2. Disclosures /
Acknowledgements
Disclosures
___________________, FAACT Representative
Speakers received no monetary or in-kind compensation
Acknowledgements
• Food Allergy & Anaphylaxis Connection Team (FAACT).
2015
• Center for Disease Control and Prevention (CDC).
Voluntary Guidelines for Managing Food Allergies in
Schools and Early Care and Education Programs.
Washington, DC: US Department of Health & Human
Services (DHH); 2013
• St. Louis Children’s Hospital. Food Allergy Management &
Education (FAME) program. 2014
3. FAACT: Who and What
FAACT's mission is to educate, advocate, and raise
awareness for all individuals and families affected by food
allergies and life-threatening anaphylaxis.
FAACT offers many education programs and hands-on
civil rights advocacy support in the school setting.
FAACT educates and informs food-allergic individuals of
their rights to safely and equally participate alongside
individuals without food allergies, particularly in schools.
FAACT’s website offers an Education Resource Center and
Civil Rights Advocacy Resource Center with many free
and downloadable resources including a food allergy
school curricula program.
FAACT offers visual aids for schools: bookmarks, posters,
etc.
4. Food Allergy – Prevalence
• Food allergies affect 8% of US Children
• 2 Students per classroom, U.S.
• 50% increase among children aged 0-17 from 1997
- 2011
• Food allergies & asthma in children = 29%
Higher risk for anaphylaxis
• 30% of allergic children allergic to multiple foods
#FAACTedu
5. Food Allergy – FAACTs
• There is NO cure for food allergies
• Management based on strict avoidance and
prompt treatment of accidental ingestions
• 18% of children reacted while at school
• 25% of first time severe reactions occur in the
school setting
• Fatalities have occurred in schools due to
delays in properly recognizing and treating
serious allergic reactions (anaphylaxis)
#FAACTedu
6. Food Allergy – FAACTs
School staff must be prepared to recognize and
treat a severe reaction in students with known
and NO known allergy
Annual training for school staff or personnel
Educating everyone who comes in contact with the
student throughout the day
Ensuring the proper medication is readily available
and accessible
Auto-Injector epinephrine training for school staff
#FAACTedu
7. “Food Allergy” – The Term
• “Food Allergy”
• An immune system response to a food
the body mistakenly believes is
harmful
• Food related conditions & diseases
often confused with a food allergy
• Food allergy can be fatal
Anaphylaxis Action Plan signed by a
medical doctor
#FAACTedu
8. Food Allergy
90% of food allergic reactions in the U.S. are
caused by eight foods:
Milk Wheat
Egg Soy
Fish Peanuts
Crustacean Shellfish Tree-nuts
Any food can cause an allergic reaction
#FAACTedu
9. Anaphylaxis
Anaphylaxis (an-a-fi-LAK-sis) is a severe allergic
reaction that is rapid in onset and may cause
death.
• Anaphylaxis from food = (within minutes –
several hours)
• Death from food = (30 min – 2 hrs. of exposure)
• Approximately 20% of ANA reactions recur
within 4-6 hrs (biphasic reaction)
MUST be transported to ER
#FAACTedu
10. Anaphylaxis – FAACTs
Can be FATAL if not treated promptly
Can include a wide range of signs & symptoms
Symptoms can occur alone, or in combination
Requires immediate treatment
(follow student’s emergency action plan on file)
Injection of epinephrine
911
Observation in ER (2-24 hrs. recommended)
#FAACTedu
12. Anaphylaxis
Risk Factors
Delay of epinephrine
Relying on
antihistamines (i.e.
Benadryl, Zyrtec… )
Peanut and Tree Nut
Allergies
Alcohol consumption
Asthma
Exercise
Groups at Higher Risk
• Adolescents
• Young adults
• Individuals with
asthma
• Children with known
food allergy
• History of
anaphylaxis
#FAACTedu
13. Signs & Symptoms
Throat
• Itchy
• Tightness / closure
• Hoarseness
• Trouble
breathing/swallowing
• Hacking cough
• Stridor
Mouth
• Itchy
• Swelling of tongue, lips,
or roof of mouth
Skin
• Itching
• Hives or other rash
• Redness/flushing
• Swelling
Gut
• Nausea
• Abdominal pain (a
sharp stabbing pain)
• Vomiting
• Diarrhea
Lung
• Shortness of breath
• Wheezing
• Repetitive Cough
• Chest pain / tightness
Mental
• Anxiety
• Panic
• Sense of doom
• Confusion
Circulation/Heart
• Chest pain
• Low blood pressure
• Pale blue skin color
• Dizziness or fainting
• Weak pulse
• Lethargic
Eyes/Nose
• Red Watery Eyes
• Runny / Stuffy Nose
• Sneezing
• Swollen Eyes
14. Epinephrine (adrenaline)
First line treatment for anaphylaxis
Naturally produced in the body
Early use to treat anaphylaxis improves a
person’s chance for survival
Effects are not long lasting, additional doses
may be needed
Administer epinephrine = call 911
All staff should be trained on epinephrine
administration
#FAACTedu
15. Epinephrine (adrenaline)
Epinephrine is a naturally occurring substance in
the body that is produced during stressful
situations.
