Food Allergy - University of Wisconsin

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Food Allergy Awareness and
Management
University of Wisconsin
Jo Hopp
[email protected]
Food Allergy Awareness Agenda
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Introduction
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Food Allergy Basics
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Peanut Allergy Basics
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Managing Peanut Allergies at School
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Reactions and the Epi-pen
Resources and Information
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Food Allergy and Anaphylaxis Network
(FAAN)
American Academy of Allergy, Asthma
and Immunology
National Institute of Allergy and
Infectious Disease
FEAST of Seattle, WA
Various websites dedicated to food allergy
advocacy (e.g. peanutallergy.com)
THANK YOU, THANK YOU
(we can’t say it enough)

Wakanda Elementary School
Administration and Teachers
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Menomonie School District
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Wisconsin

Recipients of 3 Mariel C. Furlong
Awards (2006)
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Contributions of food allergy awareness,
education and advocacy
What is a Food Allergy?
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Immunological response to food (allergic
reaction)

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Body protecting itself – release of
histamine
Affects multiple body systems:
 GI
 Respiratory
 Skin
 Cardiovascular
Exposure can cause serious problems or
death
Intolerance vs. Allergy
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Intolerance
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Reaction to the chemicals in food
No immune system response
No serious (life-threatening) sideeffects

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Bloating, gas, abdominal discomfort
Public impression
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Parental interaction
Food Allergy Facts
What the experts say
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Doubling of food allergy over the past 10
years, particularly peanut allergy.
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Latest statistics show continual increase with
peanut allergy as the leading cause
~12 million Americans affected (4%)
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~ ½ are peanut and/or tree nut
~3 million school aged children (~8%)
Onset at any age
www.foodallergy.org
Food Allergy Facts
What the experts say

Food allergy is the leading cause of
serious allergic reaction (anaphylaxis)
outside the hospital setting.
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over 30,000 ER visits per year
~ 175 deaths annually
reactions caused most often outside the home
and by products believed to be safe
Asthma increases risk of fatal reaction
Adolescents and young adults are at the
highest risk
www.foodallergy.org
Bock, et. al J Allergy Clinical Immunol 2001
Food Allergy Facts
What the experts say
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Sensitivity to the allergen can vary
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For some, a speck of allergen can have the
same effect as eating a large quantity
For some, skin contact with the allergen is
enough to cause a reaction
For some, inhalation of the allergen can cause
discomfort
Sensitivity is truly ‘unknown’
Affected systems can vary between
individuals AND reactions
Food Allergy Facts
What the experts say

No Cure

Strict avoidance is the only way to prevent allergic
reactions
Food Allergy Facts
What the experts say

Eight foods account for 90% of all
reactions
Peanut Allergy Specific
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1/250 of a peanut is enough to trigger a
reaction (cutting a peanut in half 125
times!)
J Allergy Clin Immunol 1997
Hourihane, J.
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Severe allergies are typically life-long
High cross-reactivity to tree nuts
(almonds, walnuts, etc.)
Peanut Allergy Specific

Peanut allergies tend to cause the most severe
reactions
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Peanut or tree nut allergies and asthma appear to
increase the risk for fatal reactions
A study (2001) of 32 cases of fatal food-allergy
induced anaphylaxis showed >90% had peanut and
tree nut allergies, most had asthma and emergency
medication (epinephrine) was not given or not given
soon enough.
Bock, et al. J Allergy Clin Immunol 2001
A more recent study (2007) also showed a large
majority of fatalities due to peanuts/tree nuts and
asthma.

