WELCOME. Make sure your speakers are on and the volume is up. Download the slides PDF from your handout pane.

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1 WELCOME Make sure your speakers are on and the volume is up. Download the slides PDF from your handout pane. 1 SNA CEU & 1 CPEU for RDs/DTRs available after quiz. Visit the On-Demand Library for over 65 recorded webinars.

2 Today s Moderators Sherry Coleman Collins Registered Dietitian Consultant National Peanut Board Toni Vega Aiken Senior Manager, Professional Development School Nutrition Association (SNA)

3 Questions & Answers 75 minute webinar. Attendees are in listen-only mode. Type your questions into the Question box at any time during the webinar

4 Professional Standards KEY AREA (1000) Nutrition KEY TOPIC (1100) Menu Planning SUB- TOPIC (1160) Special Diets, including Food Allergies

5 EARNING CEUs & CPEUs School Nutrition Association is a Continuing Professional Education (CPE) Accredited Provider with the commission on Dietetic Registration (CDR). CDR Credentialed Practitioners will receive 1.0 Continuing Professional Education unites (CPEUs) for completion of this activity. Complete Evaluation and Quiz Print CEU at the end of the quiz. The link is provided at the end of this webinar and ed to you.

6 Handouts This webinar has a few handouts to download. Locate the Handout panel on your control panel. Click on the name of the handout to download.

7 AFFILIATIONS AND FINANCIAL DISCLOSURES Dr. JJ Levenstein, MD is affiliated with the National Peanut Board as a consultant

8 LEARNING OBJECTIVES At the conclusion of this session, participants should be able to: Identify the basics about food allergies, food allergy management, and reliable resources for ongoing learning. Answer the most frequently asked questions about managing food allergies, Explain the benefits of collaboration amongst healthcare providers, school nursing staff, and foodservice for management of food allergies.

9 TODAY S SPEAKERS JJ Levenstein, MD Pediatrician Retired Jessica Gerdes, RN State School Nurse Consultant NASSNC

10 SECTION 1: THE BASICS ANSWERING COMMON BASIC FOOD ALLERGY QUESTIONS

11 Poll How comfortable do you feel with the training you have received in managing food allergies? Very comfortable Somewhat comfortable Somewhat uncomfortable Very uncomfortable

12 WHAT IS A FOOD ALLERGY VS. INTOLERANCE? FOOD ALLERGY Immune-mediated reaction Rapid onset: Minutes up to 2 hours Signs and symptoms can involve more than one organ system and may be life-threatening Example: Allergy to Milk FOOD INTOLERANCE Cell-mediated reaction May take hours or days to react Signs and symptoms usually isolated to the gastrointestinal tract and are not life threatening Example: Lactose Intolerance

13 THESE ARE NOT TRUE FOOD ALLERGIES Oral Allergy Syndrome Celiac Disease Lactose or other intolerance Food Aversions

14 FOOD ALLERGY FACTS 90% of food allergy reactions happen because of: milk, egg, peanut, tree nut, fish, shellfish, soy, or wheat True food allergies affect about 4-5% of adults and 6-8% of children in America The most common food allergies are milk and eggs Less than 2% of children has a peanut allergy Food allergy diagnoses have been on the rise, but so have all other allergic diseases (e.g. environmental allergies, asthma, and eczema)

15 HOW ARE FOOD ALLERGIES DIAGNOSED? Diagnosis is based on history of reactions Skin or blood tests should include only foods known to have caused reactions Submitted question: What is a RAST Test? The Radioallergosorbent Test (RAST) used to be the primary test used for diagnosing food allergies, however newer more sensitive tests are now available and RAST is no longer the standard. Oral food challenge

16 WHAT ARE COMMON SIGNS AND SYMPTOMS? Poster available for free download from FAACT

17 KEYS TO RESPONDING TO ANAPHYLAXIS Eliminate all risks of additional allergen exposure. Call and/or seek medical attention immediately. Monitoring or additional medications may be required. Repeated doses of epinephrine may be necessary every 10 minutes if the symptoms are not going away. After epinephrine has been administered, have the person lay down with his or her legs raised, if possible, to help restore blood flow to vital organs (heart, lungs, brain). Administer secondary medications to help the patient breathe, such as an asthma inhaler; antihistamines to relieve itching and hives; and other medications as directed in the Allergy and Anaphylaxis Emergency Care Plan or as instructed by emergency medical personnel.

