Managing Students with Life-Threatening Food Allergies in School
This presentation is intended to enable the viewer to understand what food allergies are, recognize signs and symptoms of food allergies and to be able to respond appropriately by administering medication in the event of a reaction. In addition, we will address ways to keep students with life-threatening food allergies safe at school and consider a few other concerns related to this topic.
Here are a few definitions related to food allergies. An allergy is an exaggerated response of the immune system to protein substances, either inhaled, ingested, touched or injected, that would not normally cause an overreaction in non-allergic people. A food allergy is an allergic reaction that occurs when the immune system responds defensively to a specific food protein. This can occur at any age, even in people who have previously NOT had a reaction to a particular food. Anaphylaxis is a life-threatening allergic reaction that involves the entire body and is characterized by low-blood pressure, wheezing, vomiting or diarrhea, swelling and possibly hives. An anaphylactic reaction may result in shock or death and thus, requires immediate medical attention.
Due to the increased prevalence of diagnosed food allergies in our youth in recent years, there has been a significant amount of research conducted about this topic. Over 3 million children under 18 years of age have food allergies. This accounts for 1 out of every 25 children, of whom 16-18% have had a reaction at school. Every year, there are 30,000 cases of anaphylaxis and 150 deaths. 25% of these anaphylaxis cases occur in children with undiagnosed food allergies. The most common food allergens include peanuts, shellfish, fish, tree nuts, eggs, milk, soy and wheat. It has been shown that each person will react differently and each reaction may differ and increase in severity. Symptoms may appear within minutes or up to several hours later and may re-occur. There is NO CURE for food allergies, avoidance of the food protein is the only way to prevent a reaction.
A student who is having a food allergic reaction may present any of the following signs and symptoms. The student may complain of dizziness, have a loss of consciousness, or have a feeling of panic or doom. You may observe swelling of the lips, face, tongue or throat. The student may be wheezing, have difficulty breathing, sound congested, have a persistent cough or complain that their throat feels tight. The student may complain of a stomach ache, nausea, vomiting, abdominal cramps or diarrhea and may exhibit hives, generalized swelling or a rash. Often, younger students have difficulty expressing their reaction in the manner you would usually expect. They may be screaming or crying or complain that the food was too spicy or that something is stuck in their throat. It is important to realize that these symptoms may indicate something more serious than we would initially think.
A student with food allergies may be prescribed many medications including an antihistamine, such as Benadryl or Zyrtec, which may be given first if an allergic reaction is mild and ingestion is not suspected. The expected side effects of an antihistamine include drowsiness, nausea, and dryness in the mouth. Epinephrine, most commonly an EpiPen or EpiPen Jr., is prescribed by the physician and provided by the parent or guardian. The EpiPen may be administered by the school nurse or trained school personnel. It is not unusual that a second dose would need to be administered and you would always call 911 if an EpiPen is being administered. Since asthma can exacerbate food allergy symptoms, a student may also have an inhaler prescribed.
If you suspect that a student is having an allergic reaction, it is best to be safe and administer their EpiPen. Some older students may carry their EpiPen in the binder or backpack while younger students keep their medications in the health office. Never leave the student alone or try to take him or her to the health office. You should call the health office to have the medications brought to the student. This video demonstrates an EpiPen administration in both an older and younger child.
Since there is NO CURE for food allergies and avoidance of the allergen is the best way to prevent a reaction, it is necessary to provide an allergen safe school environment for these students. A staff who is trained in recognizing signs and symptoms of food allergies, methods to keep students safe at school and know how to respond to a reaction is a necessary component of an allergen-safe school. Families may request that their student eat lunch at an allergen-safe lunch table with friends who have allergen-safe meals. Teachers should adapt their curriculum to exclude food allergens or food altogether. Eliminating cross-contamination by encouraging frequent hand-washing and disinfecting tables and chairs as needed is another step that can be taken. Students should be discouraged from sharing food with each other and classrooms should be kept allergen-free by limiting snacks to fruits, vegetables, and hard cheeses. Remember, it may be necessary to further limit snacks based on the specific food allergies in a particular classroom. When a student would like to celebrate his or her birthday with the class, non-food items can be brought in, such as stickers, pencils, or temporary tattoos. A parent may also choose to donate a book or indoor game to the classroom. Finally, all prescribed medications should be brought on all field trips and off-campus school sponsored activities.
