American Red Cross

1
American Red Cross

• Food Allergy Basics

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Introduction

• Food allergies and anaphylaxis
• Medications
• Video
• Demonstration
• Individualized health plan
• Food allergy management
• Legal issues
• Resources
• Quiz

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Importance of Food Allergy EducationResearch
Review

• A 2001 study concluded that it is common for
  food-allergic children to have a reaction in
  school
• 18 of the children in the study had at least 1
  reaction in school over the past 2 years
• 36 of the reactions involved 2 or more organ
  systems
• 32 of the reactions involved wheezing
• 14 of the children did not have a physicians
  order for medication
• 16 of the children did not have medication
  available
• Arch Pediatric Adolescent Medicine. 2001 July

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Research review

• A 2001 study of participants in the U.S. Peanut
  and Tree Nut Allergy Registry (PAR) were randomly
  selected for the study
• Of the 4586 participants in the PAR, 750 (16)
  indicated a reaction in school or daycare
• For 90 of the reactions, medications were given
• Treatment delays were caused by delayed
  recognition of symptoms, calling the parents, not
  following emergency plan, and an unsuccessful
  attempt to administer epinephrine
• J Pediatrics, 2001 April

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Anaphylaxis Research

• 1992 study of fatal and near fatal anaphylactic
  reactions to food in children
• 13 children ages 2-17
• 12 had asthma, all had food allergies
• The 6 patients who died had symptoms within 3-30
  minutes of ingestion of the allergen, but only 2
  received epinephrine within the first hour

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Research

• The 7 who lived had symptoms within 5 minutes of
  ingestion of the allergen and all but 1 received
  epinephrine within 30 minutes of the onset of the
  symptoms
• The researchers concluded, Dangerous
  anaphylactic reactions to food occur in children
  and adolescents. The failure to recognize the
  severity of these reactions and to administer
  epinephrine promptly increases the risk of a
  fatal outcome.

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FOOD ALLERGY FACTS

• Approximately 2 million school aged children have
  food allergy
• One in every 20 children under the age of three
  has food allergies
• Teens and young adults with food allergy and
  asthma appear to have a higher risk for severe or
  fatal allergic reactions
• 150-200 people die each year from anaphylaxis to
  food
• Food allergy reactions result in over 30,000
  emergency room admissions each year
• Statistics provided by," The Food Allergy and
  Anaphylaxis Network

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Food Allergy Definition

• Food allergy is a disease characterized by an
  overreaction of the immune system to a specific
  food protein
• Diagnosis
• Blood tests
• Skin tests
• Food challenges

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Food Allergy vs. Food Intolerance

• Food Allergy
• Involves the immune system
• Special antibodies develop against a particular
  food
• Allergic reaction is usually caused by the
  proteins in foods

• Food Intolerance
• Does not involve the immune system
• Abnormal response to a food or food additive
• Symptoms include nervousness, headache, vomiting,
  diarrhea

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The BIG 8-Most Common Food Allergens

• Milk
• Eggs
• Peanuts
• Tree Nuts
• Soy
• Fish
• Shellfish
• Wheat

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Systems Affected in an Allergic Reaction

• Skin
• Digestive
• Respiratory
• Cardiac
• Neurological

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Symptoms of an Allergic Reaction

• Symptoms can start within a few seconds or take
  up to 2 hours to occur.
• Symptoms may start out as mild (a few hives or
  some diarrhea) and then rapidly progress to life
  threatening anaphylaxis.
• There is no way to predict the severity of a
  reaction based on the history of past reactions.
• Biphasic reactions happen when symptoms seem to
  resolve but reoccur several hours later.

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Anaphylaxis

• Anaphylaxis is a sudden, severe allergic reaction
  that can affect one or more organ systems, either
  alone or in combination
• Anaphylaxis can be life threatening!

