the student’s IHP. I f there is no current IHP, begin the process of developing one.
Oak Hill School | Food Allergy Management 23
• Amend the student ’s IHP and emergency act ions to address any changes that need to be made to reduce the r isk of another exposure.
• Communicate information about exposure and changes to IHP to school staff members.
• Make arrangements with parent/guardian to replace the used epinephrine auto-injector and review the IHP with parents.
• Provide further training and education as needed.
• Complete a Student Injury Report. Returning to school after an allergic reaction Students who have experienced an al lergic reaction at school need special considerat ion upon their return to school. Meet with the parents if necessary to reassure them of the student ’s safety, and changes made to prevent another reaction. I f a student demonstrates anxiety about returning to school, checking in with the student on a dai ly basis would be indicated unt i l his/her fear is alleviated. I f a child has a prolonged anxiety response to the anaphylact ic event, strategies should be reviewed and cl inical intervention may be recommended.
Oak Hill School | Food Allergy Management 24
STATE AND FEDERAL LAWS State and federal laws provide protect ion for student’s with l i fe- threatening al lergies. State Laws Tennessee Code Annotated, Section 49-5-415 Brentson’s Law http:/ /www.state.tn.us/sos/acts/104/pub/pc0933.pdf AMEND Senate Bi l l No. 1146* House Bi l l No. 866 http:/ /www.capitol. tn.gov/Bi l ls/108/Amend/SA0290.pdf Federal Laws The American with Disabilit ies Act (ADA) of 1990 The ADA law prohibits the discr imination of individuals with a disabi l i ty. A l i fe-threatening food allergy is ident if ied as a physical disabi l i ty that substantial ly l imits one or more major l i fe act ivit ies. ht tp:/ /www.eeoc.gov/pol icy/ada.html The Family Education Rights and Privacy Act of 1974 (FERPA) Under FERPA, student information is protected by restr ict ing access to individual student records. The law addresses student conf identiality including the notif icat ion of student and parental r ights regarding access to student records. In schools, student specif ic information and records may be shared with school personnel only under certain circumstances. http:/ /www.ed.gov/policy/gen/guid/fpco/ferpa/index.html
Oak Hill School | Food Allergy Management 25
Appendix Section Appendix A – Food Label Reading & Terms Food Label Reading Thoroughly reading food labels to identify potential food allergens is an essent ial and ongoing process in prevent ion. Al l school staff should read labels carefully and recheck with each purchase for potent ial food allergens. (Manufacturers can change ingredients.) Terms that indicate the presence of cow’s MILK:
• Art if icial butter f lavor • Butter, butter fat, butter oil • Buttermilk • Casein • Caseinates (ammonium, calc ium, magnesium, potassium, sodium) • Cheese • Cream • Cottage cheese • Curds • Custard • Ghee • Half & Half ® • Hydrolysates (casein, milk protein, protein, whey, whey protein) • Lactalbumin, lactalbumin phosphate • Lactoglobul in • Lactose • Lactulose • Mi lk (derivat ive, powder, protein, sol ids, malted, condensed, evaporated,
dry, • whole, low-fat, non-fat, skimmed and goat’s milk) • Nougat • Pudding • Rennet casein • Sour cream, sour cream sol ids • Sour milk sol ids • Whey ( in al l forms, including sweet, delactosed, protein concentrate) • Yogurt • The letter "D" on the front label of a product indicates the product may
contain cow’s milk protein
Oak Hill School | Food Allergy Management 26
Terms that may indicate presence of MILK protein:
• Chocolate • High protein f lour • Luncheon meat, hot dogs, sausages • Margarine • Natural and art if icial f lavor ing: Simplesse®
Terms that indicate the presence of EGG protein:
• Albumin Macaroni • Egg (white, yolk, dr ied, powdered, sol ids) Mayonnaise • Egg substitutes Meringue • Egg Nog Ovalbumin • Globul in Ovomucin • Livet in Ovomucoid • Lysozyme (used in Europe) Simplesse® • Surimi
Terms that indicate the presence of PEANUT protein:
• Beer nuts Nu-Nuts® • Cold pressed, expel led, or extruded Nut pieces • peanut oi l Peanuts • Ground nuts Peanut butter • Mixed nuts Peanut f lour • Monkey nuts
Terms that may indicate the presence of PEANUT protein:
