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Managing Food Allergies

Managing Food Allergies. Cheryl Johnson, MS,RD,LD Director Child Nutrition & Wellness Kansas State Department of Education. Objectives. Understand food allergies. Discuss food allergy management in Child Nutrition Programs.

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Managing Food Allergies

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  1. Managing Food Allergies Cheryl Johnson, MS,RD,LD Director Child Nutrition & Wellness Kansas State Department of Education

  2. Objectives • Understand food allergies. • Discuss food allergy management in Child Nutrition Programs. • Explain ways to prevent exposing children with allergies to food allergens.

  3. Definition of Food Allergy • A food allergy is an immune system response to a food that the body mistakenly believes is harmful.

  4. Food Allergy Symptoms Swelling-Especially of the Eyelids, Face, Lips and Tongue Light-Headedness or Fainting Nasal Congestion Runny Nose Shortness of Breath Wheezing Difficulty Swallowing • Scratchy Throat • Abdominal Pain • Diarrhea • Nausea • Vomiting • Stomach Cramps • Itching of the Mouth, Throat, Eyes, Skin, or Any Area • Hives

  5. Anaphylaxis • A potentially life threatening medical condition that can occur after a person with allergies is exposed to a specific allergen. • Collection of symptoms affecting multiple systems of the body that may occur immediately or up to 2 or more hours following allergen exposure.

  6. Common Food Allergies - “The Big Eight” • Peanuts • Tree Nuts (such as almonds, pecans, walnuts)‏ • Milk • Eggs • Soy • Wheat • Fish (such as bass, cod, flounder)‏ • Crustacean Shellfish (such as crab, lobster, shrimp)‏

  7. Foods that Commonly Contain“The Big Eight” Allergens • Peanuts - peanuts, peanut oil, ground nuts, mixed nuts, nut pieces, peanut butter, chocolate candies, candy bars, ice cream • Tree Nuts - almonds, brazil nuts, cashews, chestnuts, hickory nuts, macadamia nuts, almond paste or extract, nougat, nut butters, pecans, pesto, pine nuts, pistachios, walnuts, other nut extracts. • Milk - butter, buttermilk, cheese, cream, whipped cream, cottage cheese, custard, ice cream, sherbet, nougat (found in many candy bars), pudding, sour cream, yogurt, ingredients containing casein, lactose, or whey on food labels • Egg - egg, egg substitute, macaroni, mayonnaise, meringue

  8. Foods that Commonly Contain“The Big Eight” Allergens, cont. • Soy - tofu, miso, soy sauce, tamari sauce • Wheat - bran, bread crumbs, crackers, flour (including whole wheat, enriched, all-purpose, cake and graham), gluten, granola or granola bars, macaroni, spaghetti and other pastas, soy sauce, starch, modified food starch, hydroluzed vegetable protein • Fish - Bass, cod, flounder, anchovies, tuna • Shellfish - clams, crab, crawfish, lobster, mollusks, mussels, oysters, scallops, snails, shrimp, seafood flavorings

  9. Food Allergen Labeling and Consumer Protection Act • Food product must be clearly labeled with allergen information if: • Product contains one of the top 8 allergens • Product contains derivative of top allergens • Compliance had to occur by January 1, 2006

  10. Definition of Food Intolerance • An adverse reaction to food that does not involve the immune system. • Examples: • Lactose Intolerance • Gluten Intolerance

  11. Treatment for Allergies • Antihistamines/Bronchodilators • Epinephrine • Prevention and Strict Avoidance

  12. Regulations • Require modifications to the standard meal requirements for children who are considered disabled and whose disability restricts their diets • Permit modifications for children who are not disabled but who are unable to consume regular program meals because of medical or other special dietary needs.

  13. Medical Statement The medical statement must include: • Child’s disability • Explanation of why disability restricts the diet • Major life activity affected by the disability • Foods to be omitted • Foods that must be substituted

  14. School Meal Modification Form

  15. CACFP Meal Modification Form

  16. Meal Modification Forms • School Meal Modification Form • Food Service Facts, Chapter 19 • Form 19-A Letter to Parents/Guardian • Form 19-B Medical Statement to Request School Meal Modification • Form-19-C Discontinuation of Meal Modification • CACFP Meal Modification Form • Administrative Handbook, Chapter 4 • Form 4-B CACFP Meal Modification Form

  17. Prevent Exposure • Keep children safe at all times in all locations. • Identify the children with documented food allergies, while maintaining confidentiality. • Develop standardized cleaning procedures to prevent cross contact of allergens. • Learn to recognize signs of anaphylaxis. • Activate the emergency plan if an anaphylaxis incident should occur.

  18. Vigilance in the Kitchen • Know foods to avoid to keep children safe. • Know foods to substitute. • Read foodlabels. • Prevent cross-contact by following safe food handling procedures. • Designate allergy-aware zones.

  19. Summary • The number of children with food allergies has been increasing. • Food allergies can be life-threatening. • Program staff must keep children safe. • Meal modifications are required for children who have a disability that restricts their diets. • Meal modifications are permitted for other children who are unable to consume regular program meals due to special dietary needs.

