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Food Allergy Awareness and Management

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  1. Food Allergy Awareness and Management University of Wisconsin Jo Hopp

  2. Food Allergy Awareness Agenda • Introduction • Food Allergy Basics • Peanut Allergy Basics • Managing Peanut Allergies at School • Reactions and the Epi-pen

  3. Resources and Information • Food Allergy and Anaphylaxis Network (FAAN) • American Academy of Allergy, Asthma and Immunology • National Institute of Allergy and Infectious Disease • FEAST of Seattle, WA • Various websites dedicated to food allergy advocacy (e.g.

  4. THANK YOU, THANK YOU(we can’t say it enough) • Wakanda Elementary School Administration and Teachers • Menomonie School District • Wisconsin • Recipients of 3 Mariel C. Furlong Awards (2006) • Contributions of food allergy awareness, education and advocacy

  5. What is a Food Allergy? • Immunological response to food (allergic reaction) • Body protecting itself – release of histamine • Affects multiple body systems: • GI • Respiratory • Skin • Cardiovascular • Exposure can cause serious problems or death

  6. Intolerance vs. Allergy • Intolerance • Reaction to the chemicals in food • No immune system response • No serious (life-threatening) side-effects • Bloating, gas, abdominal discomfort • Public impression • Parental interaction

  7. Food Allergy FactsWhat the experts say • Doubling of food allergy over the past 10 years, particularly peanut allergy. • Latest statistics show continual increase with peanut allergy as the leading cause • ~12 million Americans affected (4%) • ~ ½ are peanut and/or tree nut • ~3 million school aged children (~8%) • Onset at any age

  8. Food Allergy FactsWhat the experts say • Food allergy is the leading cause of serious allergic reaction (anaphylaxis) outside the hospital setting. • over 30,000 ER visits per year • ~ 175 deaths annually • reactions caused most often outside the home and by products believed to be safe • Asthma increases risk of fatal reaction • Adolescents and young adults are at the highest risk Bock, et. al J Allergy Clinical Immunol 2001

  9. Food Allergy FactsWhat the experts say • Sensitivity to the allergen can vary • For some, a speck of allergen can have the same effect as eating a large quantity • For some, skin contact with the allergen is enough to cause a reaction • For some, inhalation of the allergen can cause discomfort • Sensitivity is truly ‘unknown’ • Affected systems can vary between individuals AND reactions

  10. Food Allergy FactsWhat the experts say • No Cure • Strict avoidance is the only way to prevent allergic reactions

  11. Food Allergy FactsWhat the experts say • Eight foods account for 90% of all reactions

  12. Peanut Allergy Specific • 1/250 of a peanut is enough to trigger a reaction (cutting a peanut in half 125 times!) Hourihane, J. J Allergy Clin Immunol 1997 • Severe allergies are typically life-long • High cross-reactivity to tree nuts (almonds, walnuts, etc.)

  13. Peanut Allergy Specific • Peanut allergies tend to cause the most severe reactions • Peanut or tree nut allergies and asthma appear to increase the risk for fatal reactions • A study (2001) of 32 cases of fatal food-allergy induced anaphylaxis showed >90% had peanut and tree nut allergies, most had asthma and emergency medication (epinephrine) was not given or not given soon enough. Bock, et al. J Allergy Clin Immunol 2001 • A more recent study (2007) also showed a large majority of fatalities due to peanuts/tree nuts and asthma. • Estimated that at least ½ of deaths are result of peanut/tree nut

  14. Allergic Reactions - facts • Severity of reaction can vary from mild to serious and potentially fatal • Previous reactions DO NOT indicate future reactions • An unpredictable physiological change occurs after each exposure • Within a couple minutes to 2 hours after exposure (and in rare cases longer) • Once reaction starts, progression can vary • Not just a lunch-time event! • Can be biphasic

  15. What is anaphylaxis? • Most severe allergic reaction • Involves multiple systems at the same time • Potentially fatal, especially if medication is not given promptly (at first signs)

