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.

 

The ADA and Section 504: What it Means for Those with Food Allergies November 4, 2021

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Equal Access and Protections Under the Law:

The Americans with Disabilities Act (commonly referred to as the ADA) is a law that prevents discrimination against people with disabilities. The ADA applies to workplaces, public schools, state and federal government institutions as well as spaces of public accommodation (private entities such as restaurants, museums, movie theaters, parks, etc). The ADA not only protects those with disabilities themselves, but also those associated with individuals with disabilities (such as caregivers).

Like the ADA, Section 504 of the Rehabilitation Act of 1973 is a national law that protects qualified individuals from discrimination due to their disability. This law applies to any center of education, employer or organization that receives financial assistance from the U.S. government. Examples of this include hospitals, public schools, nursing homes, human services programs, etc.

Section 504 centers around access and inclusion. Not only does this law require schools, employers and organizations who receive federal assistance to prevent discrimination based on disability, but it also requires them to provide equal access to program benefits and services to those with a qualified disability. It defines the rights of individuals with disabilities to participate in, benefit from and have access to programs and services.

Does Food Allergy Qualify as a Disability?

Under both the ADA and Section 504, qualified individuals are defined as those with a physical or mental impairment that substantially limits one or more major life functions. Food allergies puts a patient at risk of life-threatening anaphylaxis, limiting a patient’s ability to eat and interfering with their ability to breath – two major life activities.

Depending on the situation and your ability to protect yourself reasonably, food allergy may be considered a disability under the law. The key words are equal access and inclusion to programs and their benefits when assessing whether food allergy will qualify as a disability under the law.

What is a “504 Plan”?

504 Plans – named after the law – are roadmaps used to protect students in educational settings (most often K-12 public schools) and guarantee equal access to education.

These plans document what teachers, substitute teachers, administrators, and others should do in order to protect students with food allergies. 504 Plans are created by parents and representatives at the school for each individual student (often in conjunction with the school nurse and/or a doctor’s recommendations) based on the needs of their condition.

504 Plans outline reasonable accommodations that can be made to guarantee equal access to education and inclusion in the classroom and throughout the school.

What is Does a Reasonable Accommodation Look Like?

Reasonable accommodations are changes in either environment or process that public and private entities can take to ensure equal access and inclusion to patients with food allergies and/or offer protection to them. These requests should not place an undue burden on the entity to implement or maintain.

  • In a school setting, a reasonable accommodation might be to request that students wash their hands after handling food at snack or lunchtime.
  • At work, a reasonable accommodation might be requesting a shelf or space in the office kitchen to keep safe food.
  • The ability to bring safe food into a restaurant or sport stadium might be a reasonable request in a space of public accommodation.

The right to equal access and inclusion in school, the workplace and spaces of public accommodation are guaranteed under the ADA and Section 504. Whether or not a patient with food allergies qualifies can vary – depending on both the situation and the patient’s individual allergies. That said, protecting those with food allergies and finding ways to include them in all places should be the goal of every institution public and private.

For more information, please visit The Allergy Law Project.

 

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.

 

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.

 

 

 

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.

 

Expired EpiPens? EpiPhany! October 21, 2011

After being inspired to clean out some spaces in my house that haven’t received much attention recently, I amazingly stumbled upon a large stash of expired EpiPens.  I was holding on to them with the thought that they might be useful in some way or in need of special disposal, but instead they simply sat in the back of a closet.

 

Suddenly I had an epiphany (an EpiPhany if you will).   Instead of throwing them out, I brought the EpiPens into our school nurse to help train other teachers, assistants, interns and substitutes on the administration of an EpiPen.  More than 15% of food allergic children experience a food allergy reaction while at school.  Given that statistic, emergency training with real EpiPens is only to everyone’s benefit (not least of which is my own son).

 

So, consider donating your expired EpiPens to your local school, preschool, camp or daycare facility and spread the word to any allergic adults you may know.  Our nurse was excited to use our old EpiPens and to store our old trainers for faculty food allergy training and I felt great putting them all to good use.

 

 
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