Presentation on theme: "Food Allergy Awareness and Management"— Presentation transcript:
1 Food Allergy Awareness and Management University of WisconsinJo HoppGive BOTH activities as students are walking in.IntroductionWho you areWhy you do thisTrece’s storyWhy talking to DAP classesUW-Stout CFSCFuture advocates for childrenSchools are becoming more awareaccommodations have to be madenut-free schools
2 Food Allergy Awareness Agenda IntroductionFood Allergy BasicsPeanut Allergy BasicsManaging Peanut Allergies at SchoolReactions and the Epi-pen
3 Resources and Information Food Allergy and Anaphylaxis Network (FAAN)American Academy of Allergy, Asthma and ImmunologyNational Institute of Allergy and Infectious DiseaseFEAST of Seattle, WAVarious 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 TeachersMenomonie School DistrictWisconsinRecipients of 3 Mariel C. Furlong Awards (2006)Contributions of food allergy awareness, education and advocacyTrece’s thank you storyOther kids thank yousEmapthy teaching to the kids – comments from kids to me
5 What is a Food Allergy?Immunological response to food (allergic reaction)Body protecting itself – release of histamineAffects multiple body systems:GIRespiratorySkinCardiovascularExposure can cause serious problems or deathSome affects are visible (hives, coughing, vomitting) and some are not (drop in blood pressure)
6 Intolerance vs. Allergy Reaction to the chemicals in foodNo immune system responseNo serious (life-threatening) side-effectsBloating, gas, abdominal discomfortPublic impressionParental interactionMany people believe that food allergies and food intolerances are the same thing
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 ageNot clear why there is a rise of food allergies. Many theories exist including the emphasis on sanitization. In the case of peanut allergy, one train of thought is due to the way peanuts are processed (roasting process)Onset at any age: Melissa Mihali (32)
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 annuallyreactions caused most often outside the home and by products believed to be safeAsthma increases risk of fatal reactionAdolescents and young adults are at the highest riskFinal point: studies have suggested that fatal reactions are most often caused by peanut allergies when epinephrine was not administered early enough.Bock, et. al J Allergy Clinical Immunol 2001
9 Food Allergy Facts What the experts say Sensitivity to the allergen can varyFor some, a speck of allergen can have the same effect as eating a large quantityFor some, skin contact with the allergen is enough to cause a reactionFor some, inhalation of the allergen can cause discomfortSensitivity is truly ‘unknown’Affected systems can vary between individuals AND reactionsCollege student who ate a cookie from the vending machine, allergist who ate a ‘peanut free’ cookie at a Christmas party, but the spatula used to remove the peanut butter cookies was also used to remove the ‘peanut-free’ cookieTrece and her dad playing. Trece being licked by a dog. Cases of reactions occurring after being kissed If PB is on a surface and an allergic child touches that surface, potential problem, and then if they puts their hands in their mouths or handles their lunch/snack a problem can happenTrece experiences on the airplane.In fact, such small amounts of protein like those found in breastmilk can trigger a reaction (Trece’s first)Eliminating the allergen not only reduces the risk of fatal reactions, but even if the individual does not ingest the protein, mild, uncomfortable reactions can occur and linger. Furthermore, unfortunately when dealing with young children, they often either put their hands in their mouths or do not wash well before eating, so skin contact can lead to ingestion
10 Food Allergy Facts What the experts say No CureStrict avoidance is the only way to prevent allergic reactionsNo desensitization techniques like there is with environmental allergies
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 1997Severe allergies are typically life-longHigh cross-reactivity to tree nuts (almonds, walnuts, etc.)Although some do outgrow peanut allergies, those individuals tend to have meticulous avoidance, no history of anaphylaxis, smaller skin/blood test results, fewer food allergies in general.Peanut allergic individual are strongly recommended to avoid all tree nuts as well
13 Peanut Allergy Specific Peanut allergies tend to cause the most severe reactionsPeanut or tree nut allergies and asthma appear to increase the risk for fatal reactionsA 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 2001A 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 fatalPrevious reactions DO NOT indicate future reactionsAn unpredictable physiological change occurs after each exposureWithin a couple minutes to 2 hours after exposure (and in rare cases longer)Once reaction starts, progression can varyNot just a lunch-time event!Can be biphasicBiphasic: could be more serious or less serious
15 What is anaphylaxis? Most severe allergic reaction Involves multiple systems at the same timePotentially fatal, especially if medication is not given promptly (at first signs)Most severeHives and vomiting, difficulty breathing and swelling, any combinationMost fatalities that occurred when medication was given was the result of medication not being given soon enough. If you suspect a child is having a reaction…you must give medication. You can not wait to see if the reaction will get worse or bad enough. In fact, for some children, if you suspect they have ingested an allergen, even if signs of a reaction have not yet been seen (you saw them eat a bite of PB&J), medication should be administered. Although each individual plan may differ, in general you do not want to see if a reaction will progress before you make a decision about medication. It can progress to quickly and time is preciousWhy is this important for you to understand: some schools require medication be kept in the nurses station or a locked cabinet. People feel kids should NOT be allowed to carry medication with them…THIS IS S PROBLEM…6 minutes to run to the nurse’s station, find the key, ect.FEAST story of changing the Epi-pen due to expiration
16 What is anaphylaxis?Can occur within minutes of exposure (death can occur within as few as 6 minutes)Pattern can vary among individualsPeanut/Tree nut allergies in combination with asthma is the highest riskMost severeHives and vomiting, difficulty breathing and swelling, any combinationMost fatalities that occurred when medication was given was the result of medication not being given soon enough. If you suspect a child is having a reaction…you must give medication. Furthermore, for some children, if you suspect they have ingested an allergen, even if signs of a reaction have not yet been seen (you saw them eat a bite of PB&J), medication should be administered.Although each individual plan may differ, in general you do not want to see if a reaction will progress before you make a decision about medication. It can progress to quickly and time is preciousSome will start out slow and steady, some will develop quickly and become life-threatening within minutes. The later is most often caused by peanuts and tree nuts. Trece’s first reaction, and how amazingly quick the initial symptoms came (thank God it slowed down).
