Allergy Shmallergy

Simplifying life for families with food allergies.

Food Allergies at School: Moving Beyond Food Bans December 10, 2021

For years, school administrators and parents alike have struggled with the question of how to keep students with food allergies safe while in their care. And in some cases, both schools and parents have supported school-wide bans on allergens in an effort to protect food allergic children. But for many, food bans just don’t work. So what do studies show? And what should schools be doing to safeguard children with food allergies?

School-Wide Food Bans

Food bans often prohibit all students from bringing in a specific allergen. Most often it is peanuts that are banned, followed closely by tree nuts (almonds, cashews, walnuts, pistachios, etc) or more generically “all nuts” (presumably peanuts and tree nuts). Limits like these can work on the classroom level, but are impractical when elevated to a school-wide policy.

  1. Peanuts and tree nuts are only two of the nine most common allergens and there are over 160 documented foods to be allergic to.
  2. Any allergen can cause a serious reaction. Banning nuts only protects those students and staff who have a peanut or tree nut allergy.
  3. School-wide bans cannot be enforced.
  4. Banning food school-wide often leads to the assumption that everything that comes through the school door is safe. We know that teachers and administrators cannot police every snack, special treat and lunch that each and every student and staff member brings. And the last thing you’d want to teach a food allergic child is to eat something (assuming it’s safe) without checking on the ingredients first.

Studies have also shown that food bans don’t protect students. In fact, a five-year study conducted by McMaster Children’s Hospital in Ontario, Canada notes that bans can actually stigmatize them by making them targets of frustration over food. Students with food allergies often cannot eat with their friends and become victims of bullying – a far too common, far too unmentioned experience of kids with food allergies.

When are Food Bans a Good Idea?

Preschool aged children are at a difficult developmental stage for food allergy management. They may not be able to understand the nuances and dangers of their food allergic classmates’ condition. In their effort to be a good friend, they may try to share food; and food allergic kids may be unable to distinguish safe from unsafe food at that age. And, of course, preschoolers have their hands on everything, setting the stage for cross-contact reactions.

Food bans are also a good idea within a classroom. The classroom is meant to be a safe and inclusive place for ALL students. It should be the protective home base for students with food allergies. Eliminating a student’s allergen from the classroom whenever possible is conducive to learning. If a student is worried that they may have a frightening reaction triggered by something in the classroom, they will be unable to focus on almost anything else as their minds and bodies go into fight or flight mode.

Food bans are also a good idea at group events such as the school dance, special group rewards involving food, team snacks, etc. Focusing on inclusiveness is critical – it’s a lesson in empathy and support for all involved.

What DOES Work? Better Management Ideas for Better Outcomes

Couple classroom and event-based food bans with these strategies for a protective and inclusive experience for students with food allergies:

  1. Food Allergy Education: Kids are told to protect their friends with food allergies but are never taught the basics of the condition. Lessons on food allergy fit nicely into units about nutrition and health. Bonus: lessons about food allergy tend to be very interactive. They result in noticeably stronger sense of community and empathy for this and other invisible conditions in classrooms of all ages.
  2. Food Allergy Training: Teachers, administrators and staff should also receive an education on food allergies. Theirs should include symptoms of an allergic reaction and the language a student might use to describe it, how to manage a reaction and what to do in case of emergency. They should also focus on the social/emotional impact of food allergies and related conditions so they can keep an eye on students who may be struggling.
  3. Cafeteria: There are many ways to make the cafeteria a safer place for students with food allergies. First, make the ingredients transparent for diners by either posting the inclusion of the top 9 allergens on each item without an ingredient label or offering a point person to answer questions (or both). Second, offer allergen-friendly tables or seating. Peanut-free tables do not protect students with nut or other allergies. If there is flexibility, offer a broader allergen-friendly table where kids with food allergies can eat and feel understood. Also, reserve the ends of dining tables for kids with food allergies; this way, they can eat with their friends but not feel bound on either side by potential danger.
  4. Enforce Hand Washing: Encourage or require children to wash their hands after eating and before entering their homeroom. Hand sanitizer (which is good at killing bacteria and viruses) does not remove the food protein that causes an allergic reaction. The only way to remove food protein is to wash with soap and water.
  5. Stock Epinephrine: Finally, in addition to allowing students to keep an extra set of epinephrine auto-injectors at school, schools should take advantage of the Stock Epinephrine Act to keep extra, unassigned epinephrine auto-injectors at school for use by anyone who may experience a reaction. Anyone can develop an allergy to anything at any time in their lives, so having this life-saving medication available in an emergency is critical.

 

Another Pitch for Food Allergy Education October 28, 2020

Following my fascinating time teaching a senior writing seminar at a local high school (see What Does Food Mean to You?), I was struck by two things:

  1. These high school seniors were impressively thoughtful, creative and bravely willing to share their rich and rewarding stories (and souls) with their peers. And,
  2. They wanted to talk about food allergies more than any of that.

It’s FUN to talk about food – who doesn’t love to tell stories about their food adventures, a favorite meal, a holiday celebration, their dream dessert…?! As robust as our conversation was about writing and food, the conversation that followed was absolutely enlightening.

When I mentioned to the class that, in addition to my other writing, I often write about food allergies, hands went up immediately.

“How is a food allergy different than a food intolerance?”
“Can you outgrow a food allergy?”
“Do adults acquire new food allergies?”
“Are there treatments available?”
“What that medication people carry? How does it work?”
“How can I support my friend who has a food allergy?”

We spent 45 minutes – half of their class time – talking about food allergies that day. Forty-five minutes before we needed to cut them off and return to writing.

