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Managing Food Allergies in School Nutrition
Programs
Beth Foland, MS, RDJuly 21, 2014
An Overview of Food Allergies, Reading and Managing Food Labels, Accommodating Students with Food Allergies, Avoiding Cross Contact, and Food Allergy Awareness/Resources.
An Overview of Food Allergies, Reading and Managing Food Labels, Accommodating Students with Food Allergies, Avoiding Cross Contact, and Food Allergy Awareness/Resources.
Topics for Today
Pre-assessment:
Test your food allergy knowledge
All About AllergiesObjectives
What is a Food Allergy?
Food Allergy An immune-mediated adverse reaction to
a food protein
Body’s Immune SystemBody identifies a food protein as dangerous creates antibodies (Immunoglobulin E
(IgE)) against the protein
EVEN A BITE can result in an allergic reaction.
This food is too spicy. There’s something stuck in my throat.My lips feel tight. It feels like something is poking my tongue.My throat feels thick. My tongue (or mouth) is tingling.My mouth feels funny. There is a frog in my throat.My tongue (or mouth) itches.My tongue is hot (or burning).It feels like there is a bump on the back of my tongue.
How a Child Might Describe Symptoms
One or more symptomscan occur within minutes up to 2 hours and can be MILD to SEVERE
Trouble swallowing
Shortness of breath
Repetitive coughing
Voice change
Nausea & vomitingDiarrhea
Abdominal cramping
Drop in blood pressureLoss of consciousness
Death may occur
SwellingHives
EczemaItchy red rash
Allergic Symptoms
Anaphylaxis-rapid onset; can cause death
An epinephrine auto-injector is used to treat anaphylaxis. Most commonly heard trade name is EpiPen (but there are others, e.g. Auvi-Q, Twinject..)
Team Discussion With School
Nurse Should Include:
Where are the devices kept in the school; are they accessible?
Do you need to be trained to administer an autoinjector?
What if it inject the person, and they are not really having an allergic reaction?
How do substitutes know how to respond? Do the phones near you get an outside line to call
911? Will local EMTs have epinephrine when they arrive?
What is a Food Intolerance?
Food IntoleranceAn abnormal physiological response to eating
Involves the Gastrointestinal System
Food intolerance presents with symptoms affecting the skin, respiratory tract, and gastrointestinal tract; individually or in combination. Detrimental reaction (nausea, diarrhea, vomiting). Come on gradually, not life threatening, affect the body’s organsSymptoms are often confused with food allergies.Medical name: Non-allergic Food Hypersensitivity
Absence of an enzyme to digest food Irritable bowel syndrome Food poisoning Sensitivity to food additives Recurring Stress Celiac Disease
Treatment is determined between the Licensed Physician and the patient.
Causes of Food Intolerance
Food Allergy Background
More than 3 million children have some type of food allergy.
Food allergies affect an estimated 4%–6% of children in the United States.1 (1, 2)
Children with food allergies are 2-4 times more likely to have other related conditions such as asthma and other allergies, compared with children who do not have food allergies.
Reactions primarily caused by food used in class projects and celebrations ; – 79% Classroom – 12% Lunchroom
25% of reactions in those with no known allergy!
The “Big 8” Food Allergens
EggsMilk
PeanutsTree Nuts
FishShellfish
Soy Wheat
Prevention:Strict Avoidance of Known Food Allergens
Food Allergen Labeling and Consumer Protection
Act (FALCPA)Food labels must declare major food allergen in plain language: Milk, eggs, fish, shellfish, peanuts, tree nuts, soy, and wheat
Either in the ingredient list by either of these two methods:
“Contains” followed by the name Example: “Contains: milk and wheat”
Parenthetical statement in the list of ingredients
Example: “albumin (egg)”
Label Samples
Contains…..Parenthesis…
Subscribe to food allergy recall notices and a have system to take action if you serve the product being recalled
www.foodsafety.gov
Recall Notifications
Not regulatedNot safe for people with known food allergies
“May Contain” statement
“..made on equipment that also makes….”
