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 1 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 2 Common Allergens Cow’s milk Soy © 2010 Children’s Memorial Hospital Egg white Wheat Peanut Tree nuts Fish Shellfish 3 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 4 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 5 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 6 Treatment There is no cure (yet) for food allergies. The only current treatment is AVOIDANCE. © 2010 Children’s Memorial Hospital 7 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 8 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 9 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 lifethreatening 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 10 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 11 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 12 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 13 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 14 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 15 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 16 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 17 Prevent a Reaction Avoidance is the key to preventing a reaction. Cross-contamination Mislabeled foods Unlabeled foods © 2010 Children’s Memorial Hospital 18 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 19 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 20 Managing Food Allergies in School Create a safe environment: Prevent Recognize an allergic reaction Respond © 2010 Children’s Memorial Hospital 21 Allergic Reaction: What a Child Might Say or Do Say Do “My tongue (or mouth) itches” Put their hands in their mouths “My tongue is hot/burning” Pull or scratch at their tongues “My mouth feels funny” Drool “There’s something stuck in my throat” Hoarse cry or voice “It feels like there are bugs in my ears” Slur words Become unusually clingy “This food is too spicy” © 2010 Children’s Memorial Hospital 22 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 23 Managing Food Allergies in School Create a safe environment Prevent Recognize Respond to an allergic reaction © 2010 Children’s Memorial Hospital 24 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 27 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 28 Thank you! Questions? Useful websites: – www.foodallergyinitiative.org – www.foodallergy.org – www.childrensmemorial.org/FACE © 2010 Children’s Memorial Hospital 29