18 SECTION 2: DEEPER DIVE CUTTING THROUGH THE MYTHS AND MISPERCEPTIONS

19 Poll What percent of Americans has some sort of food allergy? 35% 20% Less than 10%

20 COMBATING MYTHS AND MISPERCEPTIONS Food allergies are an important public health issue, according to the NIH, but are not as common as most people think. Consumer studies suggest that people believe food allergies to be 40 or more times more common than they are. Individuals with food allergies can lead normal lives, including traveling and dining out, but they need to take precautions. No longer a life-long diagnosis, we now know that food allergies in childhood can go away they can also crop up at any age. The risk of developing peanut allergies can be reduced in those at highest risk of developing peanut allergies by introducing peanut foods into the diet of infants as young as 4-6 months.

21 WHAT ARE THE FACTS ABOUT AIRBORNE ALLERGENS? Research supports the fact that ingestion is the cause of anaphylaxis. Just being near an allergen does not cause anaphylaxis. Citrus no evidence for airborne reactions to citrus Peanuts and Peanut Butter multiple studies show that peanut protein is heavy and settles quickly and is not detectible in the air over common eating scenarios; no clinical trial has ever shown anaphylaxis to occur due to airborne reaction (including during oral immunotherapy when the allergic individual is exposed to powdered peanuts) Fish limited research shows that fish proteins can be aerosolized immediately above steaming/boiling liquid that contains fish

22 CAN YOU EXPLAIN CROSS-CONTAMINATION? Actually cross-contamination happens with bacteria and viruses, for food allergies, you want to avoid cross-contact. Cross-contact is when one food (and its proteins) come into contact with another food s surface and some of the protein transfers from one food to the other.

23 PREVENT CROSS-CONTACT Wash hands frequently, especially before and after handling potentially allergenic foods Keep surfaces clean, especially before and after preparing potentially allergenic foods Use separate utensils and cookware for preparing and serving potentially allergenic foods (e.g. fish vs. hamburgers use separate sheet pans for prep and separate serving utensils) If you use fryers note that potatoes fried in oil with seafood may be unsafe for those with food seafood allergy Consider using designated equipment for preparing allergens OR which are allergen safe Store potential allergens away from other foods and clearly label; discard any damaged or leaking containers (e.g. ranch dressing containers)

24 DO WE NEED A PRESCRIPTION TO GET EPINEPHRINE? Regulations for prescription medications are state specific Some states allow schools to have nonstudent specific epinephrine on site, but still require a prescription from an authorized healthcare provider Epinephrine is not an over the-counter medication

25 SECTION 3: COLLABORATION THE KEY TO SUCCESSFUL FOOD ALLERGY MANAGEMENT

26 Poll My school district has a written plan for managing food allergies. Yes. No. I don t know.

27 WHO SHOULD BE PART OF IHP/IEP/504 MEETINGS? A representative from each area with responsibility for the safety of the allergic student, so potentially: Administration Teacher(s) Nursing Foodservice Transportation After school care Parents Student! It is important to have representatives at the meetings to ensure that the plan is able to be implemented based on agreed upon criteria.

28 WHAT ARE REASONABLE ACCOMMODATIONS? Accommodations vary based on the specific needs of the student. Some common accommodations include: Provide allergen-safe meals and choices at each meal or snack Allow student to self-carry emergency medication, if state permits Place alerts on point-of-sale (POS) system Notify other students of allergen in the classroom (MAY NOT reveal student/student s health information without permission) Food-free classroom Avoiding allergens for activities in the classroom Allergen-safe/aware table in the café or dining area Inclusion should be encouraged whenever safe and possible

29 REQUESTS FOR FOOD SUBSTITUTION Schools must make substitutions in lunches and after school snacks for students who are considered to have a disability and whose disability restricts their diet. (7CFR (m) 25b.c In order for schools to receive Federal reimbursement for modified meals that diverge from the program meal pattern, parent/guardian must submit a written medical statement signed by a state licensed healthcare professional supporting the request. Resource: USDA July 2017 Accommodating Children with Disabilities in the School Meal Programs: Guidance for School Food Service Professionals Each State SFA (School Food Authority) governs the food substitution rules and forms on which this statement is written. Sample Medical Statement for Meal Substitutions