Precautionary Labeling
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“Peanut-free” may create a false sense of security
FOCUS: STRATEGIES TO REDUCE ACCIDENTAL EXPOSUREAllergen-safe tables/classrooms are options to school-wide bans.Banerjee, D. K., Kagan, R.S., Turnburr, E., et al. Peanut-free
guidelines reduce school lunch peanut contents. Arch Dis Child. 2007
Take Caution When Making Statements!
Allergy ALERT We appreciate your
cooperation
DO NOTBring peanut/tree nut
productsInto this classroom
Barilla Whole Grain Spaghetti, Thin
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Made with 51% whole wheat, Ingredients Whole Grain Durum Wheat Flour, Semolina (Wheat), Durum Wheat Flour, Oat Fiber. Warnings Contains wheat ingredients. This product is manufactured on equipment that processes products containing eggs.
Hamburger Buns
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Enriched wheat flour, B vitamins, water, yeast, high fructose corn syrup or sugar, soybean oil contains 2% or less of wheat gluten, salt,calcium sulfate, vinegar, vitamin D, cornstarch,wheat starch, dough conditioners, soy flour, calcium propionate, whey, soy lecithin.
What allergens are in the hamburger bun?
A very common ingredient used in making salad dressing,
coleslaw and potato salad. Do I contain allergens?
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My ingredients include: Water, soybean oil, vinegar, high fructose corn syrup, modified food starch, sugar, salt, enzyme modified egg yolks, mustard, flour, artificial color, potassium sorbate, paprika, spice, natural flavor, dried garlic, beta carotene.
Strategies to Manage Labels and Ingredient
Lists
Communicating Food Allergy Label Information
School Nutrition StaffSchool NurseStudents, Parents or GuardianWebsite , handouts, other
How? Notebook of Labels
Software/website
When? Start of school, arrival of new
productsWhat method?
(face-to-face, phone, e-mail)
Establish procedures with team
Accommodating Students with Food-Related
Disabilities:The Law
Respect and Protect Children with Food
Allergies Civil rights and privacy
must not be violated
Prevent a child with food allergies from being singled out
Be alert to prevent and address bullying from other children and/or adults
Federal Laws
Prohibits discrimination against qualified persons with disabilities in programs or activities of any agency of the federal government’s executive branch or any organization receiving federal financial assistance.
Programs receiving federal assistance: National School Lunch Program, School Breakfast Program, Fresh Fruit & Vegetable Program, After School Snack Program
Rehabilitation Act of 1973
Federal Laws (continued)
Individuals with Disabilities Education Act (IDEA) 1975, Part B 2006
Requires a free and appropriate public education be provided for children with disabilities aged 3-21.
Americans with Disabilities Act (ADA)
1990 and 2008 Amendments
Broadens and extends civil rights protections for approximately 50 million Americans with disabilities.
Respect Privacy LawsHIPAA The Health Insurance Portability & Accountability Act (1996)- Requires all medical records disclosed be kept properly confidential.- Gives the patient rights control how health information is used.
FERPAFamily Educational Rights and Privacy Act (1974)- Protects the privacy of health information entered into a student’s record
http://origin.www.fns.usda.gov/cnd/Guidance/special_dietary_needs.pdf
Accommodating Children with Special Dietary Needs in the School Nutrition Programs
Guidance from USDA
School Meal Requirements
Schools must make substitutions in the reimbursable meal for disabled students whose disability prevents them from consuming the school meal as prepared.
No extra charge
A disability determination can only be made by a licensed physician.
Disability VS Non-Disability
Diet Order componentso Specify disabilityo How restricts dieto Major life activity affectedo Foods to omito Foods to substitute
Menu substitutions required
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Diet Order componentso How restricts dieto Foods to omito Foods to substitute
Signed by licensed MD
Signed by recognized medical authority
Option to provide menu substitutions
Food Allergy Action Plan 1 (5)
Recommended for each child with a known food allergy
Completed by student’s MD
or MD designee Use by nursing AND school personnel Outlines care in
emergency situation For the student’s safety Do you have a formal plan written for your
school?