During an anaphylactic reaction, we administer
additional epinephrine in the form of an injection
to increase the body’s natural response to the
stressful situation
Benadryl and other antihistamines will not stop the
progression of symptoms in an anaphylactic
reaction
There are NO contraindications to giving
epinephrine!!!
#FAACTedu
16. Risk Reduction Strategies
• Cleaning measures
• Reading food labels
• Creating a safe
environment
• Educating parents, students
and school staff
#FAACTedu
17. Cleaning Measures
Hands
Yes
• Soap and water
Yes
• Hand wipes
(*Wet Ones / Tidy
Tykes)
X No
• Plain water
X No
• Hand Sanitizer
Surfaces
Yes
• Lysol sanitizing wipes
• Formula 409
• Commercial cleaning
wipes
• Target brand cleaner
with bleach
• Other common
household cleaning
agents
X No
• Liquid dish soap
#FAACTedu
18. Food Labels – FALCPA
Food Allergen Labeling Consumer Protection Act
Applies to top eight allergens
Consult with parents
#FAACTedu
19. FALCPA Requirements
Manufacturers can comply with FALCPA labeling
requirement in one of three ways
1) By listing the allergen, in plain English, in the ingredient
list itself e.g., INGREDIENTS: Rice, sugar, freeze-dried
strawberries, wheat, malt flavoring, milk
2) By listing the allergen, in plain English, in a
parenthetical immediately after the scientific ingredient
term e.g., sodium caseinate (milk), semolina (wheat),
albumin (egg)…
3) By having a separate “Contains” statement
immediately after or adjacent to the list of ingredients
(in a font size at least as large as the ingredients list) e.g.,
“Contains milk and soy”
#FAACTedu
20. Creating a Safe Environment
Goal - To create a safer learning environment by reducing
children’s exposure to potential allergens
School bans?
Alternatives?
Allergen Safe Zones / Food Free Zones
(classrooms or eating area in cafeteria; library, buses)
Allergy – Aware (classroom, school)
Limiting food in the classroom
Rewards
Birthdays
Holidays
#FAACTedu
21. Creating a Safe Environment
1. Ensure the daily management of food
allergies in individual children
2. Prepare for food allergy emergencies
3. Provide professional development on
food allergies for staff members
4. Educate children & family members
about food allergies
5. Create and maintain a healthy & safe
educational environment
#FAACTedu
22. Prepare for an Allergic
Emergency
If an allergic reaction occurs on the
playground, what means of
communication is available?
Who will retrieve epinephrine, including
second dose and/or stock, if not carried
by student?
Who is responsible for administering
epinephrine?
Who is responsible if no school nurse is on-
site?
Who is calling 911?
#FAACTedu
23. Prepare for an Allergic
Emergency
Who is outside to alert first responders of location?
Who will document times?
Who will contact the parents?
Who will ride with the student?
Who will speak to students who may have
witnessed?
Who will speak to the families of other food allergic
students?
#FAACTedu
24. A Team Approach!
A Team
Approac
h
Medical
Provider
School Nurse
School Staff
(transportation,
food service,
administration,
bus drivers, P.E.
Coach, etc.) All Parents /
Students
PTA / PTO
26. St. Louis Children’s
Hospital– FAME Toolkit
Provides schools with the components of a comprehensive school-based
food allergy program to promote best practices
http://www.stlouischildrens.org/health-resources/advocacy-
outreach/food-allergy-management-and-education
27. FAACT’s Food Allergy Curricula Program
for Schools
Food allergies affect approximately 1 in 13 children – about 2 children per
classroom. With so many students affected, it is crucial for educators to
build an awareness of the seriousness of food allergy among all their
students.