I spend a lot of time talking to school administrators about the value of food allergy education – especially for young children through early adolescence. This experience not only underscores the importance of food allergy education, but it highlights the continuing need to discuss it.

Two kids in every classroom have at least one food allergy. But as teenagers grow into young adults, they’ll soon find that EVEN MORE adults have food allergies than children. According to a study by Dr. Ruchi Gupta and her colleagues at Northwestern, 1 in 10 adults live with food allergies – 25% of whom acquired a new allergy AS an adult.

Administrators often see the value of a short unit about food allergies to health education, but don’t often add it to their curriculum. Why? Because, they say, these days kids grow up around food allergies. They know all they need to know from being around their peers.

But, based on my time in the classroom, it is clear this theory that students are absorbing food allergy lessons by osmosis doesn’t cover it. Young children don’t understand what a food allergy is and why some people have them. Pre-teens may lack understanding of the frequent obstacles and dangers their peers with food allergies face day-to-day. Teenagers are expected to help keep their friends safe but don’t know what it’s really like to have food allergies and don’t know how to help. And young adults may need to know how to recognize symptoms of food allergies and use an epinephrine auto-injector to save someone’s life.

Students hear the words “food allergy” and only have a vague sense of what it means. Even by age 18, students hadn’t learned what they felt they needed to know about the food allergies that they encounter. They were left with so many questions, I could have filled several sessions answering their questions.

If we expect our children and young adults to be empathetic to their peers who are physically, socially and emotionally affected by food allergies (and other medical conditions), we need to give them a proper introduction and equip them with the age-appropriate skills to become supportive friends and classmates.

At this time, most schools STILL don’t formally teach their students about food allergies despite the fact that there are nut-free classroom, peanut-free tables, and gluten-free options in the cafeteria. A short lesson would go a long way in fostering community, building empathy, empowering helpers and protecting students.


 

COVID Life: Food (Allergies) in the Classroom this Fall? July 2, 2020

 

The American Academy of Pediatrics (AAP) came out with a statement in favor of in-person schooling for children wherever schools can do so safely.  In it, they cite the importance of school on child and adolescent mental health and academic engagement as well as the lower rate of transmission and contraction of the coronavirus. [Read the AAP’s full statement here.]. The AAP’s statement also offers guidance to schools about how they might resume in-person education while protecting students as much as possible.

 

In May 2020, the Center for Disease Control (CDC) also published guidance about schooling during the COVID-19 pandemic.  At that time, AllergyStrong co-signed a letter urging the CDC to balance their guidance with the concerns of life-threatening health conditions facing students including food allergies – which they did.  [Read the CDC’s updated guidance here.}

 

Both the AAP and CDC recommended that students eat meals in the classroom rather than the cafeteria in order to promote social distancing and limit contact between classes (cohorts) and grades.  And, both AAP and CDC mention the need to be cognizant of food allergies in that scenario.

 

 

How do you bring food into the classroom safely?

The AAP and CDC guidance leaves many parents wondering how can teachers, staff and administrators help protect their students from food allergic reactions while following this guidance?

1. Enforce a “No Sharing” food policy.  

This must be strict and plainly stated to protect classmates from food allergic reaction which can be serious.

2.  Wash hands.  

This is doubly important in the age of COVID.  But unlike a virus, food allergens are not eliminated by hand sanitizer.  Hand washing with good-old soap and water is what is recommended to prevent cross-contamination and cross-contact with food protein that can cause a severe reaction.

3.  Cleaning shared surfaces.

It is critical to clean common surfaces (again doubly so with the coronavirus at play) to prevent accidental cross-contact and protect students with food allergies.  Cleaning with soap and water is best.

4.  Review symptoms of an allergic reaction.

It is imperative for teachers and classroom staff to re-familiarize themselves with the signs and symptoms of an allergic reaction as well as how a child might describe those symptoms [Read, The Language of a Food Allergic Reaction for more information.].

5.  Know how to respond to an emergency.

Minutes matter during a food allergic reaction.  Severe reactions, called anaphylaxis send patients to the hospital and can be fatal.  Review a student’s 504 plan and any Emergency Action Plans available.  Know where epinephrine auto-injectors are stored, how to use them and WHEN to use them.

6.  Take advantage of the stock epinephrine program.

Under the School Access to Epinephrine Emergency Act, also referred to as the Stock or Unassigned Epinephrine Act, schools are allowed to keep on-hand epinephrine auto-injectors that are not prescribed to a particular patient for use in emergencies.  This program is available in 49 states and is used to save the life of any student, teacher or staff member having an allergic reaction regardless of whether they have epinephrine on file.  Up to 25% of stock epinephrine use in schools is with people who have no history of diagnosed food allergies.

 

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What can parents do to protect their children?

1. Establish/Review the student’s 504 plan.

Section 504 of the Americans with Disabilities Act protects a student’s access to equal education and academic success while preserving safety.  Provisions in a 504 plan for a student with food allergies might include class-wide hand washing, a voluntary refrain from bringing allergens into the classroom, communication with parents about allergens, or approval for a student to carry his/her own epinephrine auto-injectors. Now is the perfect time to work with your school to establish a written 504 plan for your food allergic child should you feel they need it.  [Read Kids With Food Allergies Sample Section 504 Plans for Managing Food Allergies for more information.]

2. Practice how to respond to situations with food with your child.

Because eating may be done in the classroom, a child’s peers may have questions or comments about his/her food allergy.  Practice answering these questions with your child so they feel comfortable and confident to handle anything that comes their way. [Read Armed with Words:  Teens and Food Allergies to get your conversation started.]

