Food Allergy Awareness and Management University of Wisconsin Jo Hopp [email protected].
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Transcript of Food Allergy Awareness and Management University of Wisconsin Jo Hopp [email protected].
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Food Allergy Awareness Agenda
Introduction
Food Allergy Basics
Peanut Allergy Basics
Managing Peanut Allergies at School
Reactions and the Epi-pen
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Resources and Information
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)
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THANK YOU, THANK YOU(we can’t say it enough)
Wakanda Elementary School Administration and Teachers
Menomonie School District
Wisconsin Recipients of 3 Mariel C. Furlong
Awards (2006) Contributions of food allergy awareness,
education and advocacy
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What is a Food Allergy? Immunological response to food (allergic
reaction) Body protecting itself – release of histamine Affects multiple body systems:
GI Respiratory Skin Cardiovascular
Exposure can cause serious problems or death
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Intolerance vs. Allergy
Intolerance Reaction to the chemicals in food No immune system response No serious (life-threatening) side-
effects Bloating, gas, abdominal discomfort
Public impression Parental interaction
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Food Allergy FactsWhat the experts say
Doubling of food allergy over the past 10 years, particularly peanut allergy. Latest statistics show continual increase with
peanut allergy as the leading cause
~12 million Americans affected (4%) ~ ½ are peanut and/or tree nut ~3 million school aged children (~8%) Onset at any age
www.foodallergy.org
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Food Allergy FactsWhat the experts say
Food allergy is the leading cause of serious allergic reaction (anaphylaxis) outside the hospital setting.
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.orgBock, et. al J Allergy Clinical Immunol 2001
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Food Allergy FactsWhat the experts say
Sensitivity to the allergen can vary 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
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Food Allergy FactsWhat the experts say
No Cure Strict avoidance is the only way to prevent allergic
reactions
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Food Allergy FactsWhat the experts say
Eight foods account for 90% of all reactions
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Peanut Allergy Specific
1/250 of a peanut is enough to trigger a reaction (cutting a peanut in half 125 times!) Hourihane, J. J Allergy Clin Immunol 1997
Severe allergies are typically life-long
High cross-reactivity to tree nuts (almonds, walnuts, etc.)
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Peanut Allergy Specific
Peanut allergies tend to cause the most severe reactions
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
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Allergic Reactions - facts
Severity of reaction can vary from mild to serious and potentially fatal
Previous reactions DO NOT indicate future reactions An unpredictable physiological change occurs
after each exposure
Within a couple minutes to 2 hours after exposure (and in rare cases longer) Once reaction starts, progression can vary Not just a lunch-time event!
Can be biphasic
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What is anaphylaxis?
Most severe allergic reaction
Involves multiple systems at the same time
Potentially fatal, especially if medication is not given promptly (at first signs)
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What is anaphylaxis?
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
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Managing Food/Peanut Allergies in Schools
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Strict Avoidance
No cure for food allergies
Key is helping children avoid allergens Good attitude Careful handling Cross-contamination Label reading Expecting the Unexpected
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Good Attitude
Nothing is 100% safe ‘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
Setting an example
Teaching Empathy
Good Communication with Families
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Careful handling
Allergic children can react through Ingesting Contact Inhaling
Everyone has to be aware, as reactions can occur at varying times after exposure Just because you aren’t around during lunch
doesn’t mean that you won’t be needed for a reaction
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Avoiding Cross-Contamination
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What to do Require thorough hand washing and teeth
brushing especially if you suspect a student has eaten peanuts/nuts
Clean eating and working areas carefully
Discourage food sharing
Have “safe” snacks and treats from family
Do not allow homemade goodies or home prepared foods (e.g. apples cut at home)
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Label Reading
Food Allergen Labeling and Consumer Protection Act (FALCPA) As of January 1, 2006, labels must list
common language for the top 8 allergens
Reading labels carefully can save a child’s life Foods can be analogous to poison
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Sta
ndard
Label
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“Contains” Statements
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“Contains” Statement Policy
Only required for allergens not clearly stated in the ingredient list.
Chef Boyardee Pizza
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Warning Labels
May also say “manufactured in a facility that also processes peanuts”
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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).
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What NOT to give
If label is ambiguous as to presence of peanut
If no label present
Homebaked items
Ice cream
Bakery Items
Imported Foods
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Expecting the Unexpected
What might contain peanuts/tree nuts?
It’s NOT ONLY in the food!!!
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A New School Year…new faces, new information
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Your Students and Families
Education and Support is critical to keep ALL children safe at school
Hand out Constant reminders are necessary, especially around
birthdays and holidays
Be consistent in policies Be an advocate and an example – avoid confusion
Engage the students in awareness Likely not understand necessity of peanut-free
environment Educate the students
Teach empathy Take bullying seriously PAL Program
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Management in the school and classroom
Nothing is 100% safe
Cross-contamination is a serious threat
Label reading is critical
Peanuts/nuts can be in unusual items (not even food related)
Know the students – know the plan Locations of medication How to recognize reaction How to use medication
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Possible Exposures
Ingestion
Contact
Inhalation
Eating, Mucus Membranes, Eczema
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Signs of an Allergic Reaction
Hives Difficulty Breathing Vomiting Diarrhea Eczema Flare Lightheadedness Swelling
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What a Child May Say
I think I am going to throw up
My mouth/tongue itches
My chest feels tight
I feel itchy
My tongue feels hot/burning/tingling/heavy
There’s something in my throat
My lips feel tight
My tongue feels like there is hair on it
Feels like bugs are in my ears
Food Allergy News, Vol 13, No 2; 2003
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What can be done???
GIVE EPINEPHRINE!!! (Epi-pen)
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Administering an Epi-pen
Hold 15 seconds
Jab black end into outer thighUse enough force to make a bruiseThis can be done through clothing
Remove grey activation cap
Keep patient lying down
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Call 911
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!
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Emergency Action Plan
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
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THANK YOU
You can make a difference in the life of a food allergic child. Please be an advocate.