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1 © 2010 Children’s Memorial Hospital Supported by the Food Allergy Initiative of Chicago faiusa.org/Chicago 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
2 © 2010 Children’s Memorial Hospital Definitions Key terms defined include Allergy: “adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food” 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”
3 © 2010 Children’s Memorial Hospital Soy Cow’s milkPeanutTree nuts FishShellfish Egg white Wheat Common Allergens
4 © 2010 Children’s Memorial Hospital Peanut allergy Peanut allergy doubled in children over a five-year period (1997-2002). 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
5 © 2010 Children’s Memorial Hospital 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
6 © 2010 Children’s Memorial Hospital Fatal reactions happen Risk factors: Asthma Adolescents or young adults Peanut or tree nut allergy Epinephrine administration was delayed (Bock JACI 2001/2007)
7 © 2010 Children’s Memorial Hospital Treatment There is no cure (yet) for food allergies. The only current treatment is AVOIDANCE.
8 © 2010 Children’s Memorial Hospital 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
9 © 2010 Children’s Memorial Hospital 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...
10 © 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 life- threatening 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)
11 © 2010 Children’s Memorial Hospital 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
12 © 2010 Children’s Memorial Hospital The Guidelines "Guidelines for Managing Life-threatening Food Allergies in Illinois Schools“ www.isbe.net/nutrition/htmls/food_allergy_guidelines.htm www.isbe.net/nutrition/htmls/food_allergy_guidelines.htm 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
13 © 2010 Children’s Memorial Hospital 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
14 © 2010 Children’s Memorial Hospital 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 student –Contain an EAP –Include risk reduction and emergency response measures
15 © 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
16 © 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
17 © 2010 Children’s Memorial Hospital Prevent a Reaction Avoid exposure to allergen During school day While traveling to and from school During school-funded events While on field trips
18 © 2010 Children’s Memorial Hospital Prevent a Reaction Avoidance is the key to preventing a reaction. Cross-contamination Mislabeled foods Unlabeled foods
19 © 2010 Children’s Memorial Hospital 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 surfaces. All staff members must be aware of these best practices
20 © 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.
21 © 2010 Children’s Memorial Hospital Managing Food Allergies in School Create a safe environment: Prevent Recognize an allergic reaction Respond
22 © 2010 Children’s Memorial Hospital Allergic Reaction: What a Child Might Say or Do Say “My tongue (or mouth) itches” “My tongue is hot/burning” “My mouth feels funny” “There’s something stuck in my throat” “It feels like there are bugs in my ears” “This food is too spicy” Do Put their hands in their mouths Pull or scratch at their tongues Drool Hoarse cry or voice Slur words Become unusually clingy
23 © 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.
24 © 2010 Children’s Memorial Hospital Managing Food Allergies in School Create a safe environment Prevent Recognize Respond to an allergic reaction
27 © 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
28 © 2010 Children’s Memorial Hospital Managing Food Allergies in School: Summary 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
29 © 2010 Children’s Memorial Hospital Thank you! Questions? Useful websites: – www.foodallergyinitiative.org www.foodallergyinitiative.org – www.foodallergy.org www.foodallergy.org – www.childrensmemorial.org/FACE www.childrensmemorial.org/FACE
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