3. Review symptoms of an allergic reactions with your child.

It is critical that everyone with food allergies know the signs and symptoms of an allergic reaction.  Teach these symptoms in an age-appropriate way so as not to scare younger children.  Let kids know that these symptoms typically appear soon after eating and tell them to speak up (even interrupting a teacher) if they are concerned they are having an allergic response.  [Read: React? Act! to help teach this important lesson.]

4. When age-appropriate, demonstrate how to carry/use epinephrine auto-injector.

Carrying an auto-injector is a big responsibility and a big relief to some children.  Teaching kids how to carry their epinephrine auto-injector (always have it with you, don’t let your friends play with it, etc) and how to use it is key.  In fact, invite one or two close friends over and demonstrate how to use the auto-injector with the trainer or firing off an old one on an orange or grapefruit will also help protect your child should an emergency arise.  We’ve adapted an old medical school mantra from my father-in-law for food allergies, “If you think you need to use the auto-injector, you DO need to use it!” Remember, administer epinephrine and go to the hospital immediately for further treatment and monitoring.

 

Food Allergies at the Food Pantry – Need Assistance? May 12, 2020

 

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Photo by Monirb CC BY-SA 4.0

Affording safe food is on the minds of many right now.  With layoffs, furloughs and unemployment, more people are turning to food pantries than ever.  But if you have a food allergy, you may be concerned about facing challenges to obtaining safe food.

 

If you have food allergies and need food assistance, here are some things to keep in mind.

 

Tips for Those Who Need Assistance

 

  • If you’re lucky to live near one, there are a few food allergy-specific food pantries operating in the United States.  Note: some have suspended operations due to COVID-19. They may, however, still be a resource for information during the lockdown.  Check out each organization’s page for eligibility requirements.

 

  • There are many local food pantries kindly serving the public right now and some are willing or already stocking safe supplies.

 

  • If you’re looking for specific allergy-friendly (or “free-from”) staples, those goods may be harder to find.  Sometimes, food pantries will shop for/hold items for those with medically necessary diets.  Call your local food pantry and explain your family’s needs.

 

  • Rather than relying on staff, check the food choices for you/your family personally, taking time to read labels.

 

  • Many of us are relying on brands we haven’t used before.  Read the ingredient labels of all food carefully.  Remember that allergens outside of the top 8 (dairy, eggs, wheat, soy, peanuts, tree nuts, fish, and shellfish) are not required to be labeled by their common name.  And manufacturers are not required to label for possible cross-contamination.  Call the manufacturer directly for more information.

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  • If there are prepared meals on site, ask a supervisor about whether the staff receives food allergy training and/or take measures to prevent cross-contact and always have your epinephrine auto-injector with you as usual.

 

  • Many schools are offering free lunches to their students.  Some are naturally free of certain allergens (often peanuts and tree nuts).  Call your local school district and speak with the food services manager to get details on how your district handles food allergies in these packaged meals.

 

 

  • It was just announced that SNAP recipients can buy groceries through Amazon. Shoppers get free delivery when they spend over $25.  Visit amazon.com/snap-ebt for more information.

 

 

  • Make your resources go further!  Use fresh food first, followed by frozen foods and pantry items.  Planning meal ahead of time with a thought towards how to incorporate leftovers into future meals helps eliminate waste and makes the best use of your food.

 

  • Food substitutions may be more practical than expensive free-from products.  For example, using applesauce ($2.75/jar) when baking may cheaper than buying specialty egg-replacer ($6.99/box). There are many great places to find these substitutions, like this one from Kids with Food Allergies.

 

 

 

“Spell It Out” PSA – The ABCs of Food Allergies September 10, 2019

Food allergies are a life-threatening condition that know no race, gender or economic status.  However, lack of awareness, education and preparedness are disproportionately affecting underserved families and communities where there is a higher percentage of dangerous reactions as well as higher costs of emergency care.

 

Filmed at a school that serves this population using real students with food allergies, “Spell It Out” is a public service announcement aimed at school children and their caregivers that addresses several key concepts about food allergies that are often misunderstood:

 

  1. Food allergies are real.  

Food allergies can be serious and life-threatening – different from a food intolerance which is an uncomfortable digestive condition but not life-threatening.

 

  1. Anyone can be allergic to any food at any age.

Food allergies are not simply a passing childhood condition. In fact, recent findings tell us that 1 in every 10 adults have food allergies, too.  And, despite their reputation, peanuts are not the only food to cause a serious reaction – you can be allergic to almost any food.

 

  1. Food allergies should be monitored by a doctor.

If you experience symptoms after eating, it’s important to talk to a doctor or nurse.  They can confirm a diagnosis, teach patients how to manage their food allergy, and help them get epinephrine – the only medicine capable of slowing or stopping a life-threatening reaction.

 

“Spell it Out” comes straight from the thoughtful and generous heart of Sammi Mendenhall, an Emmy-nominated producer who admits to being “that person who demanded peanuts on airplanes.” But after seeing the tragic story of Elijah Silvera on the news, she knew she had to learn more and educate others like herself.  She envisioned a project that could help and give a voice to those most at risk.  This project is a result of an amazing collaboration between several powerful advocacy organizations: End Allergies Together, AllergyStrong, Change for Kids, Elijah’s Echo, Natalie Giorgi Sunshine Foundation and Red Sneakers for Oakley.

 

Please visit spellitoutpsa.org for more information.

 

Feel free to share “Spell It Out” with your school – and contact us if you’d like information about an educational school visit for AllergyStrong or one of our outstanding partners.

