Be Aware, Don’t Scare: Better Food Allergy Management · Cherkaoui, S, et al. Accidental...

© COPYRIGHT 2016 SCHOOL NUTRITION ASSOCIATION – #ANC16 – SAN ANTONIO, TEXAS

Be Aware, Don’t Scare: Better Food Allergy

ManagementJuly 12, 2016


Speakers

• Eleanor Garrow‐Holding, President, [email protected]

• Gitta Grether‐Sweeney, MS, RD, Director, Portland Public Schools (OR)[email protected]

• Wesley Johnson, Attorney, Escamilla & Poneck, LLP (LA/TX)[email protected]

• Moderator: Sherry Coleman Collins, MS, RDN, LD, Registered Dietitian [email protected]


Disclosures & Acknowledgements• Disclosures

• Eleanor Garrow‐Holding• FAACT President & CEO• Food Allergy Education Council, National Peanut Board

• Wesley Johnson• Food Allergy Education Council, National Peanut Board

• Sherry Coleman Collins• Consultant to National Peanut Board


Objectives

• Review basic facts about food allergies• Share best practices on management in school nutrition, at the district level and in local schools

• Review legal issues to consider when managing food allergies in schools

• Address common myths regarding food allergy management in schools


Introduction to Food Allergies

Eleanor Garrow‐Holding ‐ FAACT


• Food allergies can be serious. Living with a food allergy requires thoughtful planning, communication and vigilance at home and in public. That’s why accurate diagnosis and management are so important.

• Whether you believe you or a loved one has a food allergy – or you have already been diagnosed – you have come to the right place for information and helpful tips from medical professionals and those who have been in your shoes.

• Learn More About Food Allergy Diagnosis

• How to Effectively Manage a Food Allergy
















District Policies and Procedures

Gitta Grether‐Sweeney


ADMINISTRATIVE DIRECTIVE Life Threatening Allergies 3.60.061‐AD

• Directive was Adopted in 2006• District does not support a ban on foods• Administrative Directive Includes:

• General Requirements • Family’s Responsibility • School’s Responsibility • Student’s Responsibility


Best Practices


Staff Training

Food Allergy Decision Tree for Cafeteria Staff

Serving Line Allergen Signage

Facing Students Facing Staff

Allergen Information for Parents and Students on Website


Children Who Are Not Disabled But Have Other Special Dietary Needs

• Food allergies or intolerances• NOT generally disabilities UNLESS anaphylactic

• Accommodation MAY be made BUT is NOT Required• In many cases, allergies can be dealt with through “Offer‐Versus‐Serve” or by providing additional selections

Source: http://www.fns.usda.gov/sites/default/files/accommodating_children.ppt


Legal ConsiderationsWesley Johnson


Legally Speaking

• Constitutional right to eat food of choice was addressed…..Liebau v. Romeo Community Schools, 61 IDELR 231 (Mich. Ct. App. 2013)

• But Blanket Bans on any foods don’t solve legal problems – actual create them

• Section 504 of the Rehabilitation Act of 1973 (Section 504)• Mental or physical impairment that substantially limits a major life activity of ____

• Mitigation (epi‐pens, exposure limits, etc.)• Episodic conditions• Not all cases qualify – case by case analysis!


OCR on Disability Based Harassment • Dear Colleague Letter, Oct. 26, 2010• Previously – no deliberate indifference• Now – Proactive response• ID nature of the conduct• Harassment based on disability?• Steps to eliminate hostile environment, address its effects, take steps to ensure there is no recurrence


Once Placed on Notice – (1) Evaluate and (2) Develop Plan to Ensure Safety Washington (NC) Montessori

Public Charter, 60 IDELR 79 (OCR 2012)


Proactive Responses• Individualized Planning + Generalized Planning• How to Handle Classmates?• If you put it into the Plan then you must implement!• Encinitas Union School District, Office of Civil Rights, 114 LRP 23545 (Jan. 29, 2014)

• Compare:• Catoosa County (GA) School District, 57 IDELR 141 (OCR 2011)• Virginia Beach (VA) City Public Schools, 59 IDELR 54(OCR 2012)


Is an Individual Health Plan Sufficient?• Torrington (CT) Board of Education, 60 IDELR 295 (OCR 2012)

• Allergies = Assessment for Section 504 eligibility• Not substantially limiting? IHP sufficient• Substantially limiting? Section 504 Plan• IHP can be major component of plan• Evaluation?


Must You Accommodate Every Request?

