Impact of food allergies on children What is a food allergy? Triggers that worsen food allergies Mild signs & symptoms Medical management of

Impact of food allergies on children What is a food allergy? Triggers that worsen food allergies Mild signs & symptoms Medical management of mild signs & symptoms Anaphylaxis (severe signs & symptoms of an emergency; interventions) Preventative measures

Learn the signs and symptoms of anaphylaxis Have the skills to administer an epinephrine auto injector Review the emergency plan in responding to a food allergy emergency

In accordance with Education Code (EC) Section 49414, legislation was enacted to develop minimum standards of training for school personnel in the administration of epinephrine auto-injectors. It is estimated that severe allergies affect nearly 40 million Americans in all age groups and put those individuals at risk for death from anaphylaxis.

Four out of every 100 children have food allergies Food allergies are becoming more common AND hospitalizations related to food allergies are also increasing Children with food allergies are two to four times more likely to have other related conditions such as asthma and other allergies, compared with children without food allergiesAND are more likely to experience anaphylactic reactions to foods and be at higher risk of death.

A food allergy is an abnormal response to a food triggered by the bodys immune system. No food allergy symptoms occur on the first time a person is exposed to the food First exposure primes the body to respond the next time and an allergic response occurs upon following exposure.

First exposure does not necessarily mean the first time an individual eats or tries a certain food. It can occur by touching a food allergen directly, using or eating other products with the food allergen, or touching someone or being touched by someone who has just directly touched the food allergen.

Being touched by those who have eaten a food Eating Kissing

There are 8 food allergens identified by the Food and Drug Administration that may trigger a food allergen response. These foods account for 90% of food allergic reactions ( Food allergies: What (2010)), but someone can be allergic to various other types of food.

Big 8 Allergens SoyFishMilkEggs Tree Nuts PeanutsWheatShellfish

1. Milk 2. Eggs 3. Fish (e.g. bass, cod, flounder) 4. Shellfish (e.g. crab, lobster, shrimp) 5. Tree nuts (e.g. almonds, walnuts, pecans) 6. Peanuts 7. Wheat 8. Soybeans

Common causes: Food Insect stings (bees, hornets, yellow jackets) Medications (e.g. antibiotics, aspirin, non-steroidal anti-inflammatory drugs) latex

Uncommon causes: Food dependent exercise induced anaphylaxis (rare) Idiopathic (unknown cause) anaphylaxis

Food allergies are different from food intolerance A food intolerance is the bodys abnormal reaction to a food but DOES NOT involve the immune system A doctor can confirm the presence or absence of a food allergy and/or food intolerance

Types of Food Intolerance: Lactose Intolerant Food additives Gluten Intolerance Food poisoning Histamine toxicity

Bloating Abdominal pain or cramping Diarrhea Nausea & vomiting

Symptoms of food allergies typically appear from within a few minutes to two hours after a person has eaten the food to which they are allergic.

Allergic reactions can include: Hives Flushed skin or rash Tingling or itching sensation in the mouth Itching (of any part of the body) Face, tongue, or lip swelling (or any part of the body) Vomiting and/or diarrhea

Abdominal cramps Coughing or wheezing Dizziness and/or lightheadedness Swelling of the throat and vocal cords Difficulty breathing Loss of consciousness

Mild signs & symptoms caused by food allergies may be alleviated through over the counter medications such as Benadryl or the generic name Diphenhydramine. Diphenhydramine (Benadryl) An antihistamine Relieves mild signs & symptoms like Hives Flushed skin or rash Tingling or itching sensation in the mouth Face, mouth, or lip swelling Minor throat or airway irritation

Follow the directions on the medication release form for that student. Possible side effects Drowsiness Dry mouth, nose, & throat Excitement (especially in children)

A severe, life-threatening allergic reaction is called anaphylaxis and can often lead to constricted airways in the lungs, severely lowering blood pressure and shock and suffocation by swelling of the throat (Food Allergies: What, 2010)

This can lead to: Constricted airways in the lungs Severe lowering of blood pressure and shock Suffocation by swelling of the throat

An epi-pen is used to treat someone with a severe, life-threatening allergic reaction Epi-pens should be stored at room temperature until the marked expiration date DO NOT refrigerate or expose to extreme heat or sunlight

Even mild signs & symptoms of a reaction to a food allergen can lead to a severe allergic reaction Those with known severe allergic reactions to food allergies should be prescribed medication on-hand ready to be used at any time they suspect the onset of an allergic reaction Medication most often used is epi-pen