 

Crafting a Comprehensive Food Allergy Policy at School July 23, 2019

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Across the country, schools create and reshape policies to balance the needs of their many students.  Every school should – but so often don’t – have a food allergy policy.  This policy should protect students with life-threatening food allergies – and it should be noted that although peanut allergies tend to provoke some of the most severe reactions, an allergy to ANY food can turn deadly. [Read about other allergic reactions here and here, for example.]

 

A food allergy policy is critical to give parents and their food allergic students guidelines about what to expect while their children are at school.  In addition, policies surrounding food allergies allow parents to prepare their children to safely manage their allergies in their school’s setting and gives parents and teachers time to prepare anything they need to keep their student both safe and included at school.

 

Where should schools begin?  And what should schools consider as they think of updating their current policy?

 

Some factors schools may wish to consider when formulating an inclusive food allergy policy and procedures:

 

  1. Creating a culture of inclusion and empathy:  What kinds of lessons are students receiving as part of their social-emotional learning?  What kinds of messages are students taking away from role models?  Does the behavior they see match the kindness and inclusion the school expects?  Read Including Food Allergic Students at School to review the many simple ways to begin the process.
  2. How and where to store epinephrine: Is the nurse’s office centrally located or would it be wise to also store epinephrine with a trained administrator closer to a lunchroom or classrooms?
  3. Keeping stock or unassigned epinephrine: In many states, schools are allowed to store epinephrine auto-injectors that are not prescribed to a particular student.  These stock epinephrine auto-injectors may be used with anyone who experiences a severe allergic reaction.  In a nationwide study, stock epinephrine is used in 38 percent of reactions that happen at school. That means approximately 30% of reactions happen to students and staff without a known allergy.
  4. Nursing schedules and availability: Who is trained to recognize the signs of a food allergy reaction? Do they know what to do in an emergency?  If the nurse is unavailable, who is responsible for handling this kind of crisis? Severe allergic reactions (called Anaphylaxis) are extremely serious and require IMMEDIATE attention.
  5. Hand washing:  Hand sanitizer does not remove food protein.  So actual hand washing is required when handling a student’s allergen to prevent cross-contamination. When and where should teachers enforce this habit?
  6. Communication with parents: Families of food allergic students need advance notice to make alternative arrangements for their children.  Schools benefit from this type of forethought as well.  For example, an upcoming in-school event which appeared to a teacher to be a problem for my food allergic son, turned out to be easy to manage with a few easy tweaks to the plan after we discussed the details involved.
  7. Availability of food storage space (for food allergy-friendly snacks and treats): whether the school supplies allergy-friendly snacks or families send them in, deciding where to store them for convenience and how to label them so that they are easy to identify is helpful.
  8. Field trip protocol: How will epinephrine accompany a student when he/she is off school grounds?  Who is trained to recognize symptoms of an allergic reaction and know what to do in such an emergency?
  9. The bus ride:  Are the students allowed to eat on the bus?  Do they anyway?  Is the bus driver prepared or trained to administer epinephrine if needed? Are students allowed to carry their own medication on the bus?  Is this feasible for your students based on age, maturity, income level, etc (epinephrine auto-injectors are costly in some cases)?
  10. Classroom events:  birthdays, celebrations, holidays, and special events.  Specific guidelines for what is and is not allowed must be set as well as strict adherence to the policy established. Food allergies are NOT a preference. They can result in hospitalization in a matter of minutes.
  11. Nut bans: Worthy of a separate article and discussion, schools need to weigh the burden/reward of banning nuts entirely.  And they need to discuss the extent of the restrictions (will it extend to cross-contamination warnings like, “made in a factory with…”) and how to enforce them.

 

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Faculty and staff should be educated and re-educated about food allergies each year.  They must learn to recognize the signs of severe allergic reactions (called anaphylaxis) and what those symptoms might sound like in the words of a young child. They need to learn how to react to an allergic reaction.  Understanding the basics of cross-contamination and ingredient label reading, among other lessons, will help protect food allergic students in their classrooms.

 

Clear policies that are consistently enforced, as well as appropriate and reasonable accommodations,  will help teachers, administrators and students alike have a safe and fun school year.

 

Food Allergy or Food Intolerance? January 14, 2019

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Following an illuminating study conducted by Ruchi S. Gupta and her colleagues Christopher M. Warren, et al, it is clear that most Americans don’t understand the difference between a food allergy and a food intolerance.  The study found that in the U.S.  20% of adults claim to have a food allergy, but when evaluated by a medical doctor only 10% have symptoms consistent with a true allergy.

 

What is a food allergy? What makes it unique?

Food allergies are an immune system response to food.  When the body mistakes a food as harmful, it produces a defense system (in the form of antibodies) to fight against it.  These antibodies in the immune system – called immunoglobulin E (IgE), found in the lungs, skin and mucous membranes – release a chemical that sets off a chain reaction of the vascular, respiratory, and cardiac systems.

 

Food allergic reactions can vary from hives, swelling of the mouth, lips and face, and vomiting to respiratory issues (such as wheezing), drop in blood pressure, fainting, and cardiac arrest.  Anaphylaxis is a very serious and potentially fatal condition that is characterized by a sudden drop in blood pressure, loss of consciousness and body system failure.  Epinephrine (administered by an auto-injector) is the only medication that can slow or stop anaphylaxis.

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The most common foods that cause a food allergic reaction are:  peanuts, tree nuts (such as walnuts, pistachios, pecans, etc), dairy, eggs, wheat, soy, fin fish (salmon, tuna, etc), and shellfish.  But almost any food can cause an allergic reaction.

 

 

What is a food intolerance?  How does it differ from a food allergy?

Food intolerances also make people feel discomfort.  However, this discomfort is not life-threatening.  Food intolerances are a digestive response that occur when food irritates the digestive system or makes it difficult for a person to break down the food.

