A food allergy is an abnormal response by the immune system to a food protein. The immune system is designed to protect us from harm. In the case of a food allergy, the immune system is working on “overdrive” in a sense and is trying to protect us from harmless things; in this case, food. We don’t know yet why some people develop food allergies and others don’t. When a food which the immune system thinks is harmful is ingested, the immune system immediately releases massive amounts of histamine and other chemicals to “attack” that food and protect us.
The release of massive amounts of chemicals results in symptoms of a food-allergic reaction. These symptoms can be slight, or they can be severe. There is no way to predict the severity of the reaction at its onset. Food containing protein can cause a reaction; a recent study showed that there are 160 foods implicated in allergic reactions according to the medical literature. Kiwi fruit is one example of an unusual cause of food-allergic reactions. It is important to note that at this time, there is no cure for true food allergy. Complete and strict avoidance is the only way to prevent a reaction.
Contrary to what most people believe, the list of foods that cause the majority of classical allergic reactions is relatively short. Eight foods account for 90 percent of the food-allergic reactions in the U.S. They are milk, eggs, peanuts, tree nuts (which include walnuts, cashews, pecans, Brazil nuts, etc.), wheat, soy, fish, and shellfish. Children are commonly allergic to milk, soy, eggs, peanuts, wheat, and tree nuts. Most children will outgrow their allergy with the exception of peanuts and tree nuts. Only about 20 percent of peanut-allergic children will outgrow this allergy.
The foods that cause the majority of reactions include fish, shellfish, peanuts, and tree nuts. The reactions to these foods can be severe, especially with peanuts and tree nuts. Peanuts in particular appear to the leading cause of severe reactions in both children and adults.
Having a food allergy means completely avoiding food to which you are allergic. Faithfully reading labels, and constantly asking questions about ingredients, preparation techniques, etc. is an important part of living with food allergies. For some people, a trace amount of food is enough to cause an allergic reaction. In rare cases, anaphylaxis has been reported to have been caused by the fumes released during cooking of certain foods. Vapors released from sizzling shrimp cooked tableside at a restaurant caused death in at least two shrimp-allergic individuals. These cases are rare but point out that for some individuals, reactions can occur without eating the food.
Symptoms of a reaction can vary from person to person for the same food. For example, one person might have hives after drinking milk, another might have swelling of the mouth. Symptoms can also vary from one reaction to another, even for the same person. Symptoms can occur in one or more of the organ systems and include: Respiratory tract: tingling of the mouth (often patients report that they knew immediately they were going to have a reaction because they felt tingling in their mouth as soon as they put the food in it. This may proceed to itching or swelling of the mouth area or throat. Some people develop a rapid or staccato cough, they may have difficulty breathing, asthma. Cardiovascular: As the reaction proceeds, patients may have a drop in blood pressure and progress into shock. Gastrointestinal Tract: In the GI tract symptoms may include severe abdominal cramps, vomiting, and diarrhea. Skin: Some, not all, patients develop hives and swelling, especially in the face or around the eyes. Those that have eczema may have a flare-up.
One of the most common causes of reactions is someone taking a short cut and not reading the ingredient statement. Ingredients change without warning; it is key that ingredient labels be read for every product, every time the food is eaten. In a school setting, trading food with friends is a common social event. Reactions have occurred from these situations. Parents should educate their children about not trading food or accepting food from friends unless someone has carefully read the ingredient statement. Inaccurate labeling at the manufacturing plant, for example, using old labels on new products, has also resulted in reactions. Parents should report all such reactions to the manufacturer and the FDA. Other causes of reactions include cross contact during cooking. This would happen, for example, if you used the same spatula for allergen-containing foods and allergy-free foods. Although invisible to the eye, there may be enough protein to cause an allergic reaction. Food service staff in particular should be aware of this situation.
For some, the reaction begins as soon as the food enters their mouth, even if they spit it out. Sometimes the reactions begin slowly and build to a severe reaction. For others, the reaction may be swift in its onset and severity. Parents should provide the school staff with information about their child’s history of symptoms, if possible.
When making a food allergy management plan for students, one must remember that each student will react differently. Food allergy plans must be individualized and changed as the student’s needs change. Parents must keep school staff informed of any changes in their child’s allergy and medication needs.
These are just some samples of what other school staff have done to manage food allergies in their school. Managing food allergies is a process, not an event, and parents and school staff must always go back and update the plan throughout the year. Parents should discuss “allowed” foods with the child so that the student knows what to eat and what to avoid. They should share that information with the school staff. See “Guidelines for Managing Students with Food Allergies,” available from the Food Allergy & Anaphylaxis Network (FAAN) for a list of responsibilities for parents, school, and students. Some parents prefer to have the student provide his/her own snacks and foods from home. This ensures that the student is eating a “safe” food Some schools allow only commercially prepared food with a preprinted ingredient statement for school events and designate a label reader. This will prevent the situation where someone forgets to read the label on ingredients used for home made products and causes a reaction to the allergic student. In all cases, the student’s parents should be part of the food allergy awareness team with school staff and their child. The parents and their child may have additional strategies to offer.
Wipe all surfaces thoroughly between uses, be sure not to use the same towel for the allergen-containing and allergen-free sections. Warm soap and water are best for cleaning the table tops and other surfaces. Parents can help determine the best plan for their child in the cafeteria. Some parents and school staff agree to have a designated table or section in the cafeteria for allergic students (be sure not to isolate them). They should be able to have their friends join them at the “juice table” (for milk allergy) or the “peanut-free table” provided the children’s lunches are milk or peanut free. Other schools have “Mr. Peanut” tables and children whose lunches contain any peanut products sit at these designated tables. Implement a “No food trading” rule. This levels the playing field and eliminates the chance that a child will trade a “safe” lunch brought from home for “unsafe” food from a well-meaning friend. The no food trading rule should be applied to all students, not just those who have food allergies.
Taking the emphasis away from food as a staple for all class celebrations will benefit the child with allergies and other children who have dietary restrictions. Use music or a story about the holiday to celebrate the special event. If parents are going to send in goody or gift bags in honor of their child’s birthday, ask that they send in non-food items. Party stores often sell bags of trinkets inexpensively, stickers are always popular particularly for younger students. Teachers can use stickers instead of food or candy to reward good behavior. Avoid using food items as part of a lesson plan, for example, using M&Ms in counting lessons or peanut butter to make bird feeders for classes with a child who has a peanut allergy .
There are millions of children who have food allergies in schools throughout the country. The key to successfully managing their food allergy is clear, constant communication and partnership between all parties—parents, students, and school staff.