Allergy Shmallergy

Simplifying life for families with food allergies.

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

Red sneaks notebooks school-909381_1920

 

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.

 

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

Food Allergy Bullying stats

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

 

No Appetite for Bullying

No appetite for bullying Badge

Four food allergy non-profits led by kaléo Pharma have partnered to campaign against Food Allergy Bullying.  Please visit No Appetite for Bullying for further information and to stay informed of their upcoming programming.

 

 

 

 

 

 

The Dangers of a Dairy Allergy November 17, 2017

cereal and milk pixabay StockSnap

 

Three year old, Elijah Silvera, was attending a regular day of preschool in New York City recently, when preschool workers fed him a grilled cheese sandwich despite school papers which formally documented his severe dairy allergy.  Elijah had a severe allergic reaction and went into anaphylaxis.  Standard procedure for anaphylaxis is to administer epinephrine and call 911 immediately.  Instead, the school called Elijah’s mother, who picked up her child and drove him to the hospital herself.  Doctors in the emergency room tried but were unable to save him.

 

Dairy allergy is the most common food allergy among young children.  And, although the peanut can produce some of the most severe allergic reactions (as well as some of the most tragic headlines), an allergy to milk products can be life-threatening.  The myth that a dairy allergy is not serious and doesn’t require as much vigilance causes great frustration to many who are allergic to milk, as does the idea that a food is “allergy free” if it does not contain nuts. To those who live with it, a dairy allergy requires an enormous amount of preparation and education since milk is an ingredient in so many products.

 

Dairy is cow’s milk and found in all cow’s milk products, such as cream, butter, cheese, and yogurt.  Doctors sometimes advise patients with a dairy allergy to avoid other animals’ milk (such as goat) because the protein it contains may be similar to cow and could cause a reaction.  Reactions to dairy vary from hives and itching to swelling and vomiting, to more severe symptoms such as wheezing, difficulty breathing, and anaphylaxis.  Strictly avoiding products containing milk is the best way to prevent a reaction.  The only way to help stop a severe food allergy reaction is with epinephrine; patients should always carry two epinephrine auto-injectors with them at all times.

 

Just like other allergens, cross contamination is a concern for those with a dairy allergy. Even a small amount of milk protein could be enough to cause a reaction. For example, butter and powdered cheese (like the kind you might find on potato chips) are easily spreadable in a pan, within a classroom or on a playground.  And, as with other allergens, hand sanitizer does NOT remove the proteins that cause allergic reactions.  Doctors recommend hand washing with good old soap and water – but wipes work in a pinch.

 

Those allergic to dairy must not only avoid food; they often have to look out for health and beauty products too.  Dairy can be found in vitamins, shampoo, and lotions.  It is critical to read the ingredient labels of every product you buy each time you buy it as ingredients and manufacturing procedures may change.

 

In the United States, any food product containing milk or a milk derivative must be listed as DAIRY or MILK under the current labeling laws (see The Ins and Outs of Reading Food Labels, Aug. 2016).  If you are living or traveling elsewhere, this list of some alternative names for dairy may be useful:

 

milk (in all forms: goat, whole, skim, 1%, 2%, evaporated, dry, condensed, etc)
butter (including artificial butter and margarine)
cream
buttermilk
sour cream
half and half
yogurt
cheese
ice cream
custard
sherbet
pudding
chocolate
ghee
whey (all forms)
casein
caseinates (all forms)
casein hydrolysate
lactose
lactulose
lactoferrin
lactalbumin (all forms)
diacetyl
rennet casein

 

Let’s spread the facts about dairy allergy so that our schools and teachers better understand how to accommodate and care for students with food allergies.   Any allergen can produce severe, life-threatening allergic reactions and all food allergies should be taken seriously and managed with attention.  I sincerely  hope that by informing others we can prevent another tragedy like the one the Silvera family was forced to experience.

 

The Language of a Food Allergic Reaction September 11, 2017

A food allergic reaction can vary from mild to severe and typically takes place shortly after eating or exposure.  All reactions require immediate attention.  But with severe allergic reactions, called anaphylaxis, minutes matter.

 

As kids head back to school and begin new activities, it’s important for EVERYONE to become familiar with the symptoms of anaphylaxis and what it language a young child might use to describe it.

 

Symptoms of Severe reaction

Some of the symptoms of a severe reaction are obvious: hives, vomiting, coughing.  But for others, we need to rely on verbal clues.  Young children may describe an allergic reaction a little differently than adults would.

 

Language of Food Allergic Reaction

 

Should you suspect that your child, or one in your care, is experiencing anaphylaxis, act immediately:

  1. Administer epinephrine, holding pen for 5-10 seconds in meaty part of outer thigh.
  2. Call 911.
  3. Contact parents.