 

Symptoms of a food intolerance can include bloating, gas, nausea, stomach discomfort/pain, vomiting, diarrhea, heartburn, headaches, and irritability.  Dairy, or lactose intolerance, is the most common trigger.

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What are some other differences?

 

Food allergic reactions can occur with even the smallest amount of food ingested.  In addition to the range of major symptoms when ingested, it can also cause a skin reaction just upon contact.  A food allergy is a reaction to the protein contained in a food (such as gluten with a wheat allergy).

 

With food intolerances, amount of food consumed matters.   The more food consumed, the worse the digestive reaction.  Food intolerances occur because the body cannot break down the sugar in a given food (like lactose in milk).

 

Food allergies are diagnosed in several ways.  The golden standard is an oral food challenge – where a patient eats their suspected allergen under medical supervision to note the reaction.  Patients may take an IgE blood test or be asked to take a skin prick test to diagnose and monitor food allergy.

 

When a food intolerance is suspected, patients are often asked to keep a food journal or diary in which they note the foods they ate as well as the symptoms they experience.  Patients may also be asked to eliminate a particular food from their diet and note symptoms for a period of time.

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In both cases, a doctor will help give an official diagnosis and guide the patient through any changes that need to be made to their lifestyle.   Those with food allergies will also discuss issues like cross-contamination, emergency action plans, and epinephrine.  Those with food intolerances may talk about medications that can help to ease symptoms. Avoidance of problem foods will be suggested for food allergies as well as food intolerances.

 

Knowing the difference between a life-threatening food allergy and an uncomfortable food intolerance will help keep you safe, make appropriate lifestyle changes and get you the relief you need sooner.  

 

 

 

Including Food Allergic Students at School September 17, 2018

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It’s the beginning of the school year!  Now is the perfect time to discuss best practices to keep kids with food allergies included in the classroom and beyond.  What are the best ways to keep a child safe at school?  How is teaching a food allergic child different from one without dietary restrictions?  How can teachers and parents better communicate to ensure a productive year together?

 

One of the most difficult and important places to manage food allergies is at school.  Parents, faculty, staff and administrators want and need to keep food allergic students physically safe during the school day – a place children spend the largest portion of their time outside the home. Inclusion at school is the “safe place” they need to develop psychologically and socially.

 

Where do schools begin and what factors should they consider?  

 

Education:  Not surprisingly, it all begins with EDUCATION.  Faculty and staff should be educated and reeducated about food allergies each year.  They should not only know:

but they should also learn about the perspective of their food allergic students who experience anxiety and exclusion at higher rates than their peers.

 

I urge all schools to consider adding Food Allergy Education to their Health curriculum.  Students are exposed to the idea of food allergies without understanding exactly what that means. Understanding food allergies is shown to build inclusion and community, stoke empathy and protect peers in students pre-K through high school.  In less than 20 minutes, a teacher can cover a basic lesson plan on food allergies and reap all of the above benefits in his/her classroom for the entire year.

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Exclude the FOOD (not the CHILD).

Eating In the Classroom:  Parties, holiday celebrations, and special events should be as inclusive and safe as possible.  I’ve heard from many families across the country whose children have been sent out of the room during class parties because their allergen was being served;  children who are sent to eat with the school nurse instead of their friends; children who are told to stay away from the group who are eating an allergy-laden snack while they watch.  When such a thing occurs, the message that student receives from their teacher is that their classmates’ enjoyment is more important than they are.  At such times, the student will struggle with feeling of self-worth and the [correct] impression that their teacher doesn’t know how to handle food allergies.

 

Eating Outside of Class:  Prepare for field trips by remembering food allergic students.  Snacks and lunches need to be safe.  And, don’t forget to bring emergency medication (and store it with a chaperone AT ROOM TEMPERATURE).  The best way to keep these special learning experiences special is with advanced preparation and by communicating with parents and the students directly to address concerns and implement solutions.

 

Think through the full school day for an allergic student.  How will they fare on the bus ride home?  What is the school’s policy on eating on the bus?  Is it enforced?  Is the bus driver trained and prepared to deal with an allergic reaction?  Is an allergic student allowed to carry their own epinephrine?  How does the driver handle bullying on his/her bus?  Addressing the entire school day from door to door will make a child with food allergies feel protected and looked after.

 

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Bullying by Peers or Adults:  Exclusion, name-calling or verbally doubting sets an example for the other students that such behavior is acceptable and results in stigmatizing the food allergic student. Bullying is another serious problem for all students but can have serious and even deadly results for students with food allergies.  Read the statistics here to understand the scope of the problem which is often based at school.

 

Uninformed Teachers:  Students with food allergies are savvy about their condition and quickly note when others aren’t as knowledgable.  Teachers who demonstrate a lack of knowledge do not instill confidence in even the youngest food allergic child.  Students who are concerned about surviving the day in their classroom, cannot learn.  Creating “safe zones” is psychologically beneficial to students with food allergies.  One such example is a peanut-free table or a classroom that bans a certain food for the health and protection of a student’s life. Another method is to establish a special line of communication between the teacher and student so they can express their concerns privately.  I recommend that teachers meet with a food allergic student and their parents to acknowledge that they understand the parameters of that child’s allergy, that they take it seriously, and agree upon the best method of letting parents know about upcoming events so that the family can prepare.

 

Solid and Protected Food Allergy Policies:  Schools must create a safe environment for students with life threatening food allergies. This protection begins with a comprehensive food allergy policy – one that balances safety with an emphasis on maximum inclusion.  The policy and procedures regarding food allergies need to be widely communicated, easily accessible, consistently applied and protected.