Team Approach
34
LeadersAdministratorsSchool RNFoodservice DirectorTeachers
Others need to be informed: Classroom Aides, Janitors, Bus Drivers, Coaches, Foodservice personnel, After-School Staff, Substitute Teachers, anyone working in the building
CURE
Strategies to Accommodate Students
with Food Allergies
Menu planning, label reading, follow HACCP principles
Know the requirements for serving food to students with special dietary needs. USDA FNS Guidance for serving children with disabilities and special dietary needs in child nutrition programs
www.fns.usda.gov/cnd/guidance/special_dietary_needs.pdf
STEP 1
STEP 2
Child’s Safety
Licensed Healthcare
Professional
SchoolAdministrator
NurseSchool Nutrition
FacultyOthers
Family
Parents
Child
Comm
unication
/ Education Comm
unicatio
n
/ Educa
tion
The The PartnershipPartnershipCommunication / Education
Step 3
Implement the directives in the Special Dietary Form signed by a licensed physician.
If the form indicates the student has a DISABILITY, School Nutrition Services is required to make the accommodation.
If there is no disability, the accommodation is optional.
Step 4: Accommodating Students with Food-Related
DisabilitiesStep 4
Licensed Physician Provides
5 Key ElementsWhat the disability isHow it restricts the dietMajor life activity affectedFood(s) to be omitted Food(s) to be substituted
Accommodating Students with Other Food-Related
DisabilitiesFood Related Disabilities
Diabetes
Phenylketonuria (PKU)
Food Anaphylaxis
Celiac Disease
Other Accommodations
Texture
IV
Tube Feeding
Work with distributors, brokers, and manufacturers to purchase foods to meet the needs of students with allergies.
Get specifications, ask for clarification, develop a relationship with your key partners (includes RN).
TIP: When getting information for USDA Foods, call the manufacturer, not USDA or the State Agency.
Communication with Key Partners
41
Secure, Accessible Location
Secure, Accessible Location
Cross Contact vs. Cross Contamination
Cross Contact
Allergen accidentally transferred from a food containing an allergen to a food or surface that does not contain the allergen.
Cooking does not reduce or eliminate allergen.
Cross Contamination
Microorganisms from different sources contaminate foods during preparation and storage.
Cooking does reduce or eliminate microorganisms.
Sabrina Shannon : teen had fatal anaphylactic reaction during her first year of high school, 2003.
Reaction triggered by dairy protein - likely due to cross- contamination from tongs used for poutine (potatoes topped with curd cheese and a tomato-based sauce) after ordering French fries from school cafeteria
"A Nutty Tale“ first-person radio documentary http://www.anaphylaxis.ca/flash/
Cross Contact Can Be Deadly
Avoid Cross Contact – Potential Sources
Food handling and preparation Insufficient handwashing Insufficient cleaning Shared equipment and utensils Cutting boards, counters Griddles Splatter or steam from cooking Salad bars, buffets, serving stations
Color Coding Isolate ingredients containing allergens Individual preparation of menu items with
allergens Sticker or color code wrapped food Standard Operating Procedures for
handwashing and cleaning Include allergen risk assessment in the
Food Safety Plan based on HACCP
Avoid Cross Contact – Prevention Ideas
Standard Operating Procedures
Clean and SanitizeClean with soap, hot/warm water, and friction; WILL REMOVE ALLERGEN RESIDUE
Sanitize to reduce microorganisms that cause disease; WILL NOT REMOVE ALLERGEN RESIDUE
Examples: NFSMI’s HACCP-based Cleaning and
Sanitizing Food Contact Surface SOPs NFSMI’s Serving Safe Food to Student with
Food Allergies SOP
NOTE: remember food sources outside café (BIC, FFVP, classroom projects/ASP)
Sanitation SOPs are important for managing
food allergens.
General Tips – In the Cafe
Offer designated allergen-friendly tables for young students (? optional for students with parental and physician authorization to sit at “regular” table)
Clean tables carefully Prevent food trading Encourage students to wash hands Provide supervision to ensure orderly
behavior Be prepared for an emergency (know role
in FAAP)48
RESOURCES
USDA
CDC
RESOURCES (continued)
National School Boards AssociationNational Education Association(NEA) Health Information Network