 

Minutes matter when it comes to treating anaphylaxis.  Knowing the symptoms and the different ways it might be described will help you save a life.

 

 

6 Sensational Books for Kids with Food Allergies December 19, 2016

The holidays are just days away!  Try giving a book that a family with food allergies will treasure.  Or, donate a book to your child’s classroom or school library!

 

Despite the growing number of cases, food allergic kids often feel alone with their allergy. It is so important for kids with food allergies to see this aspect of themselves reflected in literature and elsewhere.  Plus, these books are great teaching tools for both a child with a food allergy as well as their siblings and classmates!

 

1.The Bugabees – Friends with Food Allergies, by Amy Recob
Ages: preschool – 7
bugabees-book
Beautifully and colorfully illustrated, The Bugabees is a story about eight insect friends who each have one of the different Top 8 food allergies.  They talk about their need to stay away from various treats and lightly touch on allergic symptoms they might experience.  Importantly, the bugs each repeat a mantra for kids with food allergies which reinforces that they can have fun without their allergen!  My daughter immediately noted that her brother has food allergies and was singing along with their rhythmic mantra by the end!

 

bugybops-book

2.  The BugyBops – Friends for All Time is the sequel in which the Bugabees friends learn about why their friends avoid certain foods, what an EpiPen is and why it’s important, and what they can do to keep their friends safe.  This is a fantastic companion book to The Bugabees!  I would highly recommend for a classroom visit and school library.
Ages: preschool – 8

 

3. Joey Panda and His Food Allergies Save the Day: A Children’s Book, by Amishi S. Murthy, MD and Vivian Chou, MD
Ages: Preschool – 8
joey-panda-book

Written by two pediatric allergists, the story of Joey Panda – a kid with multiple food allergies who is nervous about his first day of school, a situation that many food allergy families face.  To Joey’s surprise, not only does he find out that many of his new friends are already familiar with food allergies but that he has the knowledge and power to become a superstar.  This is story that acknowledges a child’s fears about going to a new school with food allergies and turns it into a story of empowerment.  Just the kind I love!

 

4.  The Peanut Pickle, A Story About Peanut Allergy, by Jessica Jacobs
Ages: 3-8

peanut-pickle-book

Ben has a peanut allergy.  Sometimes he finds it hard to talk about.  But now that he’s six, he’s finding ways to tell family and friends about his food allergy.  Kids with food allergies will recognize themselves in Ben and the situations he faces – important for children who often feel alone with their allergy.  This is a great book for your child to practice what to say to keep him or herself safe.

 

5.  The Princess and the Peanut Allergy, by Wendy McClure
Ages: 5-9
The Princess and the Peanut Allergy

Centered around two best friends, Paula and Regina.  Regina wants a nut-laden cake for her birthday.  Her friend, Paula is allergic to peanuts – causing problems for them both.  The girls have an argument that is ultimately resolved when Regina realizes that having her nut-filled cake may compromise her friendship with Paula.  And, Regina surprises her friend by ordering her birthday cake nut-free.  The princess and pea analogy used to enlighten Regina works as a way of explaining that even the smallest bit of peanut could be extremely harmful to someone who is allergic to them.  Importantly, the book addresses some of the social issues that can arise from having a food allergy and helps articulate conflict resolution in an age-appropriate way.

 

6.  The Peanut-Free Cafe, by Gloria Koster
Ages: 5-9Grant is a new student at the Nutley School – where everyone enjoys PB&J at lunch. As a result, he’s forced to eat by himself at a peanut-free table.  In an effort get to know him, the school offers an irresistible peanut-free cafe for anyone willing to give up their peanut butter.  This story is clever and the idea of a creating a peanut-free cafe at our house and at his school greatly excited my son!

 

 

 

(Thank you in advance! A portion of the proceeds of affiliate links go toward AllergyStrong.org – an organization aimed at helping at risk families with food allergies.)

 

‘Tis the Season: 504 Plans April 15, 2016

 

Fall and the start of school seem far away – I mean, who can think about going back to school when summer is just around the corner?!  That said, many of you are now sitting in front of a pile of forms thinking about 504 Plans for your children for next fall.

 

504 refer to Section 504 of the Rehabilitation Act and the Americans with Disabilities Act.  These plans are set in place to provide accommodations to school age children with disabilities (food allergies are listed among the qualifiers) to ensure that they are afforded equal access to learning and academic success as their peers.