[Read: Food Allergy Policies at School (Aug. 14, 2018) – Considerations and Perspectives for more on what goes into a well thought-out policy.]

 


 

Inclusion means everything to food allergic students who already feel different from their peers.  Inclusion gives students a supportive platform from which to conquer the world.  Schools need safe places for kids to learn, socialize and play.   They are more than a place to grow academically; schools should be a space for students to blossom psychologically as well.  A lot of thought should go into how to include every child in the classroom – it might make all the difference for your students AND their families.

 

 

 

EpiPen Shortage: What You Need to Know Now August 27, 2018

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You’ve likely heard that there’s a shortage on EpiPens through the United States, Canada, United Kingdom and Australia.  What began as spot shortages throughout Australia and North America has escalated into a worldwide panic.  Let’s separate fact from fiction to better understand this ongoing problem and talk about interim solutions.

 

1. There is NO epinephrine shortage.  The life-saving drug epinephrine, also known as adrenaline, is in full supply.

 

2. The shortage refers to pharmacy stock of Mylan’s EpiPen , EpiPen Jr. as well as its authorized generics in North America and the UK and only EpiPen 0.3 (300 mcg) in Australia.  According to Mylan, this shortage is due to manufacturing delays by their partner Pfizer/Meridian.

 

3.  There had been a shortage of Impax Laboratories’ Adrenaclick, but that appears to have been resolved.

 

4.  Some pharmacies in the United States (including Kaiser) are reportedly rationing out only ONE pen to customers.  This is not recommended.  Customers should always carry two auto-injectors in case one pen malfunctions or two doses of epinephrine is required while waiting for emergency services.

 

5.  There IS NO SHORTAGE of Auvi-Q – the innovative epinephrine auto-injector that talks you through how to administer a shot and has a retractable needle to prevent accidental injury.

 

While this problem affects everyone trying to refill a prescription at this time, I am particularly concerned with those trying to fill a prescription for the first time.  Those patients and families who are just getting a diagnosis and hoping to find a little security in the sometimes overwhelming world of food allergies may find themselves unprepared or totally confused by the process.  I’m also worried for schools and daycares, whose stock epinephrine program saves lives.

 

What can you do while you’re waiting for the EpiPen supplies to increase?

 

1. The U.S. Food and Drug Administration has extended the expiration date of Mylan’s EpiPens by 4 months.  There is a list of which batches are affected and their extended expiration dates listed on FDA’s site – be sure to check your boxes.

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2. Should you need a set of epinephrine auto-injectors now, there ARE alternatives to EpiPens:

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  • In the United States, Auvi-Q is in full supply.  Please visit Auvi-Q’s website for instructions on how to arrange direct delivery.
  • Adrenaclick is also in stock in the United States.  Talk to your doctor and pharmacist about getting this filled in EpiPen’s place.  Be reminded, you’ll need to order a free trainer from Impax Laboratories to practice on this device.  It’s smaller than an EpiPen but operates just a little differently.  You may call Impax Laboratories at 1-855-EPINEPH to order them directly.
  • In the UK, both Jext and Emerade are available epinephrine auto-injectors.

 

3.  Should you prefer to wait for EpiPen to become available: 

  • Check the expiration date on your auto-injectors.  As long as they are stored at room temperature (and not, for example, in the car in the heat), you should be fine to use them past their expiration date according to the FDA.  According to Dr. Baker (formerly director of FARE), EpiPens can be used up to 6 months past their expiration date.
  • Check the epinephrine in your EpiPen.  If you look through the window of your EpiPen and see that the epinephrine is discolored or cloudy, it is no longer good.
  • Be sure to speak with your child’s school about the expiration date extension so that you will be allowed to store that set of EpiPens there.
    • Make a plan (and put it on the calendar!) to replace the EpiPens and deliver a fresh set to school when they become available;
    • Discuss if and how procedures will change with an expired EpiPen.  Will the school use that auto-injector or will they choose to use stock epinephrine instead?  Does that effect the timing of a call to emergency services? What is YOUR preference?
  • As always, store your epinephrine properly.  That means keeping them at room temperature as much as possible.
  • Be careful about accepting a refill from a pharmacy that wants to give you only one auto-injector, splitting up a set.  Heads up: We have heard reports of pharmacies charging a regular co-pay for even just ONE pen.  And, again, patients at risk for anaphylaxis must ALWAYS CARRY TWO auto-injectors at all times.
  • The beginning of a school year is the perfect time to review food allergy safety with your children (wash hands with soap and water before eating, no sharing food, symptoms of a reaction, what to do and who to tell).  Here are some great books to use as a jumping off point for your conversations.

 

If you’re new to the food allergy world and getting an epinephrine auto-injector for the first time, consider one of the available auto-injectors on the market if possible.  They are all equally effective and potent.  You may even find that they fit your needs and lifestyle Discuss with your doctor which one may be most appropriate for you based on your age, capabilities and lifestyle.

 

For more information, please read WebMD’s article “EpiPen Shortage Causing Concern as School Starts”.

 

Food Allergy Policies at School – Considerations and Perspective August 14, 2018

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As the school year beings for some and approaches for others, now is an excellent time to reflect on the food allergy policies and procedures at your school. As research and information about best practices emerge, schools should know that small changes can have a big impact.  Camps may also wish to track these same kind of policy shifts to keep campers safe while in their care next summer.

 

Why do schools need a food allergy policy?

 

Schools must create a safe environment for students with life threatening food allergies. Administrators should begin by creating a comprehensive food allergy policy for the entire school or school district.  Policies may vary from school to school depending on their experiences and limitations.  In fact, allergists are hesitant to suggest blanket recommendations for that reason.  Whatever each school decides, the policy and procedures set regarding food allergies need to be

1.  widely communicated;

2.  easily accessible; and

3.  consistently applied and protected.

