1. Life Threatening Food Allergies in Schools and Educational Programs Why We Need State Mandated Guidelines Suzette Cyr, RN, BSN Jennifer Kelley, RN BSN Jeremy Beaulieu, RN, BSN Why We Need State Mandated Guidelines Suzette Cyr, RN, BSN Jennifer Kelley, RN BSN Jeremy Beaulieu, RN, BSN

2. What is a Food Allergy? When the body’s immune system mistakenly believes a harmless substance is harmful to the body. It tries to protect the body by releasing histamines and IgE antibodies to attack the substance.

3. Food Allergy Response  Chemical triggers like histamine and IgE antibodies are released in response to an allergen and can cause allergic reactions with a variety of symptoms  Symptoms may vary from person to person and not all reactions appear the same  Chemical triggers like histamine and IgE antibodies are released in response to an allergen and can cause allergic reactions with a variety of symptoms  Symptoms may vary from person to person and not all reactions appear the same

4. Histamine Reaction

5. Symptom Reactions  Symptoms can range from mild to severe. Severe, life- threatening reactions are called anaphylaxis.  40-50% of people diagnosed with food allergies are judged to have a high risk of anaphylaxis.

6. Symptoms of Anaphylaxis  Tingling sensation in the mouth  Swelling of the tongue and throat  Difficulty breathing  Hives  Vomiting  Abdominal cramps  Diarrhea  Drop in blood pressure  Loss of consciousness  Death (in rare cases)

7. Common Food Allergies  Peanuts  Tree nuts  Wheat  Soy  Milk  Eggs  Fish  Shellfish  Peanuts  Tree nuts  Wheat  Soy  Milk  Eggs  Fish  Shellfish

8. Food Allergy Statistics  There is no cure for food allergies. Strict avoidance of food allergens and early recognition and management of allergic reactions to food are important measures to prevent serious health consequences.  More than 12 million Americans have food allergies. That’s one in 25, or 4 percent of the population.  Approximately 2 million school-age children (ages 5-17) have food allergies in the U.S.  The CDC reported an average of 317,000 food allergy- related ambulatory care visits per year to emergency and outpatient departments and physicians offices for children under the age of 18.  There is no cure for food allergies. Strict avoidance of food allergens and early recognition and management of allergic reactions to food are important measures to prevent serious health consequences.  More than 12 million Americans have food allergies. That’s one in 25, or 4 percent of the population.  Approximately 2 million school-age children (ages 5-17) have food allergies in the U.S.  The CDC reported an average of 317,000 food allergy- related ambulatory care visits per year to emergency and outpatient departments and physicians offices for children under the age of 18.

9. Food Allergy Statistics  In two published studies addressing fatal food anaphylactic reactions, more than half (59%) of the individuals were age 19 or younger.  In a study of 13 food allergy-induced anaphylactic reactions in school-age children, four of the six fatal reactions occurred in a school-type setting.  In two published studies addressing fatal food anaphylactic reactions, more than half (59%) of the individuals were age 19 or younger.  In a study of 13 food allergy-induced anaphylactic reactions in school-age children, four of the six fatal reactions occurred in a school-type setting.

10. Why Should Schools and Educational Programs Be Prepared to Address Food Allergies?  Schools and educational programs have a responsibility for the health and safety of children under their care.  First food allergy reactions often occur in these settings.  Fatalities can result from delaying administration of epinephrine and providing effective emergency care  Food allergies could be a complicating factor when dealing with other conditions (i.e. asthma).  Children with food allergies have unique social and emotional challenges. NSBA’s School Health Programs (2010). Food Allergies and Schools: Keeping students safe and ready to learn. [Powerpoint Slides]. Retrieved from http://static.cdn.esgn.tv/food_allergy_webcast_slides.pdf.  Schools and educational programs have a responsibility for the health and safety of children under their care.  First food allergy reactions often occur in these settings.  Fatalities can result from delaying administration of epinephrine and providing effective emergency care  Food allergies could be a complicating factor when dealing with other conditions (i.e. asthma).  Children with food allergies have unique social and emotional challenges. NSBA’s School Health Programs (2010). Food Allergies and Schools: Keeping students safe and ready to learn. [Powerpoint Slides]. Retrieved from http://static.cdn.esgn.tv/food_allergy_webcast_slides.pdf.