• A.M. ex rel J.M. v. NYC Dept. of Educ., 112 LRP 3144 (E.D.N.Y. 1/17/12)

• Requested accommodation – heating child’s food in microwave

• Don’t consider “reasonable” or “not reasonable”• Legal standard: “Meaningful access to programs and services”

• Individualized determination• Comply as quickly & thoroughly as possible to parent requests for information. Wooster City SchDist., 61 IDELR 114 (Feb. 26, 2013)


Avoid Hardline Approaches in Controversial Areas

• Statements regarding life‐threatening allergies + no real prevention plan = dangerous situation

• Food Bans• Accepting lengthy lists of requests/mandates/prohibitions w/o appropriate consideration and follow‐through

• Failure to explain severity of student’s allergies• Failure to pinpoint real accommodation needs• Widefield School District 3, 116 LRP 10050 (Jan. 12, 2016)

The Doctor’s Role

• Accommodating Students With Special Dietary Needs (USDA, 2001) PDF PPT

• Guidance for Food Staff• 7 CFR Part 15b – Physician’s Statement Required for Food Substitutions or Modifications

• Doctors don’t have unilateral decision‐making regarding educational decisions or eligibility decisions regarding Section 504

• Consider their input and ask follow‐up questions

• Document refusals for access to physicians by parents


Future Considerations

What Next?

• Universities facing ADA complaints

• Lesley University – DOJ Settlement over mandatory meal plan

• University of Washington, Tacoma – peanut/nut free classroom signs

Your Turn: Questions?


Resources




Food allergies affect approximately 1 in 13 children – about 2 children per classroom. With so many students affected, it is crucial for educators to build an awareness of the seriousness of food allergy among all their students.

FAACT’s Food Allergy Curricula Program for Schools consists of three, age-appropriate programs: K-3, grades 4-8, and high school. All curricula programs have been created by FAACT and reviewed and approved by FAACT’s Medical Advisory Board.

PowerPoint presentations, lesson plans, and activities can be used to introduce your students to common food allergens and safety protocols while encouraging empathy for classmates with a food allergy.

Please share with your schools and districts –educators and students will enjoy learning about food allergies with FAACT! Download the free program from our Web site today: www.FoodAllergyAwareness.org









PeanutAllergyFacts.org


Food Bans• Experts do not recommend bans:

• The problem with schools becoming peanut free is that this presents a false sense of security. Dr. Stanley Fineman, past president of American College of Allergy, Asthma & Immunology

• The primary goal is to avoid having the child ingest the food. Dr. Scott Sicherer, pediatric allergist at the Jaffe Food Allergy Institute at Mount Sinai

• …I'm not a big fan of the peanut‐free approach, because it can paradoxically lead to a false sense of security and inattention to things like adequate monitoring of meals and snacks, clean up after food is served, and reinforcing good practices like not sharing food at school. Dr. Wayne Shreffler, Director of the Food Allergy Center at Massachusetts General Hospital

Source: Food Allergies: Doctors Disagree on Peanut‐Free Schools/Classrooms Plus Talk on Bullying


Do Bans Keep Allergic Students Safer?• Canadian Cohort Study – showed most reactions happen at home

• Reactions that did happen in schools were more common in those that banned peanuts than those that did not

• Most reactions happen in the classroom, not in cafeteria

Cherkaoui, S, et al. Accidental exposures to peanut in a large cohort of Canadian children with peanut allergy, Clin and Translational Allergy. 2015

Nowak‐Wegrzyn, A, Conover‐Walker, MK, Wood, R. Food‐Allergic reactions in schools and preschools. 2001:155(7);790‐795


Do Parents Want Peanut/Nut Bans?

Source: Nut‐free lunch? Parents speak out


Airborne & Casual Contact• Casual contact presents little risk to children with food allergies

• Evidence does not support the idea that simply being near a food will cause an anaphylactic reaction

• Odor is caused by volatile compounds in foods, not the proteins that cause allergic reactions

• Skin and inhalation exposure may cause hives, redness, and hay fever‐type reactions

• Ingestion may cause anaphylaxis, the most serious type of reaction

Source: Simonte SJ, et al. JACI 2003; 112:180‐2. and Perry, TT, et al. JACI 2004; 113:973‐976.


Peanut Oil• Two types of peanut oil

• Highly refined – chemical process removes allergenic protein

• Aromatic/gourmet – contains allergenic proteins

• Clinical studies showed no reaction by peanut allergic individuals to highly refined peanut oil (HRPO)

• HRPO is most often used in foodservice and manufacturing, but always important to confirm

Source: Food Allergy Research and Resource Program, University of Nebraska: FAQs

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Be Aware, Don’t Scare: Better Food Allergy Management · Cherkaoui, S, et al. Accidental...

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