Estimated that at least ½ of deaths are result of
peanut/tree nut
Allergic Reactions - facts
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Severity of reaction can vary from mild to
serious and potentially fatal
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Previous reactions DO NOT indicate future
reactions
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Within a couple minutes to 2 hours after
exposure (and in rare cases longer)
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An unpredictable physiological change occurs
after each exposure
Once reaction starts, progression can vary
Not just a lunch-time event!
Can be biphasic
What is anaphylaxis?
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Most severe allergic reaction
Involves multiple systems at the
same time
Potentially fatal, especially if
medication is not given promptly (at
first signs)
What is anaphylaxis?
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Can occur within minutes of
exposure (death can occur within as
few as 6 minutes)
Pattern can vary among individuals
Peanut/Tree nut allergies in
combination with asthma is the
highest risk
Managing Food/Peanut
Allergies in Schools
Strict Avoidance
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No cure for food allergies
Key is helping children avoid
allergens
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Good attitude
Careful handling
Cross-contamination
Label reading
Expecting the Unexpected
Good Attitude
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Nothing is 100% safe
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‘peanut free’ environment only reduces the risk
of exposure, it does not eliminate risk
Even food from home is a risk
Food and food consumption IS NOT the only
risk
 Exposure can occur in non-food items
Exposure can occur on surfaces, in
projects, outdoors
Vigilance is key
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Good Attitude
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Setting an example
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Teaching Empathy
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Good Communication with Families
Careful handling
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Allergic children can react through
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Ingesting
Contact
Inhaling
Everyone has to be aware, as reactions
can occur at varying times after exposure
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Just because you aren’t around during lunch
doesn’t mean that you won’t be needed for a
reaction
Avoiding Cross-Contamination
What to do
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Require thorough hand washing and teeth
brushing especially if you suspect a
student has eaten peanuts/nuts
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Clean eating and working areas carefully
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Discourage food sharing
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Have “safe” snacks and treats from family
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Do not allow homemade goodies or home
prepared foods (e.g. apples cut at home)
Label Reading
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Food Allergen Labeling and
Consumer Protection Act (FALCPA)
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As of January 1, 2006, labels must list
common language for the top 8
allergens
Reading labels carefully can save a
child’s life
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Foods can be analogous to poison
Standard Label
“Contains” Statements
“Contains” Statement Policy
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Only required for allergens not
clearly stated in the ingredient list.
Chef Boyardee Pizza
Warning Labels
May also say
“manufactured in
a facility that also
processes
peanuts”
Ingredients: ENRICHED FLOUR
(WHEAT FLOUR, NIACIN,
REDUCED IRON, THIAMINE
MONONITRATE {VITAMIN B1},
RIBOFLAVIN {VITAMIN B2},
FOLIC ACID), SUGAR,
PARTIALLY HYDROGENATED
SOYBEAN AND/OR LIQUID
SOYBEAN OIL AND/OR
PARTIALLY HYDROGENATED
COTTONSEED OIL, HIGH
FRUCTOSE CORN SYRUP,
GRAHAM FLOUR, BROWN
SUGAR, COCOA (PROCESSED
WITH ALKALI), BAKING SODA,
CORNSTARCH, SALT,
CHOCOLATE, MILK (ENZYME
MODIFIED), NATURAL AND
ARTIFICIAL FLAVOR, SOY
LECITHIN (EMULSIFIER).
What NOT to give
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If label is ambiguous as to presence of
peanut
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If no label present
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Homebaked items
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Ice cream
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Bakery Items
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Imported Foods
Expecting the Unexpected
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What might contain peanuts/tree
nuts?
It’s NOT ONLY in the food!!!
A New School Year…new
faces, new information
Your Students and Families
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Education and Support is critical to keep ALL children
safe at school
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Be consistent in policies
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Be an advocate and an example – avoid confusion
Engage the students in awareness
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Hand out
Constant reminders are necessary, especially around
birthdays and holidays
Likely not understand necessity of peanut-free
environment
Educate the students
Teach empathy
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Take bullying seriously
PAL Program
Management in the school and
classroom
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Nothing is 100% safe
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Cross-contamination is a serious threat
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Label reading is critical
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Peanuts/nuts can be in unusual items (not even
food related)
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Know the students – know the plan
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Locations of medication
How to recognize reaction
How to use medication
Possible Exposures
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Ingestion
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Contact
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Inhalation
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Eating, Mucus Membranes, Eczema
Signs of an Allergic Reaction
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Hives
Difficulty Breathing
Vomiting
Diarrhea
Eczema Flare
Lightheadedness
Swelling
What a Child May Say
Food Allergy News, Vol 13, No 2; 2003
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I think I am going to throw up
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My mouth/tongue itches
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My chest feels tight
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I feel itchy
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My tongue feels hot/burning/tingling/heavy
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There’s something in my throat
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My lips feel tight
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My tongue feels like there is hair on it
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Feels like bugs are in my ears
What can be done???
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GIVE EPINEPHRINE!!! (Epi-pen)
Administering an Epi-pen
Remove grey activation cap
Jab black end into outer thigh
Use enough force to make a bruise
This can be done through clothing
Hold 15 seconds
Keep patient lying down
Call 911
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After injection, call 911 right away
Tell them that you have a child who
is experiencing anaphylaxis, you
have administered the epi-pen, and
to bring more epinephrine!
Emergency Action Plan
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Varies for individual child
Action plan should be in place that
is SPECIFIC for each allergic child
Know the plan
Know where the medication is
located
THANK YOU
You can make a
difference in the
life of a food
allergic child.
Please be an
advocate.
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