FAACT’s Food Allergy Curricula Program for Schools consists of three, age-
appropriate programs: K-3, grades 4-8, and high school. All curricula
programs have been created by FAACT and reviewed and approved by
FAACT’s Medical Advisory Board.
PowerPoint presentations, lesson plans, and activities can be used to
introduce your students to common food allergens and safety protocols
while encouraging empathy for classmates with a
food allergy.
Please share with your schools and districts –
educators and students will enjoy learning about
food allergies with FAACT! Download the free
program from our Web site today.
#FAACTedu
28. Civil Rights Advocacy
FAACT educates and informs food-allergic individuals of their
rights to safely and equally participate alongside non-allergic
individuals.
FAACT offers direct, one-on-one service, free of charge
Visit FAACT’s Civil Rights Advocacy Resource Center:
Individualized Healthcare Plans (IHCP)
Individualized Education Plans (IEP)
504 Plans
Know Your Rights
Sample Accommodations, Plans, Letters
http://www.FoodAllergyAwareness.org/civil-rights-advocacy/
#FAACTedu
29. Impact of Food Allergies on the Daily
Activities of Children and Their Families
Food allergies affect everyone in the family. In
surveys of parents or caregivers of children with
food allergies,
60 percent reported that food allergies
significantly affected meal preparation.
41 percent reported a significant impact on their
stress levels.
34 percent reported that food allergy had an
impact on the child’s school attendance.
#FAACTedu
30. Impact of Food Allergies on the Daily
Activities of Children and Their Families
10 percent choose to home-school their children
because of food allergies.
59 percent reported school field trips were
affected by food allergies.
68 percent reported school parties were affected
by food allergies.
The number of food allergies had a significant
impact on activity scores, but the addition of other
conditions, such as asthma and eczema, did not
significantly affect the results.
#FAACTedu
31. Impact of Food Allergies on the Daily
Activities of Children and Their Families
Review studies & references at:
http://www.FoodAllergyAwareness.org/foodallergy/
psychological_impacts-12/
#FAACTedu
32. Food Allergy Bullying
BULLYING (/boolē-ēng/ verb.)
Unwanted, aggressive behavior that involves a real or perceived
power imbalance. The behavior is repeated, or has the potential to
be repeated, over time. Includes making threats, spreading rumors,
attacking someone physically or verbally, and excluding someone
from a group on purpose.[1]
Bullying is more than just teasing among children. The difference is
the power imbalance (real or perceived) and the intention to cause
harm.[2] For children with food allergies, the power imbalance can
be quite real – and the harm potentially life-threatening.
Although most bullying reported by children happens at school, it
also occurs other places children are together, including
playgrounds, school buses, at home or in a friend’s home,
restaurants, camp, and on the Internet.[3] In some cases, the school
bully is not a student but a teacher or other adult.[4]
[1] U.S. Department of Health and Human Services, StopBullying.gov, accessed
December 2013. http://www.stopbullying.gov/what-is-
bullying/definition/index.html
33. Food Allergy Bullying
Bullying a child with a food allergy can range from
taunting the child to physically assaulting with the allergen.
It is considered a form of “disability harassment.”
[2] Dr. Rashmi Shetgiri, University of Texas Southwestern Medical
Center
[3] Shemesh, E. et al. “Child and Parental Reports of Bullying in a
Consecutive Sample of Children with Food Allergy,” Pediatrics
(2013:131).
[4] Saint Louis, Catherine.
Visit our site to learn more about Bullying:
http://www.foodallergyawareness.org/education/for_p
arents-4/bullying_-_general_information-9/
34. FAACT’s Programs
Camp TAG (The Allergy Gang)
Teen Conference
Anaphylaxis & Support Group
Leadership Summits
Education
Civil Rights Advocacy
Awareness
www.FoodAllergyAwareness.org/programs
35. Awareness
Materials & Literature:
Organize a poster
contest at your school
Distribute free or low
cost resources:
Posters, bookmarks,
flyers, signs, webinars
Schools, daycares,
restaurants, medical
offices (allergists,
pediatricians, etc)
#FAACTedu
36. Awareness
Websites & Social Networks:
Post ‘KNOW THE FAACTs’
as your Profile or Cover Photo
Post & share Food Allergy
FAACTs! Find us on:
Facebook
Twitter
LinkedIn
Pinterest
You Tube
Print & distribute FAACT’s
Information Flyer
www.FoodAllergyAwareness.org
#FAACTedu
37. Visit FAACT at www.FoodAllergyAwareness.org
Email: info@FoodAllergyAwareness.org
Call: (513) 342-1293
Editor's Notes
Introductions/Disclosures
Good __________. My name is _____________________ and I am a FAACT acknowledged educational volunteer and/or (Title).
