1. Legal and Practical Strategies for Managing Food Allergies
Christina Eldredge MD, Medical College of Wisconsin
Brenda White, Archdiocese of Milwaukee
Linda Joyner, St. Mary School, Menomonee Falls

2. Objectives Discuss why school management is important
Define and discuss signs and symptoms of anaphylaxis and food allergy
Updates on new Epinephrine Auto- injector options
Update on new law & guidelines

3. Food Allergy Basics Increasing in prevalence
Most recent study 8% children have a reported food allergy1
1/3 have had a severe reaction
No cure
Abnormal immune reaction by the body to a food protein
When food eaten, the body’s immune system abnormally thinks the food is bad and “attacks” with histamine and other chemicals²
Treatment is avoidance of food allergen & plan for accidental exposure (action plan)
1. Gupta, 2011
2. FAAN slides

4. Most Common Food Allergies
Milk
Peanut
Fish
Soy
Wheat
Shellfish
Egg
Tree nuts

5. Why is food allergy important?
Can be potentially life threatening
Anaphylaxis: “serious allergic reaction rapid in onset and may cause death”¹
Many food allergy reactions occur in school²
Approximately 25% of first time food allergy reactions occur in school
Teachers the primary first responders²
1 Sampson 2006
2.US Peanut and Tree Nut Registry

6. School Deficiencies Two Main Deficiencies:
Inadequate food allergy management plans
Recognizing reactions and prompt treatment (epinephrine)
*Young, 2009

7. Signs and Symptoms Cutaneous (Skin) >90% Hives / Swelling 85 – 90%
Flush 45 – 55%
Pruritus 2 – 5%
Respiratory (breathing) 40 – 60%
Shortness of breath / Wheezing 45 – 50%
Upper Airway Swelling 50 – 60%
Runny nose 15 – 20%
Dizziness, Loss of Consciousness, Low Blood Pressure 30 – 35%
Abdominal Involvement 25 – 30%
Seizures 1 – 2%

8. Severe Reactions or Anaphylaxis
Fatal and near fatal reactions to food are usually unpredictable
Delay in treatment a factor
Treatment: Epinephrine auto-injector
Often accidental, peanuts/tree nuts usually worse
Jr lbs, >66 adult dose

9. Where do school reactions occur?
Peanut/tree reactions*
Classroom
Craft projects
Birthday celebrations
Cafeteria
Playground
Field trips
*US Peanut and Tree Nut Registry
Not cafeteria, field trip case wrong lunch

10. Federal and State Laws
Section 504 prohibits a private school from discriminating against an individual because of a disability.
Wisconsin Statute requires the administration of medication by trained staff.
Wisconsin Act 239 governs the use of stock epi pens in schools.

11. School Policy and Guidance
School administrators and school personnel must receive medication training in accordance with DPI regulations.
No medication will be administered by school personnel without the Medication Consent Form and the Physician Order for Medication Administration Form being filled out and returned to the individual(s) administering the medication and/or the School Nurse.

12. Self Carry Policy and Guidance
Students may carry certain emergency prescription medications, such as asthma inhalers, glucagon, and EpiPens.
Students in grades K-12 may self-administer while at school only under the supervision of trained school staff/ volunteers.
Must have a release form completed and signed by the student’s physician, parent/legal guardian, principal, and homeroom teacher (refer to Form c)
The parent must provide to the school a copy of a health care plan (refer to Form d) for a student who requires an emergency prescription medication.

13. Wisconsin Act 239
The governing body of a school may adopt a plan for students with life threatening allergies.
A physician, NP, or PA may prescribe epinephrine auto-injectors in the name of a school with a plan.
Designated, trained school personnel may administer Epipen to pupils with prescription and pupils believed to be experiencing anaphylaxis in accordance with a standing protocol from a physician, APNP, or physician assistant.
Must call 911 after Epipen injection.

14. Federal Legislation
School Access to Emergency Epinephrine Act, President Obama signed on November 13, 2013.
“Encourages states to adopt laws requiring schools to have on hand “stock” epinephrine auto-injectors.”

15. School Plan
Develop a local plan for management of students with life threatening allergies
Epinephrine training for staff and volunteers
Accessible action plans for each student
Review and retention of student health records
Storage of medication
Self carry policies
No-food sharing policies (bus, classroom, cafeteria)
Hand-washing and cleaning protocols
Classroom protocols (snacks, projects, rewards)
Field trips

17. Google Forms

19. Other Possibilities… Annual coaches training
Flipping staff meetings/PD modules
???

20. FARE: Food Allergy Research & Education
allergies-for-adults

21. References:
Branum AM, Lukacs SL. Food allergy among U.S. children: trends in prevalence and hospitalizations. NCHS Data Brief. Oct 2008(10):1-8.
Food Allergy and Anaphylaxis Network. 2011; Accessed August 17th, 2011.
Hay GH, Harper TB, 3rd, Moore TG. Assuring the safety of severely food allergic children in school. J Sch Health. Nov 2006;76(9):
Sicherer SH, Mahr T. Management of food allergy in the school setting. Pediatrics. Dec 2010;126(6):
Young MC, Munoz-Furlong A, Sicherer SH. Management of food allergies in schools: a perspective for allergists. J Allergy Clin Immunol. Aug 2009;124(2): , 182 e ; quiz
Shah E, Pongracic J. Food-induced anaphylaxis: who, what, why, and where? Pediatr Ann. Aug 2008;37(8):
Rhim GS, McMorris MS. School readiness for children with food allergies. Ann Allergy Asthma Immunol. Feb 2001;86(2):
Pulcini JM, Marshall GD, Jr., Naveed A. Presence of food allergy emergency action plans in Mississippi. Ann Allergy Asthma Immunol. Aug 2011;107(2):

22. References:
Pulcini JM, Sease KK, Marshall GD. Disparity between the presence and absence of food allergy action plans in one school district. Allergy Asthma Proc. Mar ;31(2):
Boyce JA, Assa'ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. Dec 2010;126(6 Suppl):S1-58.
Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics Dec 2009;124(6):
Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. Aug ;327(6):
Jarvinen KM. Food-induced anaphylaxis. Curr Opin Allergy Clin Immunol. Jun ;11(3):
Clark S, Espinola J, Rudders SA, Banerji A, Camargo CA, Jr. Frequency of US emergency department visits for food-related acute allergic reactions. The Journal of allergy and clinical immunology. Mar 2011;127(3):
Ford LS, Taylor SL, Pacenza R, Niemann LM, Lambrecht DM, Sicherer SH. Food allergen advisory labeling and product contamination with egg, milk, and peanut. J Allergy Clin Immunol. Aug 2010;126(2):
Avery NJ, King RM, Knight S, Hourihane JO. Assessment of quality of life in children with peanut allergy. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology. Oct 2003;14(5):
  Sampson HA. Anaphylaxis and emergency treatment. Pediatrics. Jun 2003;111(6 Pt ):