• Afr ican, Chinese, Indonesian, Hydrolyzed vegetable protein • Thai and Vietnamese dishes baked goods • Marzipan Candy • Natural and art if icial f lavor ing Chocolate (candies, candy bars) • Egg rolls Nougat • Hydrolyzed plant protein Sunf lower seeds • Terms that indicate the presence of SOYBEAN protein: • Edam me Soy sauce • Hydrolyzed soy protein Soybean (granules, curds) • Miso Tamari • Shoyu Sauce Tempeh • Soy (albumin, f lour, gr its, milk, nuts, sprouts) Textured vegetable protein
(TVP) • Soy Protein (concentrate, isolate) Tofu
Oak Hill School | Food Allergy Management 27
Terms that may indicate the presence of SOYBEAN protein:
• Hydrolyzed protein Vegetable gum • Natural and art if icial f lavor ing Vegetable starch • Vegetable broth
Terms that indicate the presence of WHEAT protein :
• Bran Gluten • Bread crumbs Seitan • Bulgur Semolina • Cereal extract Spelt • Couscous Vital gluten • Cracker meal Wheat • (bran, germ, gluten, malt, starch) • Durum, durum f lour Whole wheat berr ies • Farina Whole wheat f lour • Flour (al l purpose, enriched graham, high gluten, high protein, pastry,
sof t wheat)
Terms that may indicate the presence of WHEAT protein:
• Gelat inized starch Modif ied starch • Soy sauce Natural and art if icial f lavoring • Starch Vegetable gum • Hydrolyzed vegetable protein Vegetable starch • Modif ied food starch
Terms that indicate the presence of SHELLFISH protein:
• Abalone Mussels • Clams (cherrystone, l i t t leneck, pismo, quahog) Octopus • Oysters Cockle (per iwinkle, sea urchin) • Prawns Crab • Scallops Crawf ish (crayf ish, ecrevisse) • Shrimp (crevette) Mollusks • Snails (escargot) Lobster (Langouste, langousine) • Squid (calamari) scampo, Coral, tomalley)
Terms that may indicate the presence of SHELLFISH:
• Bouil labaisse • Fish stock • Natural and art if icial f lavor ing • Seafood f lavoring (such as crab or clam extract) • Surimi
Oak Hill School | Food Allergy Management 28
Terms that indicate the presence of CORN protein:
• Baking powder Corn syrup solids • Corn Cornmeal • Corn alcohol Grits • Corn f lour Hominy • Cornstarch Maize • Corn sweetener
Terms that may indicate the presence of CORN protein:
• Food starch Modif ied food starch • Vegetable gum • Vegetable starch
Oak Hill School | Food Allergy Management 29
Appendix B – Forms Insert either the full forms or a l ink to:
- Individual Healthcare Plan (IHP) - Al lergy Action Plan (AAP)
Appendix C – Sample Letter Dear Parents/Guardians, Occasionally a health concern arises at school that requires the support of parents and classmates to help make the classroom a safe and healthy place for all students. This letter is to inform you that a student in your child’s classroom has a severe l i fe-threatening al lergy to (ex: peanuts, tree nuts, milk, eggs, shellf ish, etc). Accidental ingestion, contact, or inhaling the specif ic al lergen can cause a potential ly l i fe-threatening situation for this student. While we wi l l educate your child about these severe allergies at school, we ask that you partner with us and continue the discussion and education at home. Please remind your chi ld not to share any food, eat ing utensi ls, dr inks or food containers with other students. Hand washing is vital to ensure the safety of our students with al lergies. We also ask that you are mindful of these allergies when bringing food into the classroom. We greatly appreciate your support of these procedures and thank you for your understanding and assistance of this very ser ious concern that we all share. Our main goal is to ensure the health and safety for all students at Oak Hil l School. I f you have any questions or concerns regarding students with food allergies or our food-al lergy procedures, please feel f ree to cal l, 615-298-9545, or email, hockadayk@oakhi l lschool.org, at any t ime. Sincerely, Krista Hockaday, RN BSN Jennifer Hinote Oak Hil l School Nurse Head of School
Oak Hill School | Food Allergy Management 30
Appendix D – Resources Resources Sicherer, Mahr, & the Sect ion on Allergy and Immunology , 2010 Boyce, Assa’ad, Burks, & the Journal of Al lergy and Cl inical Immunology US Department of Health and Human Services: Food Al lergy: An Overview The Food Al lergy & Anaphylaxis Network. Food Al lergy News http:/ /www.foodallergy.org/ National Inst itute of Al lergy and Infect ious Diseases (NIAID) www.niaid.nih.gov/ American Col lege of Al lergy, Asthma, and Immunology: http:/ /www.acaai.org/allergist/al lergies/Types/latex-al lergy/Pages/latex-al lergies-safe-use.aspx#anchor407908 www.CDC.gov http:/ /health.state.tn.us/downloads/healthyschoolsguidel ines.pdf