These policies serve as a baseline for food allergic families to make decisions about additional measures they may need to take in order to keep their child safe.

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Where do schools begin and what factors should they consider in regards to their food allergy policies and procedures?  

When formulating food allergy policies and procedures, schools should consider some of the following factors:

  1.  Age of students and their cognitive and physical development:  Schools may have different policies for students of different ages.  For example, elementary schools may forbid a child from carrying his/her own epinephrine auto-injector while a middle and high school may allow that.
  2. Common risks facing the age group of their students:  Are the students allowed to share food without permission?  What are the school’s thoughts on classroom parties and celebrations? Do your students commonly face peer pressure or bullying? Are they allowed to snack/eat independently (away from a cafeteria or not during a traditional lunch time)?
  3. Stock/unassigned epinephrine: In many states, schools are either required or allowed to keep unassigned (or stock) epinephrine on-hand in case of an anaphylactic reaction.  That means that if a student, staff, or faculty member has a reaction and does not already have epinephrine prescribed to them and stored at school, the unassigned epinephrine may be used.  Consider whether your school should carry this useful medication and who should be in charge of administering it.
  4. Nursing schedule and availability:  Does your school have a full-time nurse?  How many students is he or she responsible for looking after?
  5. How and where to store epinephrine: Is the nurse’s office centrally located or would it be wise to store epinephrine with a trained administrator closer to a lunchroom or classrooms?
  6. Hand washing: Hand sanitizer does not remove the proteins that can cause a food allergic reaction.  Only a scrub with soap and water can do that. Are the students required to wash hands at any point in the day?
  7. Communication with parents:  This piece may not make it into policy, but it should be discussed.  Advanced communication with parents regarding upcoming class parties, school celebrations involving food, field trips, and other food-related events allows parents and teachers to make appropriate accommodations to keep their food allergic student safe.
  8. The classroom versus the lunchroom: How will food allergy policies differ by location within the school?  Rules in the classroom regarding food may be very different from rules in the cafeteria.  Who will be responsible in which location?
  9. Field trips: Each school should consider who is responsible for carrying and administering epinephrine when students are away from school.  Go over a plan should someone have a severe allergic reaction.  Be reminded that epinephrine must be kept at room temperature, so if you are spending time outside in hot or cold weather, epinephrine will need to be temperature controlled.  Communicate this plan to teachers and parents so that everyone is on the same page.
  10. Faculty and staff education:  Faculty and staff should be educated and RE-educated about food allergies each year.  They must learn to recognize the signs of severe allergic reactions (called anaphylaxis) and what those symptoms might sound like in the words of a young child.  [See The Language of Food Allergies for the symptoms and language students may use to describe an allergic reaction.]  They need to learn how to respond to an allergic reaction.  Understanding the basics of cross-contamination and ingredient label reading, among other lessons, will help protect food allergic students in their classrooms.

 

Food allergies are often misunderstood.  Not only can they cause severe allergic reactions that can be fatal, but they cause a great amount of time, preparation, and anxiety for students and parents alike.  This anxiety can hamper a student’s ability to learn. Therefore, it is imperative that schools make every effort to provide a safe environment for learning both academically and socially.  With two students in every classroom suffering from food allergies, it is critically important that schools consider how they can best prepare families and teachers to protect these students.

 

Alpha-Gal Allergy and the Lone Star Tick August 6, 2018

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An unusual food allergy is on the rise across the United States.  And it could strike anyone – with or without a previous history of allergies.

 

Caused by a tick bite, this once-rare condition can cause a person to develop an allergy to red meat and, in some cases, to dairy products.

 

Interestingly, this allergy is triggered by a carbohydrate (known as the alpha-gal molecule) and not a protein like most allergic reactions.  Just as fascinating, Alpha-gal allergy is characterized by a delayed on-set of symptoms.  Unlike a traditional food allergy which usually causes a reaction very soon after eating, Alpha-gal allergic symptoms typically show themselves between 3 and 8 hours after red meat consumption.

 

Alpha-gal allergy is spread through a bite from the Lone Star tick.  The Lone Star tick can be found in wooded areas and grassy areas in the southeast, east coast and midwest of the United States as well as parts of Canada and the northern portion of South America.  It can also be caused by the European Caster Bean tick and the Paralysis tick in Australia.

 

The best way to prevent a tick bite is by using tick repellant when exploring in the woods and areas of high grass. Wear long sleeves, long pants, and high socks whenever possible on such excursions.  Check your skin and hair following an outing.  Here’s the CDC’s advice on how to properly remove a tick.

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The symptoms of alpha-gal allergic reaction vary from a runny nose, nausea and diarrhea, to hives and anaphylaxis, the most severe form of allergic reaction (review the symptoms and language of an allergic reaction).  Just as with a traditional food allergy, those with alpha-gal allergies should treat their symptoms immediately with epinephrine.

 

To review the symptoms of anaphylaxis as well as how those symptoms may be described by a child, please read The Language of a Food Allergy.

 


Comment below!

I would love to hear from those who have an alpha-gal allergy!

What has your experience been like?

What are some of the trickiest foods to avoid?

What is the most difficult part of managing this allergy?

How has this changed your perspective?

 

 

 

Food Allergy Bullying: Not Just a School Problem January 22, 2018

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Last year, a 13 year old with a dairy allergy died after someone allegedly slipped cheese into his sandwich at lunch.  He was rushed to the hospital and placed in intensive care where he remained until he suffered cardiac arrest.

