August-September-October 2012 Volume 21 Number 6
INSIDE 2 We’re All in This Together
3 Laser Treatments to Cure Food Allergy Lack Scientific Evidence
4 At What Age Can a Child SelfManage a Reaction? Tips from FAAN’s Teen Advisory Council
5 Addressing Food Allergy Issues Within Child Care Centers Ask the Expert
6 Answers to Diet Dilemmas
What are good protein choices for a peanut- and tree nut-allergic teen who wishes to become a vegetarian?
Ingredient Notices
7 Allergy-Free Recipes
8 Halloween: To Trick-or-Treat or Not?
10 Research Update
New study maps food allergies; high rates of allergic reactions in young children with food allergies
11 Legislative and Advocacy Update
Standing order epinephrine; statespecific legislation
12 Poster Contest Winners Special Announcement About Food Allergy News for Kids
Food Allergy: Differences Between Adults and Children By Wayne Shreffler, M.D., Ph.D.
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e sometimes forget that although food allergy is most common in young children, a growing number of adults are also affected. An estimated 4% of the U.S. adult population is food-allergic (about 9 million people). While there is still much to learn about food allergies in adults, we know that there are some important differences that affect their management and shape new research questions. Adult food allergy is a mix of persistent and new onset disease, so the fact that food allergy in children has become more common and more persistent is resulting in an increase of allergies in adolescents and adults as well.
What foods are more likely to cause allergies in adults? How do those differ from common childhood food allergies? Most food allergies, including many of those that are common in adults, are diagnosed in children and persist into adulthood. Allergy to peanuts, tree nuts, and perhaps sesame are good examples of this category: these food allergies are usually diagnosed in childhood, but become relatively more common food allergens for adults than allergies that are more often outgrown, such as those to milk or wheat. There are some allergies, however, that tend to be diagnosed more commonly in adults, though some of these may vary by diet. For
Estimates show that allergy to crustaceans (like shrimp) was five times more common in adults than in children. example, Dr. Scott Sicherer found in a previously published study that in the U.S., estimates of allergy to fish were more than twice as high in adults than children (0.5% versus 0.2%) and allergy to crustaceans (like shrimp) was five times more common (2.5% versus 0.5%).
How common is oral allergy syndrome? One very prominent group of food allergies in adults that begins to appear in older children and adolescents and continues to do so during adulthood are those specific to plant allergens that “cross-react” to pollen allergens. In several surveys of food allergy, Differences continued on page 9
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We’re All In This Together By Maria L. Acebal, J.D.
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Food Allergy News The Food Allergy & Anaphylaxis Network, Publisher Mary Jo Strobel, Managing Editor Nancy Gregory, Media Relations & Associate Editor Hugh A. Sampson, M.D., Medical Editor Sally Noone, R.N., M.S., Medical Editor Maria L. Acebal, President & CEO Chris Fanning, Chief Financial Officer Julianne M. Puzzo, Senior V.P. of Development Eleanor Garrow, V.P. of Education & Outreach Chris Weiss, V.P. of Advocacy & Government Relations Gina Clowes, V.P. of Member Relations
Operations Nancy Ammann, Heather Busicchia, DeLois Blevins, Veronica Braun, Debbie Copan, Cindy Durant, Julie Forrest, Pascale Nouama, Kendal Rauh, Beverly Ryan, Rachel Wissinger
Medical Advisory Board S. Allan Bock, M.D., Boulder, Colo. A. Wesley Burks, M.D., Chapel Hill, N.C. Glenn T. Furuta, M.D., Aurora, Colo. John M. James, M.D., Fort Collins, Colo. Stacie Jones, M.D., Little Rock, Ark. Todd Mahr, M.D., LaCrosse, Wis. Hugh A. Sampson, M.D., New York Wayne G. Shreffler, M.D., Ph.D., Boston, MA Scott H. Sicherer, M.D., New York F. Estelle R. Simons, M.D., Winnipeg, Canada Steve Taylor, Ph.D., Lincoln, Neb. Robert A. Wood, M.D., Baltimore, Md. Robert S. Zeiger, M.D., Ph.D., San Diego, Calif. ©2012. The material in Food Allergy News is not intended to take the place of your doctor. Food Allergy News or the Food Allergy & Anaphylaxis Network will not be held responsible for any action taken by readers as a result of their interpretation of an article from this newsletter. If you have any questions or concerns, ask your physician. Never change your child’s diet without the advice or help of a physician and registered dietitian. Food Allergy News is published by the Food Allergy & Anaphylaxis Network, Inc., 11781 Lee Jackson Hwy., Suite 160, Fairfax, VA 22033-3309. ISSN #1075-4318. Periodicals postage rate paid at Fairfax, Va. POSTMASTER: Send address changes to Food Allergy News, 11781 Lee Jackson Hwy., Suite 160, Fairfax, VA 22033-3309. Our office is open Mon.-Thurs. 9:00 a.m. to 5:00 p.m., and Fri. 9:00 a.m. to 1:30 p.m. (and until 4:30 p.m. after Labor Day). If you have any questions, please call 703-691-3179. To order a subscription, send $29 in check or money order to the Food Allergy & Anaphylaxis Network. Mastercard, Visa, and American Express are also accepted. All rights reserved. This material may not be duplicated without the expressed written permission of the publisher.