 

These plans are created in collaboration with your child’s school and spell out food allergy management.  In addition to a Food Allergy Action Plan, 504 Plans can cover a broad range of topics such as snacks and meals, storage of emergency medication, addresses classroom issues related to food allergies such as science projects and other manipulatives, as well as hand washing policies.

 

Many people, including school administrators, get 504 Plans confused with IEPs.  An IEP is an Individual Education Plan which allows students with disabilities (often learning or cognitive disabilities) to receive specialized instruction and/or related services.  IEP qualification is determined both at meetings and in conjunction with standardized assessments, as well as other data collection.  504 Plans are determined by looking at medical records. Both are federally funded programs: 504 Plans guarantee access to education while IEPs provide supplemental academic services.

 

I recently came across an incredibly thorough and helpful article written by Vivian Stock-Hendel on fellow blogger, Sharon Wong’s blog “Nut Free Wok.”  Entitled, Food Allergy 101: 1, 2, 3…504 , you will learn everything you need to know about completing a 504 Plan and what to do if you need both a 504 and IEP.

 

Keep in mind, both plans can be used at schools which receive federal funding.  If your child attends private school, ask someone in administration if the school makes food allergy accommodations through 504 Plans or by another means.

 

Best of luck!

 

Additional Resources:

FARE: Advocacy – Section 504 and Written Management Plans

Food Allergy Action Plan Template

 

Food Allergy Education: Allergy and Asthma Today Spring 2016 March 8, 2016

 

As you all know, I strongly support the need for food allergy education in school.  The non-profit Allergy and Asthma Network (AANMA) recently picked up one of my articles on the subject for their publication, “Asthma and Allergy Today.”

asthma allergy today spring 2016

Here’s a link to my article in their Spring 2016 issue:  Thank You For Being a Friend.

 

Or, read it below. And in the meantime, I’d love to hear from you!  Comment below, on our Facebook page, or email me: erin@allergystrong.com:

  • I’d love to hear your thoughts on:
  • What your school is doing right;
  • Any issues you or your child has faced as a result of insufficient food allergy information/education;
  • Suggestions you have for schools/teachers to create a safer, more inclusive school environment;
  • General comments.

Thank you as always for your support!

 

Thank You For Being a Friend
published in Allergy & Asthma Today – Spring 2016
By Erin Malawer

 

Walking through the halls of an elementary school, you might see inspirational bulletin boards, posters promoting “School Spirit Week,” perhaps a donation box for clothes or backpacks.

 

You would not expect to see a whole walnut rolling around on the floor. That’s what some students at my son’s elementary school found recently. At first they didn’t even know what it was.

 

One of the students bent down to inspect it. “Hey,” he yelled to my 10-year- old son, who is allergic to tree nuts. “Come over here. Is this a walnut?”

Feeling a little nervous, my son backed away, explaining that he, of all people, is not qualified to be a nut inspector. A classmate, a girl also diagnosed with food allergies, stepped in to remind everyone about my son’s allergies. Soon after, the kids began to file into their classroom. Somehow the nut followed them.

 

My son’s deskmate grabbed the walnut and teased him with it, waving the walnut close to his face saying, “Oooooh … A walnut.”

 

My son began to speak up – we had practiced for these types of situations at home. The same girl quickly interjected, “Are you crazy? He’s ALLERGIC to nuts! He could go to the hospital!”

 

My son wasn’t harmed. But he WAS upset when I picked him up from the bus.

 

“Mom,” he said, “I know I seem really tough – like my feelings are as thick as a wall. But inside, they can be as thin as paper.”

 

We discussed what he was feeling, things he would have liked to have said, how thankful he was to have a friend like the girl who stood up for him. He felt sure his classmates acted out of misunderstanding or lack of education, rather than malice.

 

This incident was innocent enough. The first boy was curious; the second boy truly didn’t understand the potential consequences of his actions. He thought my son would join in on the joke because they are friends.

 

I asked the school if I could come into the classroom to teach the kids about food allergies – and they agreed. The students were attentive and engaged, and had intelligent questions. They were very sympathetic to how difficult it is to manage food allergies.

 

Both boys apologized to my son, explaining they had no idea about the severity of allergic reactions.

 

In the end, the incident brought my son and his classmates closer together. Looking back, it’s very easy to imagine a different outcome. But as my husband rightly points out, “Kids WANT to do the right thing and be supportive. Sometimes they don’t have enough facts to know how.”

 

Statistically, there are two students in every classroom with food allergies.  But that number is growing.  We need to teach our kids the facts about this condition, so they can act appropriately. And we need to teach them to be supportive of each other.  A lesson in food allergies is a lesson in empathy – and it just might save a life.

 

If your school doesn’t include food allergy education in their health curriculum, I encourage you to volunteer your time to do it yourself.