Allergy Shmallergy

Simplifying life for families with food allergies.

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.

 

Food Allergy Treatment: OIT 101 January 21, 2020

[DISCLAIMER: Oral Immunotherapy is always conducted under the direction and supervision of a medical doctor.  It is an individualized plan.  Please talk to your doctor if you’re interested in learning more about OIT.  This is not an endorsement of OIT and is for informational purposes only.]

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UPDATE:  Palforzia was approved by the FDA in late January 2020 and is use today.  If you choose to pursue OIT, discuss whether Palforzia or other OIT programs are best for you with your healthcare provider.

While the U.S. Food and Drug Administration considers whether to approve Aimmune’s  Palforzia – possibly the first drug to be approved for peanut allergy, let’s get an overview of OIT.

Oral immunotherapy isn’t a new concept.  In fact, it has been discussed in medical journals for over a century and used for decades to help patients desensitize to environmental and drug allergies as well as build a tolerance to venom.  OIT has been studied in food allergy (mostly for peanut allergy) for the last 20 years and been in medical trials for just over 10 years.

Following a successful presentation to the U.S. FDA in September 2019, we stand on the cusp of seeing the first oral immunotherapy drug (Palforzia) approved.  Until now, food allergic patients have had no other option but to avoid their allergen for the life of their allergy.  FDA-approved drugs, like Palforzia, and other therapies would offer some patients progress, giving them much-needed treatment options to increase tolerance and protect them from life-threatening reactions for the very first time.

What is OIT?

Oral immunotherapy – or OIT – is a treatment option for some with food allergies that is managed and is strictly monitored by a patient’s allergist.  [NOTE: OIT and desensitization should ONLY be done under medical supervision and with guidance from your personal doctor.]

Oral immunotherapy is a safeguard.  It is a therapy intended to protect patients should they accidentally be exposed to their allergen.  It can also bolster a patient and caregiver’s mental health by reducing anxiety and stress caused by the heavy burden of food allergy management and unexpected, potentially life-threatening reactions.

Immunotherapy (whether oral, epicutaneous, sublingual or otherwise) is a treatment option to help patients tolerate a higher level of allergenic protein and is NOT a cure for food allergies.

boy and girl eating cookies

Photo by cottonbro on Pexels.com

How does it work?

OIT is a form of desensitization – that is, the process of retraining a patient’s body to tolerate a larger amount of the allergen to which they are allergic without causing a reaction.

For example, if a patient is allergic to peanuts, a doctor would give a patient an amount of peanut protein (beginning with a tiny dose of 1/100th of a peanut or three milligrams). That dose is gradually increased until that patient can safely eat a level of protein that would otherwise cause a reaction.  The goal of many OIT programs is to get the patient to tolerate at least 600 mg of peanut protein (or the equivalent of 2 peanuts), although these goals vary from practice to practice and patient to patient.

milk OIT

Dairy OIT solution – photo by OakleyOriginals via Flickr (CC BY 2.0)

Is OIT only for those with a peanut allergy?

Although the FDA is currently only reviewing a drug aimed at peanut allergy, oral immunotherapy trials are available for those who suffer from other food allergies as well.

How effective is oral immunotherapy?  Does it work?

Peanut, egg and milk OIT has been studied most closely and shown to desensitize 60-80% of participants.  Studies related to peanut oral immunotherapy specifically have between 85-90% success rates.  Other food allergens have not been studied as thoroughly and initial results show they may not be as effective at increasing a patient’s tolerance.  These  numbers are the result of oral challenges and not real-world accidental exposure.

Can anyone pursue oral immunotherapy?

If you’re interested in OIT, it’s best to speak with your doctor.  The process of going through OIT can be demanding and does not fit every lifestyle.  And, there are certain food allergy-related conditions (such as eosinophilic esophagitis – EOE – and others) that might make immunotherapy more difficult.

computer desk laptop stethoscope

Photo by Negative Space on Pexels.com

Consider this…

There are a few side effects that are possible while undergoing OIT.  The most common issue patient’s experience is gastrointestinal (reflux, cramping and vomiting), followed by oral itching, hives, and wheezing.  The risk for anaphylaxis is higher for those going through immunotherapy due to a patient’s regular exposure to their allergen.   Patients also risk  developing/inciting EOE – which often goes away when therapy discontinues.

The process of oral immunotherapy can be rigorous.  It requires an oral challenge, frequent doctor’s visits, and a comfort with using an epinephrine auto-injector.  Therapy also puts some restrictions on the life of patients as a precaution. For example, after dosing patients are required to rest to keep their body temperatures steady for 2 to 4 hours. And, daily monitoring is required.

Patients often need to take a daily or weekly maintenance dose indefinitely to keep up their tolerance.

Finally…

Oral immunotherapy is a much-needed treatment options for those seeking some protection and relief from the demands of living with food allergies.  Safeguarding patients against cross-contamination and accidental exposure is important for a patient’s physical as well as mental well-being.  But OIT is not for everyone.  If you’re interested, talk to your doctor about OIT and see if it’s a good fit for your lifestyle.

For more information, please read:

The Current State of Oral Immunotherapy from AAAAI

 

Summer Resolution: Train the Sous-Chefs June 19, 2012

Ok, I realize that summer resolutions may not be as traditional as those made at New Year’s.  However, the end of the school year feels like just the right time to begin my new undertaking.

 

My resolution for the summer is to get the kids more involved in cooking with me.  I’ve given up trying to convince the boys that the healthy meal I’ve made for them is also delicious.  If they have a hand in making the meal, perhaps they’ll be more interested in gulping it down at dinnertime.  And, for my food allergic son, this will be a great way to get him thinking about what goes into different kinds of dishes so he can help protect himself when we’re not together.

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To take a tip from the First Lady, I’ve allowed my son’s to each pick a vegetable plant to tend to throughout the summer.  My younger son chose a pepper plant; the older one, a tomato plant.  Plus, we have pumpkin vines growing in the yard where our old jack-o-lanterns were ransacked by squirrels a few years ago, as well as mint and basil that keeps sprouting up whether or not I plant it.  It’s not a produce section, but it’s a start.

 

My husband and I also had a heart-to-heart with the boys one night after everyone was either very difficult about or refused altogether to try a very family-friendly dinner I had prepared.  We’re putting the kids’ suggestion for trying new dishes into practice: each week, the kids will pick a recipe of their choice for the family to taste at dinner.

 

Finally, the boys are getting in on the preparation.  They are old enough to help with the meals.  Not only does this give them an appreciation for making the meals AND give them an incentive to eat their creations, but it also teaches them how to cook.  I only learned when my oldest son was diagnosed with food allergies and commercially prepared dishes just weren’t an option.  I want our kids to see cooking as a family affair. To enjoy the process of learning a new dish.  To appreciate the culture from which it comes.  And, most of all, to feel confident in a kitchen and appreciate healthy, well-prepared food.

 

This is especially important for my oldest son, who may not outgrow many of his food allergies.  I want him to feel confident about food, not nervous around it.  I want him to eventually possess the skills he needs to prepare nearly any dish he cares to try.  And, as stated above, I’d like him to be familiar with the kinds of ingredients that are common to various dishes so that he can ask the appropriate questions and protect himself from reaction when I’m not around to do it for him.

 

I’m excited to begin next week.  And, who knows what we’ll be having.  I have some kid-friendly cookbooks handy and can’t wait to taste those peppers and tomatoes when they ripen.  Wish me luck!  I may need it….

 

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