11. What is Currently in Place for Maine’s Educational Programs? Department of Education Manual of Policies:  Defines the role of school nurse  Forms for food allergy action plans  Student assessment form for epi-pen use  504 plans are implemented in schools for health/safety/environmental modifications necessary for students with disabilities  State policy supports students’ right to carry and self- administer prescribed asthma/allergy/anaphylaxis medications in schools Department of Education Manual of Policies:  Defines the role of school nurse  Forms for food allergy action plans  Student assessment form for epi-pen use  504 plans are implemented in schools for health/safety/environmental modifications necessary for students with disabilities  State policy supports students’ right to carry and self- administer prescribed asthma/allergy/anaphylaxis medications in schools

12. Issues That Need to Be Addressed in Maine Schools  Quality of training/education provided to staff caring for children with food allergies  Assessment of signs and symptoms of reaction and potential for anaphylaxis  Assessment of signs and symptoms of children with asthma and other co-morbidities  Competency of staff and their knowledge of food allergies (i.e. safety, prevention, food handling, recognizing symptoms, and responding to reactions)  Quality of training/education provided to staff caring for children with food allergies  Assessment of signs and symptoms of reaction and potential for anaphylaxis  Assessment of signs and symptoms of children with asthma and other co-morbidities  Competency of staff and their knowledge of food allergies (i.e. safety, prevention, food handling, recognizing symptoms, and responding to reactions)

13. Issues That Need to Be Addressed in Maine Schools  School’s responsibility toward understanding social and emotional challenges of children with food allergies  Importance of disseminating general educational information on food allergies to staff, parents, and children  Information provided to parents about prepared food ingredients, food preparation, and cleaning practices  School’s responsibility toward understanding social and emotional challenges of children with food allergies  Importance of disseminating general educational information on food allergies to staff, parents, and children  Information provided to parents about prepared food ingredients, food preparation, and cleaning practices

14. Lack of Consistency in Maine Schools A review of several schools found the following:  Scarborough: Written regulations regarding students diagnosed with food allergies/sensitivities (adopted 9/3/09)  SAD 6: No written policy; verbal guidelines exist  Auburn: No written policy; follow state department of education guidelines for school nurses  Portland: No written policy could be located A review of several schools found the following:  Scarborough: Written regulations regarding students diagnosed with food allergies/sensitivities (adopted 9/3/09)  SAD 6: No written policy; verbal guidelines exist  Auburn: No written policy; follow state department of education guidelines for school nurses  Portland: No written policy could be located

15. Problems With Relying Only On 504 Plans  Plans are individualized, therefore there are no standardized guidelines for managing allergic reactions and assisting parents with developing plans based on child’s needs  Stigmatization may prevent parents from making requests for their child’s needs to schools  Plans are individualized, therefore there are no standardized guidelines for managing allergic reactions and assisting parents with developing plans based on child’s needs  Stigmatization may prevent parents from making requests for their child’s needs to schools

16. What Needs to Be Done  Legislation with mandated guidelines for managing life threatening food allergy reactions in school/educational settings.  A collaborative training approach involving school staff and services to identify and monitor students with food allergies, established health care plans, and emergency care plans  Legislation with mandated guidelines for managing life threatening food allergy reactions in school/educational settings.  A collaborative training approach involving school staff and services to identify and monitor students with food allergies, established health care plans, and emergency care plans

17. What Needs to Be Done  Establish written emergency protocols to prepare for and respond to food allergy emergencies  Implement practices that minimize exposure to allergens  Establish written emergency protocols to prepare for and respond to food allergy emergencies  Implement practices that minimize exposure to allergens

18. Resources Available for Funding State Mandated Guidelines  FDA Food Safety Modernization Act (2010):  Section 112: Food allergy and anaphylaxis management  Establishment of voluntary food allergy and anaphylaxis guidelines  Local and state agencies can receive grants for developing school-based food allergy management programs  FDA Food Safety Modernization Act (2010):  Section 112: Food allergy and anaphylaxis management  Establishment of voluntary food allergy and anaphylaxis guidelines  Local and state agencies can receive grants for developing school-based food allergy management programs