  20. Allergy and Anaphylaxisin the School Setting The Role of the School Nurse

  21. Allergy Prevention, Recognition, and Response Careful planning and prevention can greatly reduce the risk of students experiencing anaphylaxis, or a life-threatening allergic reaction at school

  22. What School Nurses Can Do • There is no cure for allergies or anaphylaxis. • But there are steps we can take: • To prevent exposure, • To recognize when an exposure has occurred, and • To respond quickly and effectively.

  23. Prevention • Management of food allergies is based on a coordinated approach using effective partnerships among school nurse, food service personnel, other school staff, children and their parents and healthcare provider(s). • Implement a process to collect health related information from students on at LEAST a yearly basis (health intake/registration/history form). See HANDOUT.

  24. Prevention • Once a student has been identified to have a “food allergy”, a Family Food Allergy Health History form should be completed. https://www.nasn.org/portals/0/resources/faat_1a_family_history.pdf

  25. Prevention • Student medical home is identified. • Student has health insurance. • Student has a “Medical Statement to Request School Meal Modification” form on file completed by a healthcare provider. (Original kept on file with Food Service Director, and copies kept in student health folder and with building food service kitchen manager).

  26. Prevention • The school nurse will develop an Individualized Healthcare Plan (IHP) based on each child’s unique needs and treatment. • The school nurse will develop an Emergency Action Plan (EAP). • The IHP will provide specific prevention steps for the individual child and the EAP will provide student specific symptoms to observe. • Students with food allergies and anaphylaxis must not be excluded from school activities and the IHP and EAP will provide steps to keep the student safe.

  27. Prevention • Communicate with ALL staff who interact with the students on a regular basis, ensuring they understand food allergy, can recognize symptoms, know what to do in an emergency and work collaboratively to eliminate or reduce the exposure to food allergens. • Ensure medications are appropriately stored, and allow student to “carry their own epinephrine” as much as possible. • Delegate school personnel to administer medications in accordance with Kansas Nurse Practice Act. • Work with district transportation staff to ensure their training includes “food allergy” symptoms awareness and what to do if a reaction occurs.

  28. Prevention • Recommend that all buses have communication devices in case of emergency. • Enforce a “no eating” policy on school buses. • Discuss field trips with the parents and school staff to decide appropriate strategies for managing the food allergy (at least 2 weeks notice for in-state field trips and 2 months notice of out of state field trips). Take Emergency Action Plan and Medication on field trips. • Encourage classroom teachers to adopt a “no sharing” or “trading” food in their student population(s).

  29. Prevention/Education • Consider art and science materials, including pet foods. • Promote hand washing before and after eating. • Read food labels every time food is served. • Consider talking with the parent of the child with an allergy to send home a letter to parents in the class.

  30. Response to an Allergic Reaction The Emergency Action Plan

  31. Steps to Take • If a student displays signs and symptoms of an allergic reaction and/or reports an exposure to their allergen, school personnel should immediately: • Notify the school nurse (if available) and initiate the Emergency Action Plan • Locate the student’s epinephrine immediately; or administer via protocol, if “stock” epinephrine is available • Call 911 if epinephrine has been administered.

  32. Act Quickly! Do Not Delay! • Epinephrine is the medication of choice for the treatment of acute anaphylaxis and delay of, or failure to administer Epinephrine, may contribute to a fatal outcome. When in doubt, use the EpiPen! • The side effects of the EpiPen could include fast heart beat, jittery feeling, and other cardiovascular symptoms. The life-saving benefit of Epinephrine outweighs the risks of side effects in an anaphylactic reaction.

  33. Other Medication for use with Allergic Reactions • Antihistamine • Diphenhydramine hydrochloride – Brand name includes: Benadryl • Cetirizine – Brand name includes: Zyrtec • May cause drowsiness, nausea, and dryness of the mouth. • NOTE: Antihistamines should not be the only medication given in anaphylaxis since epinephrine is the drug of choice. There is no contraindication to give epinephrine for anaphylaxis along with an oral antihistamine.

  34. Online Resources • FAAN Back to School Tool Kit: http://www.foodallergy.org/section/back-to-school-tool-kit • FAAN School Guidelines for Managing Students with Food Allergies: http://www.foodallergy.org/file/school-guidelines-faan.pdf • FAAN Food Allergy Action Plan: http://www.foodallergy.org/file/emergency-care-plan.pdf • CDC National Center for Chronic Disease Prevention and Health Promotion: http://www.cdc.gov/healthyschools/foodallergies/index.htm • American Academy of Allergy, Asthma and Immunology. (AAAAI): http://www.aaaai.org/

  35. References • School Tools: Allergy & Asthma Resources for Professionals. https://www.aaaai.org/conditions-and-treatments/library/school-tools • The Food Allergy and Anaphylaxis Network (FAAN). www.foodallergy.org • National Association of School Nurses. http://www.nasn.org http://www.nasn.org/ToolsResources/FoodAllergyandAnaphylaxis • Asthma & Allergy Foundation of America. http://www.aafa.org • Food Allergy Field Guide: http://www.foodallergy.org/field-guide

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