Allergies PPT 3-24-2011 final

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
© 2010 Children’s Memorial Hospital
Key terms defined include
Allergy: “adverse health effect arising from a specific immune
response that occurs reproducibly on exposure to a given
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”
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Common Allergens
Cow’s milk
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Egg white
Tree nuts
Peanut allergy
 Peanut allergy doubled in
children over a five-year period
 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
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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
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Fatal reactions happen
Risk factors:
 Asthma
 Adolescents or young adults
 Peanut or tree nut allergy
 Epinephrine administration was delayed
(Bock JACI 2001/2007)
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There is no cure (yet) for food allergies.
The only current treatment is AVOIDANCE.
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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
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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
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)
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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
The Guidelines
"Guidelines for Managing Life-threatening Food Allergies in
Illinois Schools“
 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
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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
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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
– Contain an EAP
– Include risk reduction and emergency response measures
© 2010 Children’s Memorial Hospital
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
Managing Food Allergies in School
Create a safe environment for students
with food allergies.
PREVENT reactions
RECOGNIZE reactions
RESPOND to reactions
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Prevent a Reaction
Avoid exposure to allergen
 During school day
 While traveling to and from school
 During school-funded events
 While on field trips
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Prevent a Reaction
Avoidance is the key to preventing a reaction.
 Cross-contamination
 Mislabeled foods
 Unlabeled foods
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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
 All staff members must be aware of these best practices
© 2010 Children’s Memorial Hospital
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
Managing Food Allergies in School
Create a safe environment:
 Prevent
 Recognize an allergic reaction
 Respond
© 2010 Children’s Memorial Hospital
Allergic Reaction:
What a Child Might Say or Do
 “My tongue (or mouth)
 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
 “This food is too spicy”
© 2010 Children’s Memorial Hospital
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
Managing Food Allergies in School
Create a safe environment
 Prevent
 Recognize
 Respond to an allergic reaction
© 2010 Children’s Memorial Hospital
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
Managing Food Allergies in School:
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
Thank you!
 Questions?
 Useful websites:
© 2010 Children’s Memorial Hospital