1. 1 © 2010 Children’s Memorial Hospital Supported by the Food Allergy Initiative of Chicago faiusa.org/Chicago Food Allergy Guidelines for Managing Life-Threatening Food Allergies in Illinois Schools: A Primer Christine Szychlinski, MS, APN, CPNP Manager, Bunning Food Allergy Program Coordinator, Food Allergy Community/Professional Education Division of Allergy, Children’s Memorial Hospital

2. 2 © 2010 Children’s Memorial Hospital Definitions Key terms defined include Allergy: “adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food”  Food: “any substance intended for human consumption”  Food allergens: “specific components of food or ingredients within foods (typically proteins but sometimes also chemical haptens) that are recognized by allergen-specific immune cells and elicit specific immunologic reactions, resulting in characteristic symptoms”

3. 3 © 2010 Children’s Memorial Hospital Soy Cow’s milkPeanutTree nuts FishShellfish Egg white Wheat Common Allergens

4. 4 © 2010 Children’s Memorial Hospital Peanut allergy  Peanut allergy doubled in children over a five-year period (1997-2002).  Accidental ingestion of peanut associated with fatal anaphylaxis –FAAN estimates 100 deaths per year and 1500 trips to the Emergency Department due to peanut allergy

5. 5 © 2010 Children’s Memorial Hospital Multiple Food Allergies  There are more children in schools now with multiple food allergies  Studies published in 2007 have shown that milk and egg allergy can persist into a child’s teen years (Skripak JACI 2007)  Focusing on peanut is not addressing the entire problem

6. 6 © 2010 Children’s Memorial Hospital Fatal reactions happen Risk factors:  Asthma  Adolescents or young adults  Peanut or tree nut allergy  Epinephrine administration was delayed (Bock JACI 2001/2007)

7. 7 © 2010 Children’s Memorial Hospital Treatment There is no cure (yet) for food allergies. The only current treatment is AVOIDANCE.

8. 8 © 2010 Children’s Memorial Hospital More than just a physical risk  Recognize possible emotional needs –“At risk” for eating disorders, anxiety, and depression  Be aware of teasing/ bullying  Avoid isolating and stigmatizing  Involve the school social worker as needed

9. 9 © 2010 Children’s Memorial Hospital Impact on the school nurse  2004 Telephone survey of 400 school nurses 44% increase in food allergies >33% at least 10 students with food allergy 78% did staff training 74% did guideline development »Weiss, C Jrnl of School Nurs 2004  Need for standardized guidelines...

10. 10 © 2010 Children’s Memorial Hospital Managing Food Allergies in School: The Law In 2009, Illinois passed Public Act 96-0349 which amended the IL School Code to state that:  By July 1, 2010, ISBE, in conjunction with IDPH, must develop guidelines for the management of students with life- threatening food allergies.  ISBE and IDPH must establish a committee of experts to develop these guidelines.  School personnel who work with students must be trained at least every 2 years at an in-service conducted by individuals with expertise in anaphylactic reactions and management. 105 ILCS 5/2-3.148; 105 ILCS 5/10-22.39(e)

11. 11 © 2010 Children’s Memorial Hospital Managing Food Allergies in School: The Law (Continued) The guidelines must include but are not limited to:  Education and training for school personnel  Procedures for responding to life-threatening allergic reactions to food  A process for implementing individualized health care and food allergy action plans  Protocols to prevent exposure to food allergens By January 1, 2011, each school board must implement a policy based on and consistent with these guidelines. 105 ILCS 5/2-3.148

12. 12 © 2010 Children’s Memorial Hospital The Guidelines "Guidelines for Managing Life-threatening Food Allergies in Illinois Schools“  www.isbe.net/nutrition/htmls/food_allergy_guidelines.htm www.isbe.net/nutrition/htmls/food_allergy_guidelines.htm  Used to create school policies and best practices  Contain template forms for school districts: - Emergency Action Plan (EAP) - Individual Health Care Plan (IHCP) - 504 Plan - Allergy History Form - Medical Alert to Parents/Guardians