80% of parents reported that their children with food allergies have been teased, excluded or harassed by their school mates as well as adults.  In a 2010 study conducted by researchers at Mount Sinai Medical Center, most kids felt their bullying had been due to their food allergies alone.  Others reported that issues related to their food allergies (such as carrying medication, being set apart at lunch and receiving what appeared to be “special treatment”) were also factors in being taunted or harassed.

The psychological damages associated with bullying are heartbreaking and can last into adulthood: depression, anxiety, eating disorders, self-harming behavior, Post-Traumatic Stress Disorder (PTSD) and suicidal thoughts.  Couple these dark emotions and behaviors with the heightened state of anxiety and concerns over safety that those with food allergies already experience as well as the very REAL and severe dangers of anaphylaxis and we’re facing a crisis that needs to be addressed immediately.

Profile of a bully:

According to psychologists, bullies share a few common traits:

  1. Typically bullies act for several reasons including power and perceived popularity;
  2. Their actions are deliberate, repeated and often involve a verbal component; and
  3. Because they tend to lack prosocial skills, they see themselves and their actions positively.  In essence, bullies don’t self-identify as bullies.

We’re all familiar with stories of generalized bullying.  But what makes food allergy bullying different?  A few things:

  1.  Bullies who use food to target those with food allergies may not understand the very serious consequences their actions will have;
  2. Teens who speak about being harassed often report that it’s not just their peers doing the bullying.  Parents and teachers who make it clear that those with food allergies are an inconvenience are sending a message that kids are receiving and taking personally;
  3. The line between a classmate jokingly waving a peanut at a child with food allergies without understanding the gravity and a bully who uses an allergen to threaten or harm a peer may seem clear.  But the psychological implications and possibility of rapid and dangerous health outcomes of both situations can result in the victim feeling unsafe and more susceptible to harassment in the future.

Although many cases of bullying occur at school because of the close proximity of peers, bullying isn’t a problem that can – or should – be resolved entirely by schools themselves.  Bullying is a communal problem and it’s one we all must work to prevent.

What can we do about food allergy bullying?

It all begins with education.

  • Students need to be taught about food allergies formally.  With two food allergic kids in every classroom, all students are exposed to this epidemic but few are equipped to truly understand it.  Food allergies are mentioned in school but not rarely formally taught.  For over a decade, I have taught preschool through 7th grade students lessons about food allergies; a lesson that includes a heavy dose of empathy which results in a stronger sense of fellowship.  Empathy is one the key skills psychologists recommend schools and parents teach their children to thwart bullying and build community.
  • But it’s not just the children who need a lesson in food allergies.  So do adults.  I recently gave a seminar to educators to raise their awareness of food allergies and help them protect their allergic students emotionally, socially, physically, and academically.  Identifying food allergic reactions and understanding protocols, preventing cross-contamination in the classroom, lessons of inclusion and empathy, and the psychosocial issues (like anxiety and stress) that both food allergic students and their parents face have been immensely helpful to teachers who are trying to cater to the whole child. And they have seen these seminars reap great rewards in their schools.
  • Parents of non-allergic children need to learn about food allergies to keep play dates safe and deepen their empathetic muscle so that they can impart those lessons to their own children.  Occasionally (and not infrequently), we hear stories of parents who feel their children are entitled to bring whatever food they want into school regardless of the dangers they might pose on another child.  These parents are missing the greater message – which is that we are a community; communities protect each other and THAT is what makes us all stronger.  Not peanut butter sandwiches or cheese puffs.

At home, parents of food allergic children need to emphasize and practice lessons in self-advocacy and problem-solving. Kids with food allergies face their fear of reactions several times, every single day. Empowering them to speak up and stand firm to protect themselves and others is an invaluable skill – for them and for life.

Keep communication open between you and your child.  Offer stories about when you were their age and include difficulties you may have faced and ways you overcome challenges.  Get your children involved in figuring out how you should have handled your childhood issues.  This reassures kids in many ways: First, it reminds them that they are not alone in their experiences.  Second, it shows them, by example, different perspectives on common issues.  And, it helps them self-identify as problem-solvers, instilling in them the confidence and perseverance they need to deal with sometimes complex obstacles.

Signs of Bullying:

Half of kids who have been bullied don’t talk about it with their parents or other trusted adult.  Parents and teachers: please take note if you see these classic signs of food allergy bullying occurring to your child/student.

  • food allergy reactions happening at school
  • excuses to stay home
  • physical signs (on the body, books, backpack, etc)
  • falling grades/loss of interest at school
  • behavioral/emotional changes (sadness, outbursts, excessive worry)

Bullying already in progress?

If you’re already dealing with a bully issue, there are a few extra things you may wish to do:

  1.  Stay calm and collected.  Reassure your child that you will help resolve this conflict.  Approach the school first if that’s where the incidents are occurring.
  2. Practice language they can use to deal with bullies without retaliation (which could escalate things).  Teach them to say, “STOP” and, ideally walk away.
  3. Identify trusted adults that your child can turn to if they have a problem at school (a teacher, a coach, administrator, the school nurse, etc).  In addition to you, are there other adults in your child’s life that could help?  It takes a village, now’s a great time to rely on that village.
  4. Children with food allergies are often protected legally under Section 504 of the 1973 Rehabilitation Act, Title II and the Individual with Disabilities Education Act (IDEA).  The argument is that harassment and bullying prevents equal access to benefits that education provides.  Section 504 covering disability harassment applies to children from elementary school through college and university.

SCHOOLS:

There are a number of ways schools can reduce the possibility of dangerous food allergy bullying.  Please contact me directly to discuss programs that work for each stage of education: erin@allergystrong.com

 

 
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