When we receive information that a student has a food allergy, we ask the parents to provide a Emergency Action Plan from their physician and complete an allergy history form and an individualized health care plan. This helps the parents, nurse and teacher to develop the Section 504 Accommodation Plan needed to keep the student safe at school. Copies of the Emergency Action Plan and Section 504 Plan are distributed to all staff who has contact with the student.
Unfortunately, students may experience bullying from others due to their food restrictions or if they experience a reaction at school. We may need to discuss the matter with classes if problems become apparent. As more and more students are diagnosed with allergies, hopefully, this will become less of a concern. Students and their families may require more support because of the food allergies. As always, we should comply with regulations regarding privacy and confidentiality.
In summary, having a specific plan with necessary accommodations in place and training staff to be able to prevent, recognize and respond to food allergy reactions will enable students with life-threatening food allergies to be able to attend school safely.
* BY: Dena Hinkle, RN, BS, ILCSN
** Overview of food allergies * Definitions * List major allergens * Signs and symptoms * Medications* Respond * Recognize reactions * Administer medication* Prevent Exposure * Allergen-safe school environment * Knowledgeable staff* Other Considerations
** Allergy – An exaggerated response of the immune system to protein substances, either inhaled, ingested, touched or injected, that do not normally cause an overreaction in non-allergic people* Food Allergy – allergic reaction that occurs when the immune system responds defensively to a specific food protein* Anaphylaxis – life-threatening allergic reaction that involves the entire body; characterized by low-blood pressure, wheezing, vomiting or diarrhea, swelling and hives; may result in shock or death; requires immediate medical attention
** Over 3 million children under 18 have food allergies* 1 out of every 25 children * 16%-18% had a reaction at school* 30,000 cases of anaphylaxis and 150 deaths annually * 25% are undiagnosed food allergies* Peanuts, shellfish, fish, tree nuts, eggs, milk, soy and wheat* Each person will react differently* Each reaction may differ and increase in severity* Symptoms usually appear within minutes but may occur within two hours after exposure and re-occur* NO CURE – avoidance is the only way to prevent a reaction
** General – dizziness, loss of consciousness, feeling of panic or doom* Mouth – swelling of lips, face, tongue, throat* Breathing – wheezing, difficulty breathing, congestion, cough, tightness of throat* Stomach – discomfort, nausea, vomiting, abdominal cramps, diarrhea* Skin – hives, swelling, rash* Younger students may describe their reaction in an unusual manner * Screaming or crying * Complains that food is spicy or something is stuck in their throat
** Antihistamine – Benadryl or generic equivalent; Zyrtec or generic equivalent * May be given first if allergic reaction is mild and ingestion is not suspected * May cause drowsiness, nausea and dryness of mouth* Epinephrine – EpiPen, EpiPen Jr. or Twinject auto-injector * Provided by parent/guardian * May be administered by school nurse or trained school personnel * May need to administer second dose * ALWAYS CALL 911* Inhaler – asthma can exacerbate food allergy symptoms
** Train staff* Allergen-safe lunch table, if desired* Adapt curriculum to exclude allergens or food altogether* Eliminate Cross-Contamination * Frequent hand washing * Disinfect tables and chairs as needed* Eliminate food sharing* Allergen-safe snacks and classrooms * Fruits, vegetables and hard cheeses * May need to be further limited* Non-food birthday celebrations * Stickers, pencils, temporary tattoos, classroom game or book, etc.* Medications taken on all field-trips and off-campus school sponsored activities
** Emergency Action Plan * Medication orders; signed by physician * Distribute to all staff who has contact* Allergy History Form* Individualized Healthcare Plan* Section 504 Plan * School Nurse, teacher, parent * Distribute to all staff who has contact
** Bullying* Support for students and family* FERPA privacy and confidentiality