13. 13 © 2010 Children’s Memorial Hospital The Guidelines  Contain specific checklists for School nurse/designated personnel Administration Classroom Teachers/specialists Custodial Staff Food service Transportation services Outside of Classroom Activities Parents of children with food allergy Children with food allergy

14. 14 © 2010 Children’s Memorial Hospital The work flow of best practice...  Schools are active at identifying children with known FA –food allergies to be included on forms  Each child with diagnosed FA has a written plan –Emergency Action Plan (EAP) must be signed by a licensed health care provider  Each child with a FA and an EAP will also have an Individual Health Care Plan and/or 504 Plan that, at minimum, –Will describe what the school will do to accommodate the student –Contain an EAP –Include risk reduction and emergency response measures

15. 15 © 2010 Children’s Memorial Hospital Specifics of Staff education  Conduct and track emergency drills  Education to include: –symptom recognition –review of high risk areas –how to prevent exposure to allergens –how to respond to emergencies –how to administer epinephrine auto-injector –how to respond to students with previously unknown allergy –legal protection

16. 16 © 2010 Children’s Memorial Hospital Managing Food Allergies in School Create a safe environment for students with food allergies.  PREVENT reactions  RECOGNIZE reactions  RESPOND to reactions

17. 17 © 2010 Children’s Memorial Hospital Prevent a Reaction Avoid exposure to allergen  During school day  While traveling to and from school  During school-funded events  While on field trips

18. 18 © 2010 Children’s Memorial Hospital Prevent a Reaction Avoidance is the key to preventing a reaction.  Cross-contamination  Mislabeled foods  Unlabeled foods

19. 19 © 2010 Children’s Memorial Hospital Prevent a Reaction  Multiple studies show it is possible to keep a school environment safe for a student with food allergies if attention is paid to details.  Allergens must be physically removed from hands and surfaces.  All staff members must be aware of these best practices

20. 20 © 2010 Children’s Memorial Hospital Prevent a Reaction: So what do studies tell us?  Exposure to food allergens by touch or inhalation is unlikely to cause a life-threatening reaction. (Simonte SJ JACI 2003)  However, risk of ingestion (and reaction) if child touches allergen and then place fingers in or near mouth or nose.

21. 21 © 2010 Children’s Memorial Hospital Managing Food Allergies in School Create a safe environment:  Prevent  Recognize an allergic reaction  Respond

22. 22 © 2010 Children’s Memorial Hospital Allergic Reaction: What a Child Might Say or Do Say  “My tongue (or mouth) itches”  “My tongue is hot/burning”  “My mouth feels funny”  “There’s something stuck in my throat”  “It feels like there are bugs in my ears”  “This food is too spicy” Do  Put their hands in their mouths  Pull or scratch at their tongues  Drool  Hoarse cry or voice  Slur words  Become unusually clingy

23. 23 © 2010 Children’s Memorial Hospital Recognize a reaction: Anaphylaxis  The medical diagnosis for a severe reaction.  Symptoms rapid in onset and severe.  Involves the most dangerous symptoms including but not limited to: breathing difficulties and a drop in blood pressure (shock).  Always a risk of death, even if treated appropriately.

24. 24 © 2010 Children’s Memorial Hospital Managing Food Allergies in School Create a safe environment  Prevent  Recognize  Respond to an allergic reaction

27. 27 © 2010 Children’s Memorial Hospital Allergic reaction: Respond Follow the Food Allergy Emergency Action Plan prescribed by licensed health care provider  Take all symptoms seriously  Do not delay in giving epinephrine when required – Safe and simple to use  If epinephrine given, call 911

28. 28 © 2010 Children’s Memorial Hospital Managing Food Allergies in School: Summary Create a safe environment  Prevent a reaction: – Avoidance – Know the IHCP for your student  Recognize a reaction: Know the signs and symptoms  Respond to an allergic reaction: – Know the EAP for your student. Respond quickly. – Practice emergency response drills

29. 29 © 2010 Children’s Memorial Hospital Thank you!  Questions?  Useful websites: – www.foodallergyinitiative.org www.foodallergyinitiative.org – www.foodallergy.org www.foodallergy.org – www.childrensmemorial.org/FACE www.childrensmemorial.org/FACE