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Skin Symptoms of Allergic Reaction

• Hives
• red, itchy, swollen areas of the skin

Hives
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Skin Symptoms of Anaphylaxis

• First signs of anaphylaxis
• Warmth, flushing, tingling, itching of mouth
• Itchy, red rash
• Hives
• Paleness

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Digestive Symptoms of Anaphylaxis

• Cramps
• Nausea
• Vomiting
• Diarrhea
• Difficulty swallowing

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Respiratory Symptoms of Anaphylaxis

• Itchy eyes and throat
• Coughing
• Shortness of breath
• Chest tightness
• Wheezing

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Heart/Blood Vessel Symptoms of Anaphylaxis

• Low blood pressure
• Increased heart rate
• Shock
• Loss of consciousness

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Neurological Symptoms of Anaphylaxis

• Lightheadedness
• Anxiety/Sense of doom
• Weakness

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Common Myths and Truths About Anaphylaxis

• Myth 1 Each episode of anaphylaxis will become
  more severe.
• Truth 1 Subsequent episodes may be the same,
  more severe or less severe.
• Myth 2 Anaphylaxis is always life threatening
• Truth 2 Some anaphylaxis is mild and will go
  away without treatment, but this cannot be
  predicted.

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More Common Myths and Truths About Anaphylaxis

• Myth 3 Anaphylaxis can occur hours or days
  after eating a food.
• Truth 3 Almost all episodes occur within 2
  hours of contact with an allergen.
• Myth 4 Anaphylaxis takes at least 20 minutes to
  begin, so there is always time to get treatment.
• Truth 4 Reactions can occur within seconds of
  contact with an allergen.

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More Common Myths and Truths About Anaphylaxis

• Myth 5 Anaphylaxis will subside within 1-2
  hours.
• Truth 5 Symptoms can last more than 2 hours,
  and a second wave of symptoms can occur 3-4 hours
  after exposure. This is called a biphasic
  reaction
• Myth 6 All cases of anaphylaxis have hives or
  swelling.
• Truth 6 About 20 of people with anaphylaxis do
  not have skin symptoms.

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More Common Myths and Truths About Anaphylaxis

• Myth 7 Anaphylaxis can be prevented by taking
  Benadryl before eating the problem food.
• Truth 7 Preventing anaphylaxis is not usually
  possible with medications, however, Benadryl may
  mask early symptoms and prevent early treatment.
• Myth 8 All peanut reactions cause severe
  anaphylaxis.
• Truth 8 Some people with peanut allergy
  experience only mild reactions.

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More Common Myths and Truths About Anaphylaxis

• Myth 9 Contact reactions are common causes of
  anaphylaxis.
• Truth 9 Contact reactions can cause
  anaphylaxis, but local reaction is more common.

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Medications -

• ALWAYS follow the Dr.s orders
• Know the policy of your institution
• The 5 rights of medications
• Right person
• Right medication
• Right time to administer
• Right dose
• Right route

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Epinephrine

• What is it?
• Hormone we naturally produce in our bodies, also
  referred to as adrenaline
• Commonly known as the EpiPen
• The ONLY medication that can reverse anaphylaxis

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Epinephrine

• How it works
• Relaxes muscles around your airway
• Makes the heart beat faster and stronger
• Narrows blood vessels ?Increases your blood
  pressure
• Life saving properties
• Relaxed airway muscles opens the airway to
  breathe easier
• Faster heart beat and increase blood pressure
  means more oxygen gets from your lungs to the
  rest of your body

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Epinephrine

• If Epinephrine is given, the person requires
  immediate transport to a hospital via an
  Ambulance.
• Epinephrine works quickly, but only lasts in the
  body for 15-20 minutes
• EMS will be able to provide additional support
  with oxygen, IV fluids, and medications, if
  needed

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Antihistamines

• Common names Benadryl, Zyrtec, Claritin,
  Clarinex, Allegra
• How it works
• Blocks where histamine binds on the cells that
  cause the itching and runny nose
• Desired effects
• Mostly for comfort - relieves itching, runny nose
• Does NOT reverse anaphylaxis

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Inhalers

• Can alleviate some symptoms but can not reverse
  anaphylaxis
• Epinephrine should always be used to treat
  respiratory symptoms of anaphylaxis

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Medication Storage

• Keep at room temperature
• Epinephrine is heat sensitive
• Keep epinephrine out of direct light as light can
  degrade epinephrine and reduce its strength
• VERY clearly labeled
• Names (child, parent, doctor, medication),
  directions for giving the medication,
  individualized management plan
• Keep medications easily accessible in a secure
  location

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Food Allergy Management Plan

• Plan for management and prevention specific to
  the child
• Includes
• childs allergy
• parents name and phone number
• symptoms of allergic reaction
• locations of the EpiPen
• school management plan
• instructions for the room parent (parent helper)
• Doctor and parents are involved in designing the
  plan