  16. What is anaphylaxis? • Can occur within minutes of exposure (death can occur within as few as 6 minutes) • Pattern can vary among individuals • Peanut/Tree nut allergies in combination with asthma is the highest risk

  17. Managing Food/Peanut Allergies in Schools

  18. Strict Avoidance • No cure for food allergies • Key is helping children avoid allergens • Good attitude • Careful handling • Cross-contamination • Label reading • Expecting the Unexpected

  19. Good Attitude • Nothing is 100% safe • ‘peanut free’ environment only reduces the risk of exposure, it does not eliminate risk • Even food from home is a risk • Food and food consumption IS NOT the only risk • Exposure can occur in non-food items • Exposure can occur on surfaces, in projects, outdoors • Vigilance is key

  20. Good Attitude • Setting an example • Teaching Empathy • Good Communication with Families

  21. Careful handling • Allergic children can react through • Ingesting • Contact • Inhaling • Everyone has to be aware, as reactions can occur at varying times after exposure • Just because you aren’t around during lunch doesn’t mean that you won’t be needed for a reaction

  22. Avoiding Cross-Contamination

  23. What to do • Require thorough hand washing and teeth brushing especially if you suspect a student has eaten peanuts/nuts • Clean eating and working areas carefully • Discourage food sharing • Have “safe” snacks and treats from family • Do not allow homemade goodies or home prepared foods (e.g. apples cut at home)

  24. Label Reading • Food Allergen Labeling and Consumer Protection Act (FALCPA) • As of January 1, 2006, labels must list common language for the top 8 allergens • Reading labels carefully can save a child’s life • Foods can be analogous to poison

  25. Standard Label

  26. “Contains” Statements

  27. “Contains” Statement Policy • Only required for allergens not clearly stated in the ingredient list. • Chef Boyardee Pizza

  28. Warning Labels May also say “manufactured in a facility that also processes peanuts”


  30. What NOT to give • If label is ambiguous as to presence of peanut • If no label present • Homebaked items • Ice cream • Bakery Items • Imported Foods

  31. Expecting the Unexpected • What might contain peanuts/tree nuts? • It’s NOT ONLY in the food!!!

  32. A New School Year…new faces, new information

  33. Your Students and Families • Education and Support is critical to keep ALL children safe at school • Hand out • Constant reminders are necessary, especially around birthdays and holidays • Be consistent in policies • Be an advocate and an example – avoid confusion • Engage the students in awareness • Likely not understand necessity of peanut-free environment • Educate the students • Teach empathy • Take bullying seriously • PAL Program

  34. Management in the school and classroom • Nothing is 100% safe • Cross-contamination is a serious threat • Label reading is critical • Peanuts/nuts can be in unusual items (not even food related) • Know the students – know the plan • Locations of medication • How to recognize reaction • How to use medication

  35. Possible Exposures • Ingestion • Contact • Inhalation • Eating, Mucus Membranes, Eczema

  36. Signs of an Allergic Reaction • Hives • Difficulty Breathing • Vomiting • Diarrhea • Eczema Flare • Lightheadedness • Swelling

  37. What a Child May Say Food Allergy News, Vol 13, No 2; 2003 • I think I am going to throw up • My mouth/tongue itches • My chest feels tight • I feel itchy • My tongue feels hot/burning/tingling/heavy • There’s something in my throat • My lips feel tight • My tongue feels like there is hair on it • Feels like bugs are in my ears

  38. What can be done??? • GIVE EPINEPHRINE!!! (Epi-pen)

  39. Remove grey activation cap • Jab black end into outer thigh • Use enough force to make a bruise • This can be done through clothing • Hold 15 seconds • Keep patient lying down Administering an Epi-pen

  40. Call 911 • After injection, call 911 right away • Tell them that you have a child who is experiencing anaphylaxis, you have administered the epi-pen, and to bring more epinephrine!

  41. Emergency Action Plan • Varies for individual child • Action plan should be in place that is SPECIFIC for each allergic child • Know the plan • Know where the medication is located

  42. THANK YOU You can make a difference in the life of a food allergic child.Please be an advocate.