1. Food Allergies in the School Albemarle County Public Schools

2. What is a Food Allergy?  A food allergy is an immune response to a food that the body mistakenly thinks is harmful.  Happens after the body has been exposed to the food (allergen) and develops antibodies to it.  Subsequent exposure causes a release of chemicals that produce the symptoms of the allergic reaction.  Symptoms range from mild to severe and can affect many systems in the body.

3. Symptoms of Food Allergies  Skin: flushing, hives, itching  Upper respiratory: nasal congestion, runny nose  Lower respiratory: wheezing, coughing, throat or chest tightness, hoarseness, shortness of breath  Gastrointestinal tract: mouth or tongue itching and swelling, cramps, nausea, vomiting, diarrhea  Cardiovascular: fast heart rate, slow heart rate, low blood pressure, chest pain, loss of consciousness

4. Anaphylaxis Anaphylaxis is a severe food allergy reaction that if untreated can lead to death. Can occur from minutes to hours after exposure. Can recur up to 8 hours after initial reaction (biphasic).

5. Food Allergies in Children  6% to 8% of children may have food allergies.  Incidence is increasing.  14 students at Hollymead School have been diagnosed with food allergies.

6. Common Food Allergies in Children Not usually outgrown:  Peanuts  Tree nuts  Shellfish  Fish Commonly outgrown:  Milk  Soy  Egg  Wheat

7. School Guidelines for Managing Students with Food Allergies The following delineation of responsibilities is adapted from guidelines developed with participation of the following organizations: The American School Food Service Association The American School Food Service Association National Association of Elementary School Principals National Association of Elementary School Principals National Association of School Nurses National Association of School Nurses National School Boards Association National School Boards Association The Food Allergy & Anaphylaxis Network The Food Allergy & Anaphylaxis Network

8. Family’s Responsibility  Notify school of student’s allergies.  Provide Food Allergy Care Plan* signed by parent and physician with emergency contact numbers.  Provide properly labeled medications and replace upon expiration.  Educate child on self-management** as child’s development permits.  Review policies/procedures with school staff and physician after allergic reaction occurs.

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10. ** Self Management of Food Allergies (Family and Student’s Responsibility)  Know which foods are safe and which are not.  Know strategies for avoiding unsafe food.  Learn how to read food labels.  Know symptoms of food allergy.  Know to tell an adult when a food allergic reaction may be occurring.

11. School’s Responsibility I  Review health records submitted by parents and physicians.  Include food-allergic students in all school activities.  Develop an allergy prevention plan.  Assure that staff know which students are food allergic, and are knowledgeable about prevention and symptoms of an allergic reaction.  Assure that there are staff members trained in recognizing and treating symptoms of food allergies.  Ensure medications are properly stored and easily accessible to trained staff members.

12. School’s Responsibilitiy II  Permit student to self-carry emergency medication if criteria are met.  Review policies, prevention and treatment plan after an allergic reaction occurs.  Assure transportation personnel are knowledgeable in recognizing symptoms and treatment of allergic reaction.  Discuss and plan for field trips and other changes in routine with family prior to occurrence.  Not tolerate threats or harassment against food allergic child.

13. Student’s Responsibility  Should not trade food with others.  Should not eat anything with unknown ingredients or known to contain allergens.  Participate in food allergy prevention and treatment plan as development permits.  Should notify an adult immediately if an allergen may have been ingested or if symptoms of a food allergy occur.

14. Cafeteria, Lunchtime and Snacks  Provide peanut-free table(s). May provide other allergen free table if requested.  Clean tables with clean cloth per table. Children who eat peanut butter for lunch may not clean the peanut-free table.  Students who eat peanut butter must wash hands after lunch and before recess.  No student will be isolated at lunchtime due to food allergies.  Ingredient lists for cafeteria foods will be provided to parents on request.  Food services personnel will be trained on how to avoid cross contamination of common allergy foods with other foods.  Children who eat peanut butter for snacks will wash their hands and desks afterwards. Desks may be washed with commercially prepared wipes.

15. Treating Food Allergies  Avoid the food that triggers the allergy  Food Allergy Care Plan should be provided for each student  Antihistamine for certain symptoms -- skin  Epinephrine injection  Emergency medical care

16. How to Administer Epi-Pen Call or designate call to 9-1-1. Step 1: Unscrew cap of holder. Step 2: Check to see that the pen has not expired. Step 3: Make a fist around the auto-injector and remove gray safety cap. Do not touch the black tip.

17. Administering Epi-Pen (Cont.) Step 4: Hold the auto- injector at a right angle to the upper outer part of the thigh. Step 5: Press the black tip hard into the upper outer thigh until a click is heard or felt. Hold in place for 10 seconds. May go through clothing.

18. Administering Epi-Pen (Cont.) Step 6: Carefully take the pen away. Do not touch the needle which will now be sticking out of the black tip. Gently rub the thigh for 10 seconds. Step 7: Check to see that the pen is empty. Step 8: Record the time the pen was administered. Give the pen and the time to rescue squad personnel.

19. Video Clip Instructions http://www.galantandlin.com/medical/video/i ndex.htm http://www.galantandlin.com/medical/video/i ndex.htm http://www.epipen.com/howtouse.aspx

20. Food Allergy Myths Myth 1: The cause of the allergic reaction is obvious. Often it is not. Students should be referred to an allergist who can do testing. Myth 2: Food allergic reaction always involves the skin first. 10 to 20 % do not have skin symptoms. Myth 3: Prior episodes predict future reactions. Pattern or severity is not predictable. Myth 4: Anaphylaxis is easy to avoid by avoiding the known allergen. Even when everybody is extremely careful, an accidental exposure can happen.

21. Other Causes of Allergic Reactions: Insect Venom  0.5 to 5% of American are sensitive to insect venom.  Common symptoms: local pain, redness, swelling.  Anaphylaxis: hives, red skin, flushing, difficulty breathing, low blood pressure, feeling faint, dizzy, loss of consciousness.  Common culprits: bees, wasps, hornets, fire ants.

22. Other Causes of Allergic Reactions: Latex  1 to 6% of population.  Repeated exposure increases risk. Children with chronic illnesses and health care workers at risk.  Reactions: rash, hives, itching, swelling, runny nose, difficulty breathing, cough, wheezing.  Triggers: protein in rubber latex, latex gloves, balloons, bandages, rubber bands, hot water bottles, clothing elastic.

23. Treatment  Depends on the severity of allergy.  Avoidance of trigger.  Antihistamines for skin reactions.  Epinephrine may be prescribed for children with severe allergy. Care Plan should also be provided.

24. Conclusion Students with food allergies can safely participate in all school related activities. Students with food allergies can safely participate in all school related activities. School staff should be knowledgeable about which students have allergies to what, how to avoid the allergen, and how to recognize and promptly treat allergic reactions. School staff should be knowledgeable about which students have allergies to what, how to avoid the allergen, and how to recognize and promptly treat allergic reactions. Parents, doctors, school personnel, students with allergies and their classmates all have a role to play in keeping allergic children safe at school. Parents, doctors, school personnel, students with allergies and their classmates all have a role to play in keeping allergic children safe at school.