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Food Allergy Awareness and Management University of Wisconsin Jo Hopp

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1 Food Allergy Awareness and Management University of Wisconsin Jo Hopp

2 Food Allergy Awareness Agenda  Introduction  Food Allergy Basics  Peanut Allergy Basics  Managing Peanut Allergies at School  Reactions and the Epi-pen

3 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)

4 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

5 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

6 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

7 Food Allergy Facts What 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

8 Food Allergy Facts What 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 Bock, et. al J Allergy Clinical Immunol 2001

9 Food Allergy Facts What 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

10 Food Allergy Facts What the experts say  No Cure Strict avoidance is the only way to prevent allergic reactions

11 Food Allergy Facts What the experts say  Eight foods account for 90% of all reactions

12 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.)

13 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

14 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

15 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)

16 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

17 Managing Food/Peanut Allergies in Schools

18 Strict Avoidance  No cure for food allergies  Key is helping children avoid allergens Good attitude Careful handling Cross-contamination Label reading Expecting the Unexpected

19 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

20 Good Attitude  Setting an example  Teaching Empathy  Good Communication with Families

21 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

22 Avoiding Cross-Contamination

23 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)

24 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

25 Standard Label

26 “Contains” Statements

27 “Contains” Statement Policy  Only required for allergens not clearly stated in the ingredient list.  Chef Boyardee Pizza

28 Warning Labels May also say “manufactured in a facility that also processes peanuts”

29

30 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).

31 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

32 Expecting the Unexpected  What might contain peanuts/tree nuts?  It’s NOT ONLY in the food!!!

33 A New School Year…new faces, new information

34 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

35 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

36 Possible Exposures  Ingestion  Contact  Inhalation  Eating, Mucus Membranes, Eczema

37 Signs of an Allergic Reaction  Hives  Difficulty Breathing  Vomiting  Diarrhea  Eczema Flare  Lightheadedness  Swelling

38 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

39 What can be done???  GIVE EPINEPHRINE!!! (Epi-pen)

40 Administering an Epi-pen  Hold 15 seconds  Jab black end into outer thigh  Use enough force to make a bruise  This can be done through clothing  Remove grey activation cap  Keep patient lying down

41 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!

42 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

43 THANK YOU You can make a difference in the life of a food allergic child. Please be an advocate.


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