1. Special Dietary Needs in Child Nutrition Programs Lesson 3: Managing Food Allergies
Learning Objectives
Summarize key components regarding food allergies.
Explain ways food service personnel can prevent exposing children with allergies to the allergen.

2. Food Allergies
Definition
Symptoms
Anaphylaxis

3. Common Food Allergies peanuts tree nuts (almonds, pecans, walnuts)
milk
eggs
soy
wheat
fish (bass, cod, flounder)
crustacean shellfish (crab, lobster, shrimp)

4. Anaphylaxis Sudden, severe, potentially fatal reaction
Potentially life threatening can occur after person with allergies is exposed to a specific allergen
Collection of symptoms affecting multiple body systems, may occur immediately or up to 2 or more hours following allergen exposure
Most dangerous symptoms-breathing difficulties and blood pressure drop or shock, can be fatal
Anyone with a previous history of anaphylactic reactions is at risk for another severe reaction

5. Treatment for Allergies
Antihistamines/Bronchodilators
Epinephrine
Prevention and Strict Avoidance
Action Plan

6. Food Item
Source of
Allergen
Milk
Soy
Egg
Meatballs
Crinkle cut fries
Biscuits
Chicken nuggets
Mashed potatoes
Creamed corn
Hotdogs
Hotdog buns
Cheese ravioli
Tacos
Cheese pizza
Carrot/celery
ranch dressing

7. Food Allergen Labeling Laws
January 2006 law requiring manufacturers clearly identify on food labels
8 major allergenic foods and food groups
Milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans (90% of all food allergies)
Applies in schools, not if label before Jan ‘06
Exemptions-raw agricultural commodities-fresh fruits/vegetables, highly refined oils

8. Allergy Scenarios Read and identify problem areas One-spatula-gloves
Two-slicer
Three-knife cleaning-jelly/bread loaf
Four-check label
Five-substitute

9. Regulations Accommodations with Approval of Food Service Director
Accommodations Required
Allergies with no anaphylaxis
Food intolerances
Allergies with the potential of anaphylaxis
Celiac disease

10. Food Intolerance Definition: Food intolerance is an
adverse reaction to food that does not involve the immune system.
Examples
Lactose Intolerance
Gluten Intolerance

11. Celiac Disease Inherited autoimmune disorder, cause unknown
Affects 1 in 133 Americans
Affects digestive process of small intestine and causes gluten intolerance
If consumes gluten (protein in wheat, rye, barley), immune system attacks small intestine and inhibits absorption of important nutrients into body
Symptoms
Recurring abdominal pain and bloating
Chronic diarrhea/constipation
Weight loss
Pale, foul-smelling stool
Treatment gluten-free diet-eliminate grains such as wheat, rye, barley, possibly oats,* and derivatives of these grains

12. Food Services Preventing exposure to allergens in the kitchen.
Read food labels.
Know what to avoid and how to substitute.
Designate kitchen allergy-free zones.
Follow safe food handling practices.

13. Food Services
Preventing exposure to allergens in the cafeteria and throughout the school.
Understand the allergy plan.
Identify children with documented food allergies.
Develop standardized cafeteria cleaning procedures.
Learn to recognize signs of anaphylaxis, and know how to activate the school’s emergency plan if anaphylaxis should occur in a child with a life threatening food allergy.

14. Distribution of Peanut Allergen in Environment
Ara h 1-major peanut allergen-none on water fountains, none on desks/cafeteria tables. Nonallergic volunteers ate peanuts /peanut butter in cafeteria. No airborne Ara h 1 detected.
Cleaning Ara h 1-found common household cleaning agents, such as Formula 409®, Lysol® Sanitizing Wipes, Target brand® cleaner with bleach, removed allergen from tabletops (except for dishwashing liquid, which left traces of allergen).
Removal from hands, liquid soap, bar soap, commercial wipes were very effective. Plain water/antibacterial hand sanitizer left detectable levels of peanut allergen.
Conclusions-Ara h 1 is easily cleaned from hands/surfaces and does not appear to be widespread on cafeteria tables/desks in preschools/schools. Airborne peanut allergen was not detected, despite testing levels in multiple simulated environments, but more research needs to be done in order to make firm conclusions about exposure to peanut allergens in schools. Source: Journal of Allergy and Clinical Immunology, Vol. 113, No. 5.

15. Special Dietary Needs in Child Nutrition Programs Lesson 4: Understanding Inborn Errors of Metabolism
Learning Objectives
Define inborn errors of metabolism, identify the more common errors, and explain dietary treatment for children with inborn errors of metabolism.
Describe accommodations for these children and understand the need for a professional consultant in difficult cases.

16. Inborn Errors of Metabolism
Rare genetic disorders in which the body cannot metabolize food normally
By-products of metabolism, amino acids, sugars, fatty acids build up in the body, causing serious complications
Dietary treatment: strict diet management to avoid toxic buildup of dietary by-products
Special foods or formulas may be needed

17. Phenylketonuria (PKU)
Cannot process the amino acid phenylalanine
Dietary treatment:
low-protein diet (to prevent increase in phenylalanine)
special formula to provide protein

18. Galactosemia Cannot process the sugar galactose
Dietary treatment: no milk or dairy products

19. Hereditary Fructose Intolerance
Cannot process the sugar fructose
Dietary treatment:
no fructose (high-fructose corn syrup, honey, fruit)
no sucrose (table sugar)

20. Maple Syrup Urine Disease
Cannot process branched chain amino acids leucine, isoleucine, valine
Dietary treatment:
low-protein diet
special formula to provide protein

21. Food Services
Maintain communication among food personnel, parents, teacher, school nurse, and consultant if needed
Understand dietary restrictions prescribed in the plan and keep on file and with the school nurse
Obtain and serve special formula or foods
Follow prescribed portion sizes
Report mistakes immediately
Keep information confidential

22. Snack
Generally, provided by family (unless all students provided snack)
Student needing snack during school day- ‘right to a snack’ under Section 504 as an accommodation depending on severity
Must allow to obtain (eat when, where, how, time necessary accommodation-bus)
Special Ed Connection, January 16, 2008

23. A special diet could be a related service under IDEA, Letter to Williamson, 211 IDELR 419 (OSEP 1986), but under following conditions-
1. Special diet must be related to a child's disability.
2. Special diet must be determined by IEP Team as a related service that is required to receive a free appropriate public education. While a physician's note might be required for meal substitutions, etc., only IEP team can conclude that a service (diet, transportation, nursing, etc.) is a "related service" that would be funded by special education dollars.
3. LEA's nutrition service, as a "related service" provider, should participate in IEP Team discussions of special diets as a related service.
4. Special diet must be based on "peer reviewed research to extent practicable". Controversial dietary therapies may be lacking in peer-reviewed research. Some dietary therapies have been shown to have negative health effects. IEP team must consider any research brought to its attention about dietary therapies.
5. Special education is payer of last resort. If there are other funds available, those must be used first.
6. Special education funds must supplement, not supplant other state, federal, and local sources of funds. For example, if USDA provides funds for a student's meals, and student's special meals cost $5.00/day, amount that special education funds could pay would be difference between USDA payment and daily cost. If special education funds paid entire amount, that would violate IDEA's supplement-not-supplant clause.
Thomas A. Mayes, Legal Consultant
Bureau of Student & Family Support Services, Iowa Department of Education
3/4/08