hough summer still lingers in the muggy air here in the Washington, D.C. area, fall is just around the corner, and fall this year means fifth grade, third grade, and preschool for my crew of three. Since my oldest, Nina, was first diagnosed with peanut allergy, the start of a new school year has always been one of the most stressful times of the year. What a change from when I was growing up. Back then, I absolutely loved “back to school:” the excitement of a new year, shopping for school supplies, catching up with old friends. Today, I dread that first meeting with her teachers because I’m not sure whether I will be received with understanding or with skepticism. I know, though, that every year does get a little better, probably for a lot of different reasons. With prevalence at an average of two kids per classroom, teachers are much more likely now to know something about food allergies and to have already encountered a student with food allergies in the classroom. Nina is older and can advocate for herself more and more. And, as we get to know more and more families at this new school we joined just a year ago, the community that knows and
Looking for Resources for Teachers?
www.facebook.com/FoodAllergyFAAN
FAAN’s Safe@School training presentation is an essential tool for schools that are developing a food allergy management policy. The CD is available for purchase from FAAN for $20.
www.twitter.com/foodallergy www.youtube.com/FAANPAL www.flickr.com/foodallergy
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August-September-October 2012
cares about her food allergies feels more substantial now. Still, that fear that epinephrine will not be used in time during an anaphylactic emergency is hard to shake. I’ve been wondering more and more lately what it feels like from my daughter’s point of view? What is her level of comfort at school? What makes things better? What makes things worse? And, why have I never asked her these questions directly? For me, it’s a hard line to navigate between putting up a strong face so as not to burden her with my own anxiety while still feeling like I’m adequately addressing these critical issues. So this year, I am going to share this FAAN back-to-school newsletter with Nina. There is so much in this issue to prompt discussion. At worst, I’ll get an eye roll punctuated by an exasperated “Oh, Mom!” But, I might just get lucky and get a glimpse inside her pre-teen mind and a hint at how to best support her in managing her food allergies. I hope you and your family enjoy this issue as much as I did. Wishing you a safe, adventurous, and fulfilling school year,
Food Allergy News
Awareness
This Is Why I Walk
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AAN’s Walk for Food Allergy events have brought together thousands of families across the nation, united in their goal to raise money to benefit food allergy awareness, education, and research programs. Wendi Trilling, who has raised nearly $43,000 since 2008 for the FAAN Walk in Los Angeles, shares what these events mean to her family. For every story we share, there are so many more! Please join us as we offer our most sincere gratitude to all of the hardworking, dedicated people who have supported the Walks. We began participating in the FAAN Walk for Food Allergy when my son Max (pictured) was just 3 years old and being pushed in a stroller alongside his twin brother Joe. We knew that Max wouldn’t really understand what the day was about or what “raising money” for food allergy meant, but we hoped that eventually he would understand and feel proud that his family was trying to do something to help him and other people with food allergies. Our Walk team, Max and Joe’s Team, built a fundraising webpage through the Walk for Food Allergy website. At first, we
Advocacy
Education
Research
weren’t sure if our request for support for FAAN would garner much of a response since people get asked to make contributions to so many worthy causes. Our requests, though, have generated so much support among our friends and colleagues – it is very gratifying. We are fortunate to have so many people in our lives who want to help. As he is about to turn 7, Max is starting to understand what the FAAN Walk is all about, and even though he was too shy to go to the stage when Max Trilling’s Team was called as a top fundraiser, we could tell by the look on his face that he was proud of what his team has accomplished.