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Emergency Action Plan

• Gives directions for what to do in the event of
  an allergic reaction (see handout)
• Includes
• Symptoms constituting a minor or major reaction
• What to do in the event of a minor or major
  reaction (who to call, meds to give, etc)
• Emergency contacts
• Allergy trained staff members and their room
  numbers
• EpiPen administration directions
• Signed by parent and doctor

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Getting Started

• Parent meets with teachers/staff
• Discuss childs condition and specifics of the
  allergy
• Clarify food allergy management plan and
  emergency action plan
• Maintenance of privacy
• vs
• allergy alert sign in the childs class
• vs
• telling/educating other children about the
  students allergy
• Also consider notification of other parents

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Think AheadField Trips

• Always have the childs EpiPen as well as a
  trained adult (or school nurse if possible)
  accompanying the field trip
• Medic alert bracelet
• Bring a cell phone!
• If field trip is over lunch or includes a
  special lunch (for example, eating out at a
  fast food restaurant), ensure that the allergic
  child brings their own lunch

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Thinking aheadparties

• Look at ingredients that vendors usecross
  contamination may be possible
• Reconsider using a pizza shop that makes pesto
  containing pine nuts (very common) because even
  if you ordered a pizza free of allergy inducing
  ingredients, there may be cross contamination at
  the pizza shop
• Ask childs mom to send a special snack with the
  child when it is party time so that the
  allergic child can still participate

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Thinking aheadclass pets

• Food and bedding of class pets may contain nut
  products
• Hamsters
• Guinea pigs
• Room of a child with a nut allergy should NOT
  have these (or similar) class pets

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Thinking aheadfood related learning activities

• Carefully read all ingredients before bringing
  the activity into the classroom
• Example peanut butter craft projects, making
  ginger bread houses out of foods which may
  contain nuts or wheat (graham crackers)

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Managing Food Allergies At School

• Avoidance Strategies
• Cleaning procedures
• Hand washing
• PAL Program

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Avoidance Strategies

• There is no cure for food allergies
• Strict avoidance of the allergen is the only way
  to avoid a reaction.
• - Label reading
• - Prepared meals

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Label Reading

• Caregivers must read the ingredient list on
  all products
• food
• soaps
• lotions
• pet foods and bedding
• bean bags

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Better Safe than Sick

• Always read the ingredient list before giving a
  child foods, soaps, and lotions.
• Safe lists are dangerous because manufacturers
  can routinely change ingredients.

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Reading Labels

• May contain trace amounts of
• This product was processed on equipment utilized
  in the production of
• The last ingredient
• Never serve a product containing an allergen to
  an allergic child.

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Other Names for Common Allergens

• Milk- Casein, curds, lactulose, and whey.
• Eggs- Albumin, mayonnaise, lecithin, and surimi.
• Peanuts- Ground Nuts, peanut flour, African,
  Asian, and Mexican dishes.
• Wheat- Bran, gluten, kamut, and semolina.
• Soy- Edamame, natto, soya, and tofu.
• Tree Nuts- Almonds, Brazil Nuts, cashews,
  chestnuts, hickory nuts, macadamia nuts, pecans,
  pistachios, walnuts, and marzipan/almond paste
  (used in many bakery cookies).
• Shellfish- Abalone, lobster, mollusks, mussels,
  shrimp (crevette), and squid (calamari).
• Natural and Artificial flavorings can contain
  food allergens.

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Prepared Meals

• Bring meals from home
• - reduces stress
• - familiarity with food lists and
  preferences
• Food from home should be stored in labeled
  containers.

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Avoidance Strategies for Infants and Toddlers

• Ask the parents to provide you with a list of
  foods and ingredients the child should avoid
• Designate one person to be responsible for the
  food for the allergic child.
• Designate a backup person .
• Write the childs name on the bottle so bottles
  are not given to the wrong child.

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Avoidance

• Write the childs name on all baby food jars
• Feed toddlers in high chairs to keep children
  separated during mealtime
• Designate a shelf for allergy free foods and
  clearly label the foods for each child.
• Label and assign a cup for the allergic child to
  use or use disposable cups.