Today’s presentation contains general information about food allergies, anaphylaxis, and treatment. …… The information is not advice, and should not be treated as such. All questions of a medical nature to a students individual health should be addressed by his/her medical doctor.
Acknowledgments
Today’s presentations is based on best practices recommended by:
The Center’s for Disease Control and Prevention – in 2013, the CDC released voluntary guidelines for schools and early childhood educational programs to help with the risk of food allergies (FA’s) and severe allergic reactions in children. These voluntary guidelines were developed with the Center’s for Disease Control and Prevention of the US Department of Health and Human Services, in consultation with the U.S. Department of Education.
The Food Allergy Management & Education program created by St. Louis Children’s Hospital; and
The Food Allergy & Anaphylaxis Connection Team; with review by their medical advisory board.
For those of you who have been in education a while, not only have you most likely noticed the increase of students entering your school with food allergies each year, but you have probably noticed the increase of students entering your school with multiple food allergies, such as egg, dairy, wheat and other foods.
2) Recent research tells us that today in the United States, food allergies affect 1 in 13 children, which averages out to about two students per classroom in the U.S. In other countries such as Australia, research reports that 1 in 10 babies will develop a food allergy.
3) Food allergies affect approximately 8% of US Children (most who attend federal and state supported schools or early care & education programs)
3 million children under 18 years of age
Food allergies & asthma in children = 29%
Individuals who also have asthma, in addition to food allergies, are at a higher risk for anaphylaxis
Of those with food allergy, 30% are allergic to multiple foods
* Osborne et al. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunolol 2011; 127: 668-676
1) There is NO cure for food allergies. Strict avoidance is the only way to prevent a food allergic reaction from occurring. This means reducing the risk in our classrooms and schools through education and awareness.
2) While we may successfully manage to avoid known allergens in the school setting, school staff must also be prepared to recognize and treat a severe reaction in students with known and NO known allergy.
Annual training for school staff or personnel
Educating everyone who comes in contact with the student throughout the day
Ensuring the proper medication is readily available and accessible
Auto-Injector epinephrine training for school staff
1. While we may successfully manage to avoid known allergens in the school setting, school staff must also be prepared to recognize and treat a severe reaction in students with known and NO known allergy.
Annual training for school staff or personnel
Educating everyone who comes in contact with the student throughout the day
Ensuring the proper medication is readily available and accessible
Auto-Injector epinephrine training for school staff
2. 25% of previously undiagnosed children experience their first reaction in a school setting
1) The term “allergy” is often loosely used. An immune system response to a food the body mistakenly believes is harmful
2) Today, individuals who manage different types of dietary restrictions, including Celiac Disease, gluten, dairy intolerance, vegan diets, and even religious beliefs – will often state they have an “allergy” to the food they are avoiding. This can sometimes become confusing for educators or food service staff, so it’s important to understand each student’s needs when notified of an allergy.
While these other food related conditions and diseases may be serious, they are not immediately life-threatening.
A student’s food allergy action plan is a helpful resource for school staff when notified by a parent or caregiver that a student has a food allergy, as the document is signed by a medical doctor describing the individual’s specific medical needs.
Any food can cause an allergic reaction, and there are more than 170 foods are known to cause IgE mediated food allergies.
In the United States, there are eight foods or food groups account for 90% of serious allergic reactions: milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts, and tree nuts.
____________________________________________________________________________________________________________
4 Boyce JA, Assa’ad A, Burks AW, et al; NIAID-Sponsored Expert Panel. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(suppl 6):S1-S58.
Anaphylaxis caused by a food can occur within minutes to several hours after food ingestion.
Death to food-induced anaphylaxis may occur within 30 minutes to 2 hours of exposure.
By the time symptoms of an allergic reaction are recognized, a child is likely to already be experiencing anaphylaxis.
Symptoms can progress slowly, appear rapidly, or appear with shock in the absence of other symptoms (rare).
Approximately 20% of ANA reactions recur within 4-6 hrs. (biphasic reaction)
Strict avoidance is key!