Upcoming FAAN Walk for Food Allergy Dates Aug. 11 Aug. 12 Aug. 18 Aug. 25 Sept. 8 Sept. 15 Sept. 16 Sept. 22 Sept. 23
Buffalo, NY Denver, CO Indianapolis, IN Rogers, AR Morgantown, WV Houston, TX Minneapolis, MN Long Branch, NJ Albany, NY Kansas City, KS Philadelphia AreaPennsauken, NJ Pittsburgh, PA Nashville, TN Austin, TX Lansing, MI Northern Virginia, VA Baltimore, MD Boston, MA Columbus, OH
Sept. 29 Sept. 30 Oct. 6 Oct. 7 Oct.13 Oct.14 Oct.21
Charlotte, NC Portland, ME Triangle Area, NC Chicago, IL Seattle, WA Detroit, MI Las Vegas, NV Salt Lake City, UT Miami, FL Milford, CT California Bay Area Westchester, NY Lincoln, NE Atlanta, GA Long Island, NY Los Angeles, CA Ridgewood, NJ
For a complete list of 2012 dates, visit www.foodallergywalk.org.
Laser Treatments to Cure Food Allergy Lack Scientific Evidence
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e’ve recently learned that some health care practitioners are using laser treatments as a means to “cure” food allergies, but there is no scientific evidence to support this claim. Michael J. Welch, M.D., an allergist and co-director of the Allergy and Asthma Medical Group and Research Center, and Clinical Professor at the University of California, San Diego School of Medicine, writes, “I recently had a young child and parent come in to my office talking about their ‘laser treatment’ for their child’s severe egg allergy. This child, who has a history of extreme IgE-mediated sensitivity to egg, was taken by his parents to a local chiropractor for his food allergy problem. At this clinic, which made advertised claims about helping people
conquer their various food allergy problems with a new and modern technique, he was given a ‘laser treatment session.’ Mom was told after this treatment that his food allergy was remedied, and now it was safe to introduce egg to him at home. “A similar case saw me a few weeks later. This child had severe nut allergy, and after a series of laser treatments by the family chiropractor, he was pronounced ‘cured of his nut allergy’ and his parents were told he could now be given peanut and tree nuts. “Fortunately, neither parent fed their child their food allergens, but instead waited to consult me. My evaluation, using their history and specific IgE testing, showed both patients were still highly allergic.” While there are many promising advances in research Food Allergy News
that are being made for food allergy therapies and treatments, we do not yet have a cure. Strict avoidance of an allergy-causing food is still the key to avoiding an allergic reaction. In fact, CA Senator Bob Huff helped encourage the California Board of Chiropractic Examiners to adopt regulations that specifically prohibit the use of laser therapy for the treatment of allergies. “Stay informed, keep an eye out for new and promising therapies for food allergy, and rely on respected resources like FAAN to educate you about those that have a chance to be effective,” Dr. Welch writes. “Always remain a skeptic, and know it is highly unlikely a cure is going to be discovered overnight that the rest of the world does not know about.” u August-September-October 2012
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At What Age Can a Child SelfManage a Food Allergy Reaction?
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ne of the key issues that parents of children with food allergies face is when to transition the responsibilities of managing a food allergy to the child, which raises the critical question: is your child able to self-administer epinephrine? Overall, most allergists expect that by the age of 12-14 years, children with food allergies should be able to take on most responsibilities associated with recognizing anaphylaxis and using an epinephrine auto-injector, according to a recently published study in the Annals of Allergy, Asthma & Immunology. To learn more about how physicians are approaching this educational component of food allergy management with their patients, researchers surveyed members of the American Academy of Pediatrics’ Section on Allergy and Immunology. The objective of this questionnaire was to find out the age at which pediatric allergists begin to transfer the responsibility of recognizing symptoms of anaphylaxis and using an epinephrine auto-injector from parents to children. In the table below, we summarize some of the results (figures represent percentages of survey respondents).