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Avoidance Strategies for Preschool Aged Children

• Involve the parents in planning activities such
  as class parties and field trips
• Ask the childs parent to provide you with a
  complete list of foods and ingredients to avoid
• If other parents volunteer for class activities,
  make sure they know who are the food allergic
  children and of the management policies for the
  food allergy

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Avoidance strategies cont.

• Try to have two caregivers be responsible for
  giving food to the allergic child. One can act as
  a backup.
• Keep the allergic childs food clearly labeled
  and stored on a special shelf.
• Have the parent provide you with a box of safe
  snacks the child can eat in the event of
  unplanned parties or events.
• Monitor the child during mealtime to prevent
  cross contamination from other sources.

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Cleaning Strategies

• Soap and water
• Followed by sanitizing solution
• Dedicated sponge and bucket
• Waterless sanitizers do not work

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Hand washing

• Wash hands thoroughly before and after meals
• Wash your hands for the
• length of time it takes you
• to sing the Happy Birthday
• Song
• Adults and children
• Waterless sanitizers do not work!

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PAL Program,Protect A Life

• 1. Food allergies are serious
• 2. Dont share food with allergic friends
• 3. Wash hands after eating
• 4. Help your friends avoid allergens
• 5. If your allergic friend becomes ill, get help!

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Discussion of PAL

• Friends should not be limited to peer aged
  individuals. Parents of friends as well as
  teachers can be seen as PALs. Discuss with
  parents how they wish to involve the school
  community.

• Pros
• More eyes
• Education
• Allergen free classroom

• Cons
• Confidentiality
• Embarrassment
• Teasing

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• We have
• a student
• with an
• allergy to
• ________
• in our
• classroom.

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Special Tables

• Pros
• Dedicated table makes choosing easy for the child
• Eliminates some worry
• Easy identification of allergic child for
  rotating staff
• Cons
• Remember to use a dedicated bucket and sponge
• Schools with more than 1 type of food allergy
• Isolation of the child

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Managing Airborne Allergies

• During cooking, vapors may be released from the
  allergen and travel in the air.
• Allergic children should not go in the kitchen
  facility.
• Cafeteria staff should become familiar with the
  professional standards for dealing with food
  allergies.

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Federal Laws

• Federal Laws that protect people with
  disabilities include The Rehabilitation Act of
  1973, Section 504 and The American Disabilities
  Act (ADA) of 1990.
• Children who have been diagnosed with potentially
  life-threatening food allergies could be
  considered disabled.

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504 for Federally Funded Schools

• No otherwise qualified individual with a
  disability in the United States, as defined in
  section 706(8) of this title, shall, solely by
  reason of her or his handicap, be excluded from
  participation in, be denied the benefits of, or
  be subjected to discrimination under any program
  or activity receiving Federal Financial
  assistance or under any program or activity
  conducted by any Executive agency or by the
  United States Postal Service.... 29 U.S.C.
  794(a) (1973).
• This applies to preschool and child care centers
  that receive federal funds or services.

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The Americans with Disabilities Act of 1990

• No individual shall be discriminated against on
  the basis of disability in the full and equal
  enjoyment of the goods and servicesof
  anypublic accommodation.
• Titles II and III affect children with food
  allergies.
• Title II affects children who are in a child care
  center or preschool that is run by a state or
  local government.
• Title III affects children in private child care
  centers and private preschools.

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Lets Talk

• Stressed parent
• Notifying other parents in the classroom
• Packing own foods
• Communication
• Emergency Action Plan
• Fearful child
• Reassure child
• Include child in as many activities as possible

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Lets Talk

• Easy going parent
• Staff professionalism
• Continuing education
• Communication
• Recognize severity of food allergies
• Staff flexibility

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FOOD ALLERGY CHAIN OF SURVIVAL

• Staff and parents meet to discuss the childs
  food allergy management plan
• Identify the child at risk to staff and
  volunteers
• Develop a written plan for managing the food
  allergy including staff training of emergency
  medication usage
• Follow the Emergency Action Plan if a reaction
  occurs
• Evaluate response, modify plan as needed

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Resources

• The Food Allergy and Anaphylaxis Network
  www.foodallergy.org
• American Academy of Allergy Asthma and Immunology
  www.aaaai.org
• Food Allergy Initiative
• www.FoodAllergyInitiative.org
• In Cincinnati, Ohio-FAAST, Food Allergy
  Awareness, Support and Training,
  www.FAASTCincy.org