Allergies PPT 3-24-2011 final
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Transcript Allergies PPT 3-24-2011 final
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
Supported by the Food Allergy Initiative of Chicago
faiusa.org/Chicago
© 2010 Children’s Memorial Hospital
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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”
© 2010 Children’s Memorial Hospital
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Common Allergens
Cow’s milk
Soy
© 2010 Children’s Memorial Hospital
Egg white
Wheat
Peanut
Tree nuts
Fish
Shellfish
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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
© 2010 Children’s Memorial Hospital
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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
© 2010 Children’s Memorial Hospital
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Fatal reactions happen
Risk factors:
Asthma
Adolescents or young adults
Peanut or tree nut allergy
Epinephrine administration was delayed
(Bock JACI 2001/2007)
© 2010 Children’s Memorial Hospital
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Treatment
There is no cure (yet) for food allergies.
The only current treatment is AVOIDANCE.
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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
© 2010 Children’s Memorial Hospital
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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 . . .
© 2010 Children’s Memorial Hospital
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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 lifethreatening 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)
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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
© 2010 Children’s Memorial Hospital
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The Guidelines
"Guidelines for Managing Life-threatening Food Allergies in
Illinois Schools“
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
© 2010 Children’s Memorial Hospital
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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
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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
© 2010 Children’s Memorial Hospital
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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
© 2010 Children’s Memorial Hospital
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Managing Food Allergies in School
Create a safe environment for students
with food allergies.
PREVENT reactions
RECOGNIZE reactions
RESPOND to reactions
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Prevent a Reaction
Avoid exposure to allergen
During school day
While traveling to and from school
During school-funded events
While on field trips
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Prevent a Reaction
Avoidance is the key to preventing a reaction.
Cross-contamination
Mislabeled foods
Unlabeled foods
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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
© 2010 Children’s Memorial Hospital
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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.
© 2010 Children’s Memorial Hospital
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Managing Food Allergies in School
Create a safe environment:
Prevent
Recognize an allergic reaction
Respond
© 2010 Children’s Memorial Hospital
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Allergic Reaction:
What a Child Might Say or Do
Say
Do
“My tongue (or mouth)
itches”
Put their hands in
their mouths
“My tongue is hot/burning”
Pull or scratch at their tongues
“My mouth feels funny”
Drool
“There’s something stuck
in my throat”
Hoarse cry or voice
“It feels like there are bugs
in my ears”
Slur words
Become unusually
clingy
“This food is too spicy”
© 2010 Children’s Memorial Hospital
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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.
© 2010 Children’s Memorial Hospital
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Managing Food Allergies in School
Create a safe environment
Prevent
Recognize
Respond to an allergic reaction
© 2010 Children’s Memorial Hospital
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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
© 2010 Children’s Memorial Hospital
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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
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Thank you!
Questions?
Useful websites:
– www.foodallergyinitiative.org
– www.foodallergy.org
– www.childrensmemorial.org/FACE
© 2010 Children’s Memorial Hospital
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