The signs & symptoms of anaphylaxis usually appear rapidly, within seconds or minutes, after an exposure to an allergen. Sometimes the reaction can be delayed for 1 to 3 hours depending on the substance causing the reaction

Some have an anaphylactic reaction and symptoms go away only to return in a few hours This is called a bi-phasic reaction If an epinephrine auto-injector is used for a student at a school site, staff must call 9- 1-1

What to do in an emergency Notice the signs & symptoms Take all reactions seriously Try to keep calm Initiate Epi-Pen medication (or other epinephrine auto- injector)as prescribed by the doctor immediately If no epinephrine auto-injector is available use the stock Epi-Pens kept at the school site locked in the medication cupboard. CALL 9-1-1 FOR AN AMBULANCE, THEN CALL THE PARENT/GUARDIAN 1 in 4 will have a latent reaction

In order to prevent severe allergic reactions individuals should do the following: Strictly avoid known food allergens Be able to recognize and manage allergic reactions to food early Read food labels prior to consumption. Promptly administer epinephrine auto-injector during early symptoms of anaphylaxis AND have an action plan to help guide food allergy management.

An Emergency Care Plan A dietary prescription completed by a doctor (food allergies only) A medication Authorization form An epinephrine auto-injector (e.g. Epi- Pen) All staff trained to use an epinephrine auto-injector MUST have current CPR

Center for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA 30333 USA800-CDC-INFO (800-232-4636) TTY: (888) 232- 6348 Email: [email protected] http://www.cdc.gov/asthma/ Phone: (800) [email protected] http://www.cdc.gov/asthma/ Phone: (800) 822-2762 Food Allergy and Anaphylaxis Network 11781 Lee Jackson Highway, Suite 160 Fairfax, VA 220333309 Phone: 800929 4040 www.foodallergy.org www.foodallergy.org Food Allergy Initiative 1414 Avenue of the Americas, Suite 1804 New York, NY 100192514 Phone: 2122071974 www.faiusa.org www.faiusa.org

National Institute of Allergy & Infectious Diseases 6610 Rockledge Drive, MSC 6612 Bethesda, MD 20892-6612 Phone: 301-402- 1663 Email: [email protected] Fax: 301-402- 0120 [email protected] Fax: 301-402- 0120 www.niaid.nih.gov U.S. Food and Drug Administration 10903 New Hampshire Avenue Silver Spring, MD 20993 Ph. 1- 888-INFO-FDA (1-888-463-6332) http://www.fda.gov/ http://www.fda.gov/

Branum, A. M., & Lukacs, S. L. U.S. DEPARTMENT OF, National Center for Health Statistics. (2008). Food allergy among U.S. children: Trends in prevalence and hospitalizations. Centers for Disease Control and Prevention websiteCenters for Disease Control and Prevention website Centers for Disease Control and Prevention, (2012). Food allergies in schools. http://www.cdc.gov/healthyyouth/foodallergies/ http://www.cdc.gov/healthyyouth/foodallergies/ Mondello, W. (2009, Oct/Nov). Food-allergic children and their emotional wellbeing. Living Without. http://www.livingwithout.com/issues/3_6/Emotion al-State-Food-Allergic-Children-1022-1.htmlhttp://www.livingwithout.com/issues/3_6/Emotion al-State-Food-Allergic-Children-1022-1.html National Center for Biotechnology Information, U.S. National Library of Medicine (2011). Diphenhydramine. http://ttp://www.ncbi.nlm.nih.gov/pubm edhealth/PMH0000704/http://ttp://www.ncbi.nlm.nih.gov/pubm edhealth/PMH0000704/

National Institutes of Health, National Institute of Allergy and Infectious Diseases. (2010). Food allergy: An overview. Retrieved from NIH http://www.niaid.nih.gov/topics/foodAllergy/Documents/fo odallergy.pdf http://www.niaid.nih.gov/topics/foodAllergy/Documents/fo odallergy.pdf U.S. Food and Drug Administration, Silver Spring, MD. (2010). Food allergies: What you need to know. Retrieved from website: http://www.fda.gov/downloads/Food/ResourcesForYou/Con sumers/UCM220117.pdf http://www.fda.gov/downloads/Food/ResourcesForYou/Con sumers/UCM220117.pdf U.S. Food and Drug Administration. (n.d.). Food allergies: Reducing the risks (video) [Web]. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm 182842.htm http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm 182842.htm