Food Allergy Guidelines for Managing Life-Threatening Food Allergies in Illinois Schools: A Primer

1. Food Allergy Guidelines for Managing Life-Threatening Food Allergies in Illinois Schools: A Primer Christine Szychlinski, MS, APN, CPNP Manager, Bunning Food Allergy Program Coordinator, Food Allergy Community/Professional Education Division of Allergy, Children’s Memorial Hospital Supported by the Food Allergy Initiative of Chicago faiusa.org/Chicago © 2010 Children’s Memorial Hospital

2. Definitions Key terms defined include Allergy: “adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food” • Food: “any substance intended for human consumption” • Food allergens: “specific components of food or ingredients within foods (typically proteins but sometimes also chemical haptens) that are recognized by allergen-specific immune cells and elicit specific immunologic reactions, resulting in characteristic symptoms” © 2010 Children’s Memorial Hospital

3. Common Allergens Cow’s milk Egg white Peanut Tree nuts Soy Wheat Fish Shellfish © 2010 Children’s Memorial Hospital

4. Peanut allergy • Peanut allergy doubled in children over a five-year period (1997-2002). • Accidental ingestion of peanut associated with fatal anaphylaxis • FAAN estimates 100 deaths per year and 1500 trips to the Emergency Department due to peanut allergy © 2010 Children’s Memorial Hospital

5. Multiple Food Allergies • There are more children in schools now with multiple food allergies • Studies published in 2007 have shown that milk and egg allergy can persist into a child’s teen years(Skripak JACI 2007) • Focusing on peanut is not addressing the entire problem © 2010 Children’s Memorial Hospital

6. Fatal reactions happen Risk factors: • Asthma • Adolescents or young adults • Peanut or tree nut allergy • Epinephrine administration was delayed(Bock JACI 2001/2007) © 2010 Children’s Memorial Hospital

7. Treatment There is no cure (yet) for food allergies. The only current treatment is AVOIDANCE. © 2010 Children’s Memorial Hospital

8. More than just a physical risk •  Recognize possible emotional needs • “At risk” for eating disorders, anxiety, and depression • Be aware of teasing/ bullying • Avoid isolating and stigmatizing • Involve the school social worker as needed     © 2010 Children’s Memorial Hospital

9. Impact on the school nurse • 2004 Telephone survey of 400 school nurses • 44% increase in food allergies • >33% at least 10 students with food allergy • 78% did staff training • 74% did guideline development • Weiss, C Jrnl of School Nurs 2004 • Need for standardized guidelines . . . © 2010 Children’s Memorial Hospital

10. Managing Food Allergies in School: The Law In 2009, Illinois passed Public Act 96-0349 which amended the IL School Code to state that: • By July 1, 2010, ISBE, in conjunction with IDPH, must develop guidelines for the management of students with life-threatening food allergies. • ISBE and IDPH must establish a committee of experts to develop these guidelines. • School personnel who work with students must be trained at least every 2 years at an in-service conducted by individuals with expertise in anaphylactic reactions and management. 105 ILCS 5/2-3.148; 105 ILCS 5/10-22.39(e) © 2010 Children’s Memorial Hospital

11. Managing Food Allergies in School: The Law (Continued) The guidelines must include but are not limited to: • Education and training for school personnel • Procedures for responding to life-threatening allergic reactions to food • A process for implementing individualized health care and food allergy action plans • Protocols to prevent exposure to food allergens By January 1, 2011, each school board must implement a policy based on and consistent with these guidelines. 105 ILCS 5/2-3.148 © 2010 Children’s Memorial Hospital

12. The Guidelines "Guidelines for Managing Life-threatening Food Allergies in Illinois Schools“ • www.isbe.net/nutrition/htmls/food_allergy_guidelines.htm • Used to create school policies and best practices • Contain template forms for school districts: - Emergency Action Plan (EAP) - Individual Health Care Plan (IHCP) - 504 Plan - Allergy History Form - Medical Alert to Parents/Guardians © 2010 Children’s Memorial Hospital