Early and quick recognition and treatment of allergic reactions that may lead to anaphylaxis can prevent serious health problems or death.
Food allergies account for 35% - 50% of all cases of anaphylaxis in the emergency care setting.
In the United States, fatal or near fatal reactions are most often caused by peanuts (50%–62%) and tree nuts (15%–30%)
Students have died in schools due to delay or NO administration of epinephrine
In a reported study, 70% of food allergy related fatalities were due to delay or no administration of epinephrine
Relying on oral antihistamines to treat symptoms (i.e. Benadryl, Zyrtec… )
Consuming alcohol and the food allergen at the same time
Diagnosis of asthma
Concurrent exercise
Adolescents and young adults – risk taking behaviors, peer pressure, etc.
Children with known food allergy
History of anaphylaxis
Symptoms of anaphylaxis can develop rapidly after exposure to an allergen
Peak severity usually occurs within 5 to 30 minutes, but can be delayed up to 2 hrs.
Sometimes, a second phase of reaction (known as biphasic reaction) can occur 6 – 72 hours after the initial reaction
Occurs in approximately 20 – 25% of cases
Typically within 10 hrs. after the initial reaction
It’s important to note that the lung, heart, and throat are immediate life-threating symptoms. It’s also important to note that a food allergic reaction can present symptoms the same as an asthma attack; however, asthma medication will ONLY treat an asthma attack, AND epinephrine will treat BOTH.
It’s also important to note that antihistamines are only used to treat mild symptoms of an allergic reaction.
Epinephrine is first-line treatment for anaphylaxis. Antihistamines and other treatments (inhalers, etc.) all have a delayed onset of action and should only be used as secondary treatment. *Refer to the student’s EAP in the event of an emergency.
Worth noting that 80-90% of cases of anaphylaxis will have dermatologic manifestations (hives, rash), although the absence of rash does not rule out the possibility of anaphylaxis. In fact, some of the most severe cases of anaphylaxis occur in the absence of a rash.
`
Early use of epinephrine to treat anaphylaxis improves a person’s chance of survival and quick recovery.
Epinephrine rapidly improves breathing, increases heart rate, and reduces swelling of the face, lips, and throat.
Epinephrine is always the treatment of choice for anaphylaxis.
Epinephrine is the only medication that will halt and prevent the progression of anaphylaxis.
Perry, T. et al. Distribution of peanut allergen in the environment Journal of Allergy and Clinical Immunology, Volume 113, Issue 5, May 2004, Pages 973-976
Persistence of peanut allergen on a table surface
Wade TA Watson12*, AnnMarie Woodrow2 and Andrew W Stadnyk12
Simonte, S J et al. Relevance of casual contact with peanut butter in children with peanut allergy, J Allergy Clin Immunol 112 (2003), pp. 180-182.
Maloney, J.M., et al. Peanut allergen exposure through saliva: Assessment and interventions to reduce exposure Journal of Allergy and Clinical Immunology, Volume 118, Issue 3, September 2006, Pages 719-724
Federal law requires food labels in the United States to clearly identify the food allergen source of all food and ingredients that are, or contain any protein derived from, common allergens.
This law does not include arts & crafts, beauty products, medications, etc.
FALCPA does NOT mandate “may contain” or “produced in a facility” statements. Such statements are completely voluntary by manufacturers. While studies show that approximately 8% of such foods HAVE been contaminated with the listed allergens. It is a personal decision as to whether to avoid such foods- always check with families to understand their comfort levels with such statements.
School bans cannot guarantee a totally safe environment because there is no reasonable or fail-safe way to prevent an allergen from entering into a building.
Even with a ban in place, a school still has a responsibility to properly plan for children with any life-threatening food allergies, to educate all school personnel accordingly, and ensure that school staff are trained and prepared to prevent and respond to a food allergy emergency.
Ask yourself these questions? These are example questions that will come up, need to be answered, and implemented into the student’s emergency action plan.
Ask yourself these questions? These are example questions that will come up, need to be answered, and implemented into the student’s emergency action plan.
Some children with food allergies face health issues that can affect their ability to learn and their social and emotional development.
Guidelines call for strong partnerships among families, medical providers, and school staff to help children overcome the challenges of living with a food allergy.
When schools and early care and education programs develop and implement plans to effectively manage the risk of food allergies, they help keep children safe and remove one more health barrier that keeps some children from reaching their full potential!