18 Strict Avoidance No cure for food allergies Key is helping children avoid allergensGood attitudeCareful handlingCross-contaminationLabel readingExpecting the Unexpected
19 Good Attitude Nothing is 100% safe ‘peanut free’ environment only reduces the risk of exposure, it does not eliminate riskEven food from home is a riskFood and food consumption IS NOT the only riskExposure can occur in non-food itemsExposure can occur on surfaces, in projects, outdoorsVigilance is keyWhen Trece asks if a food is safe, we always say, “I think so”Peanut butter is a problem for this as it is so sticky and stays on…protein remains intact
20 Good Attitude Setting an example Teaching Empathy Good Communication with Families
21 Careful handling Allergic children can react through IngestingContactInhalingEveryone has to be aware, as reactions can occur at varying times after exposureJust because you aren’t around during lunch doesn’t mean that you won’t be needed for a reactionReminder: reactions can occur a few minutes to 2 hours after exposure (even 4 hours). If you are the music specialist three hours after lunch, you STILL have to be competent to handle a reaction. A reaction could occur due to something the child ate OR a reaction could occur because the kid sitting next to the allergic child ate something and it is still on his/her hands.
22 Avoiding Cross-Contamination Food proximity (same plate, same bag, same platter)Using the same utensilUsing the same area/surfaceNot cleaning the area/plate/utensil thoroughlyUsing the same cooking material/machine (toaster)Transfer of allergens (nut falling into a plate, but plate not getting clean)Notice sources of cross-contact here… NAME SOMECross-contamination at risk foods: NAME SOME
23 What to doRequire thorough hand washing and teeth brushing especially if you suspect a student has eaten peanuts/nutsClean eating and working areas carefullyDiscourage food sharingHave “safe” snacks and treats from familyDo not allow homemade goodies or home prepared foods (e.g. apples cut at home)
24 Label ReadingFood Allergen Labeling and Consumer Protection Act (FALCPA)As of January 1, 2006, labels must list common language for the top 8 allergensReading labels carefully can save a child’s lifeFoods can be analogous to poisonTop 8 allergens must be clearly stated in ingredient list.May have Contains statementMay have cross-contamination statement
25 Standard LabelFrom the picture on the box, it does not appear that there are nuts in this product. Is it safe?
31 What NOT to give If label is ambiguous as to presence of peanut If no label presentHomebaked itemsIce creamBakery ItemsImported Foods
32 Expecting the Unexpected What might contain peanuts/tree nuts?It’s NOT ONLY in the food!!!Activity ANSWERSTwo examples of unexpected places:Jen’s wedding – hazelnuts in groundsPacific Science Center in Seattle – Mancala game with brazil nuts
34 Your Students and Families Education and Support is critical to keep ALL children safe at schoolHand outConstant reminders are necessary, especially around birthdays and holidaysBe consistent in policiesBe an advocate and an example – avoid confusionEngage the students in awarenessLikely not understand necessity of peanut-free environmentEducate the studentsTeach empathyTake bullying seriouslyPAL ProgramParents are often resistant at first because they are not aware of the issues. Education generally eases all concerns.If you let the cookies from home or the bakery be served just once, then it will be more difficult to prevent it in the future.Teach the students about allergies and the importance of safety. Explain why keeping all kids safe is importantChildren don’t understand how something so benign can be lethal. They would never pick up a gun or knife and threaten another classmate, however to a peanut allergic child, for example, peanut butter is no different than a gun or knife. Bullying based on the child’s food allergy can cause more than hurt feelings and has to be dealt with appropriately.
35 Management in the school and classroom Nothing is 100% safeCross-contamination is a serious threatLabel reading is criticalPeanuts/nuts can be in unusual items (not even food related)Know the students – know the planLocations of medicationHow to recognize reactionHow to use medication
36 Possible Exposures Ingestion Contact Inhalation Eating, Mucus Membranes, Eczema
37 Signs of an Allergic Reaction HivesDifficulty BreathingVomitingDiarrheaEczema FlareLightheadednessSwelling
38 What a Child May Say I think I am going to throw up Food Allergy News, Vol 13, No 2; 2003I think I am going to throw upMy mouth/tongue itchesMy chest feels tightI feel itchyMy tongue feels hot/burning/tingling/heavyThere’s something in my throatMy lips feel tightMy tongue feels like there is hair on itFeels like bugs are in my ears
39 What can be done???GIVE EPINEPHRINE!!! (Epi-pen)
40 Administering an Epi-pen Remove grey activation capJab black end into outer thighUse enough force to make a bruiseThis can be done through clothingHold 15 secondsVERY easy to give.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!THIS is a must. The child will look better, feel better and want to sit up. BUT recall the reaction may not be over. Biphasic reactions and Epi only lasts 15 minutes.
42 Emergency Action Plan Varies for individual child Action plan should be in place that is SPECIFIC for each allergic childKnow the planKnow where the medication is locatedRequire that your allergic students have an action plan and familiarize yourself with that plan.
43 THANK YOUYou can make a difference in the life of a food allergic child. Please be an advocate.