30 WHERE ARE REACTIONS MOST LIKELY TO HAPPEN? Classroom: Birthdays Rewards Parties Teaching tool Snack Contributing factors: Change in routine (often unexpected) Substitute teachers Lack of a plan

31 WHAT IF A PARENT WANTS TO BAN A FOOD? Schoolwide or districtwide bans are not necessary and have not been proven to be safer for those with food allergies. They may create a false sense of security. Research: A Canadian study showed that food allergy reactions were almost twice as likely to happen in schools that banned peanuts as compared to those that did not. In a study of reactions in Massachusetts schools, epinephrine was no less likely to be administered in schools that banned peanuts as compared to those that did not.

32 WHAT ARE EFFECTIVE WAYS TO REDUCE THE RISK? Comprehensive Food Allergy Management Policies Annual Training Allergen-Aware/Safe Areas Stock Epinephrine Team Based Approach Evidence-based Plans

33 COMPREHENSIVE FOOD ALLERGY MANAGEMENT POLICIES What are they? Start with an assessment. Includes everyone charged with student care Considers all areas of increased risk Provides for regular training Outlines reasonable accommodations What resources exist to help? SNA Food Allergy Resource Center CDC Voluntary Guidelines & Toolkit FAME Toolkit NASN

34 ANNUAL TRAINING All staff should receive some food allergy training every year to include how to reduce the risk of a reaction, identify a reaction, and respond to a reaction. Staff with direct student oversight should receive more intensive training. Administration of epinephrine is simple and training should be provided to as many people as is determined feasible and reasonable.

35 TRAINING RESOURCES SNA Food Allergy Resource Center Food Allergy & Anaphylaxis Connection Team (FAACT) FAACT s for Schools Program Food Allergy Research & Education (FARE) Food Allergies: Keeping Students Safe and Included Institute of Child Nutrition (formerly NFSMI) PeanutAllergyFacts.org ServSafe Allergen Training Websites of manufacturers of epinephrine auto injectors National Association of State School Nurse Consultants

36 ALLERGEN-AWARE/SAFE AREAS Food-free classrooms Allergen safe tables Placemats/Assigned seating in the classroom or cafe No food on the bus/transportation Eliminate or limit food use as rewards, celebration, or teaching No sharing food

37 STOCK EPINEPHRINE Non-student specific prescription required Know the law: varies by state Nearly every state requires or allows stock epinephrine Grants may be available to cover cost Grants or free kits may be available to cover cost

38 Poll My state has legislation that allows for schools to stock epinephrine Yes. No. I don t know.

39 IMPORTANT CONSIDERATIONS FOR STOCK EPINEPHRINE Where will the epinephrine be kept? Who can access the medication? Who is trained and approved to administer the medication? What about after regular school hours? ASP? School activities and sports? What happens after epinephrine is administered? Not meant to replace student-specific epinephrine.

40 BEST PRACTICES IN FOOD ALLERGY MANAGEMENT

41 SNA FOOD ALLERGY RESOURCE CENTER SNA Food Allergy Webinars On-demand Food Allergy: Discussing the Science Behind the Facts Food Allergy Management in Schools: What you Must Know Get the FAACTs about Food Allergies in Schools Teamwork is Key to Successful Food Allergy Management in Schools

42 Questions? Answers.

43 UPCOMING WEBINARS: Excite and Inspire Students with Fruit 2pm ET on Wednesday, November 1 st Best of #ANC17 3 of 3: USDA Hot Topic: Offer Vs. Serve Simplified 2pm ET on Wednesday, November 8 th All Webinar Wednesday s begin at 2PM Eastern Standard Time

44 Never miss an SNA webinar again! On-Demand Webinars The SNA On-Demand library Over 60 webinars All Key Areas Meet professional standards training requirements Every Webinar Wednesday is recorded and posted to On-Demand library within 1-2 days.

45 Evaluation THANK YOU Evaluation & Quiz Please TYPE the link EXACTLY as it is displayed below: bit.ly/wwoct All Caps