13. The Guidelines • Contain specific checklists for • School nurse/designated personnel • Administration • Classroom Teachers/specialists • Custodial Staff • Food service • Transportation services • Outside of Classroom Activities • Parents of children with food allergy • Children with food allergy © 2010 Children’s Memorial Hospital

14. The work flow of best practice... • Schools are active at identifying children with known FA • food allergies to be included on forms • Each child with diagnosed FA has a written plan • Emergency Action Plan (EAP) must be signed by a licensed health care provider • Each child with a FA and an EAP will also have an Individual Health Care Plan and/or 504 Plan that, at minimum, • Will describe what the school will do to accommodate the student • Contain an EAP • Include risk reduction and emergency response measures © 2010 Children’s Memorial Hospital

15. Specifics of Staff education • Conduct and track emergency drills • Education to include: • symptom recognition • review of high risk areas • how to prevent exposure to allergens • how to respond to emergencies • how to administer epinephrine auto-injector • how to respond to students with previously unknown allergy • legal protection © 2010 Children’s Memorial Hospital

16. Managing Food Allergies in School  Create a safe environment for students with food allergies. • PREVENT reactions • RECOGNIZE reactions • RESPOND to reactions © 2010 Children’s Memorial Hospital

17. Prevent a Reaction  Avoid exposure to allergen • During school day • While traveling to and from school • During school-funded events • While on field trips © 2010 Children’s Memorial Hospital

18. Prevent a Reaction Avoidance is the key to preventing a reaction. • Cross-contamination • Mislabeled foods • Unlabeled foods © 2010 Children’s Memorial Hospital

19. Prevent a Reaction • Multiple studies show it is possible to keep a school environment safe for a student with food allergies if attention is paid to details. • Allergens must be physically removed from hands and surfaces. • All staff members must be aware of these best practices © 2010 Children’s Memorial Hospital

20. Prevent a Reaction:So what do studies tell us? • Exposure to food allergens by touch or inhalation is unlikely to cause a life-threatening reaction. (Simonte SJ JACI 2003) • However, risk of ingestion (and reaction) if child touches allergen and then place fingers in or near mouth or nose.  © 2010 Children’s Memorial Hospital

21. Managing Food Allergies in School   Create a safe environment: • Prevent • Recognize an allergic reaction • Respond © 2010 Children’s Memorial Hospital

22. Allergic Reaction: What a Child Might Say or Do Say • “My tongue (or mouth) itches” • “My tongue is hot/burning” • “My mouth feels funny” • “There’s something stuck in my throat” • “It feels like there are bugsin my ears” • “This food is too spicy” • Do • Put their hands in their mouths • Pull or scratch at their tongues • Drool • Hoarse cry or voice • Slur words • Become unusually clingy © 2010 Children’s Memorial Hospital

23. Recognize a reaction: Anaphylaxis • The medical diagnosis for a severe reaction. • Symptoms rapid in onset and severe. • Involves the most dangerous symptoms including but not limited to: breathing difficulties and a drop in blood pressure (shock). • Always a risk of death, even if treated appropriately. © 2010 Children’s Memorial Hospital

24. Managing Food Allergies in School   Create a safe environment • Prevent • Recognize • Respond to an allergic reaction © 2010 Children’s Memorial Hospital

27. Allergic reaction: Respond Follow the Food Allergy Emergency Action Plan prescribed by licensed health care provider • Take all symptoms seriously • Do not delay in giving epinephrine when required • Safe and simple to use • If epinephrine given, call 911 © 2010 Children’s Memorial Hospital

28. Managing Food Allergies in School: Summary  Create a safe environment • Prevent a reaction: • Avoidance • Know the IHCP for your student • Recognize a reaction: Know the signs and symptoms • Respond to an allergic reaction: • Know the EAP for your student. Respond quickly. • Practice emergency response drills © 2010 Children’s Memorial Hospital

29. Thank you! • Questions? • Useful websites: • www.foodallergyinitiative.org • www.foodallergy.org • www.childrensmemorial.org/FACE © 2010 Children’s Memorial Hospital