Describe some anaphylaxis symptoms Recognize need for selfinjectable epinephrine Demonstrate selfinjection using trainer Begin carrying epinephrine autoinjector Take responsibility for learning to self-inject Self-inject epinephrine Use live auto-injector to inject into an orange
Most allergists chose the 9-11 age range for the timeframe by which they expect children to be able to begin to describe symptoms of anaphylaxis, recognize the need for carrying an epinephrine auto-injector, and demonstrate the use of the device with a trainer. Most allergists did not expect children to begin to self-carry, take responsibility for learning to selfinject, or be able to self-inject until the child turns at least 12. The majority of allergists who responded to the survey (75%) indicated there were several factors they weighed when considering whether a child is ready to begin to take on the responsibility of managing his or her own food allergy. These factors included the ability of the child to demonstrate how to self-inject using a trainer, to describe symptoms, their developmental level, their history of anaphylaxis, their comfort level with use of an epinephrine auto-injector, or the presence of a developmental delay. Other factors considered “very important” were anaphylaxis triggered by an allergen known to cause a fatality (such as peanut), a high level of sensitization, presence of persistent asthma, the child’s age, fear of needles or procedures, the ability to read, and the need for independence due to
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T ip s f r o m een F A A N ’ s T u n c il Co A d v is o r y “I keep my epinephrine auto-injector in a bag with a bright, eye-catching print on a counter near the door. When I’m planning to go somewhere, I hang it on the doorknob so that I’ll see it when I’m leaving.”
Age 6-8
Age 9-11
Age 12-14
Age 15-18
11.6
31.4
32.6
19.8
3.4
4.8
10.7
38.1
34.5
11.9
~Isabelle P., age 16
1.2
15.1
40.7
36.0
7.0
2.4
13.1
28.6
44.0
11.9
6.0
34.5
44.0
15.5
“When I’m in school, I always keep my epinephrine with me in my backpack, and I keep one at the nurse’s office. I play the French horn and when I am at a music camp or at a concert venue, I keep an auto-injector in my horn case.”
3.6
28.6
46.4
19.1
5.8
15.1
17.4
8.1
August-September-October 2012
Food Allergy News
Never
Simons E, Sicherer SH, Simons FE. Timing the transfer of responsibilities for anaphylaxis recognition and use of an epinephrine auto-injector from adults to children and teenagers: pediatric allergists’ perspective. Ann Allergy Asthma Immunol, 2012:108:321-325.
Younger than age 6
Note: Age ranges most often selected by pediatric allergists are shown in bold.
Age 19 or older
family circumstances. This is the first study to give an overview on the timing of transferring responsibilities from caregiver to child. “Beyond the age-specific considerations reported and discussed in this study, during an anaphylactic episode, regardless of age, patients potentially have impaired recognition of what is happening to them and impaired ability to self-inject epinephrine correctly and safely, especially if symptoms progress rapidly,” the study’s authors wrote. “It is therefore recommended that backup and support from a responsible adult should be available to a child or teenager experiencing an anaphylactic episode.” The authors also noted more studies on this topic are needed. u
1.2
~Sarah G., age 14 “I prefer to carry a small purse or satchel to keep my epinephrine in.”
~Justin J., age 17 2.4 53.5
“I carry my epinephrine in a case that attaches to my belt loop, so I can always have my EpiPen ® on me.”
~Reed P., age 16
Awareness
Advocacy
Education
Research
Addressing Food Allergy Issues Within Child Care Centers
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here are no uniform guidelines for child care centers to follow concerning food allergy management for their preschool students. However, as the authors of a review recently published in the journal Current Allergy and Asthma Reports point out, some approaches taken in large-scale centers may not apply to smaller centers. Many centers use guidelines from their local school districts, but certain aspects may not apply to younger children. “Given the limited healthcare experience of many child care personnel, the ability of these systems to thoroughly administer and respond to food allergies is limited,” the authors wrote. Among the recommendations for parents outlined in this review are: l Providing the center prescribed medication such as epinephrine auto-injectors and fast-acting antihistamines l Providing a Food Allergy Action Plan approved by the child’s physician Recommendations for child care centers include: l Providing annual food allergy training to personnel that includes recognition of symptoms of allergic reactions l Reviewing food safety precautions including cleaning techniques and ways to avoid cross-contact l Reviewing emergency procedures l Enlisting local healthcare personnel to demonstrate use of epinephrine auto-injector l Reviewing of food allergy plans and child care policies l Meetings with parents that include director and staff to allow forum for parents to raise concerns and awareness
Because of the young age of the children enrolled in childcare facilities, workers must be mindful of some issues that are not as prevalent in other schools, such as hand to mouth contamination and lack of verbal skills to communicate symptoms. Specifically designated seating arrangements and color-coding of foods should be considered. Teachers and parents should be aware of the potential for exposure during classroom activities as well.
“Until intervention and treatment strategies evolve, avoidance of allergic reactions and quick appropriate response to allergic reactions require the development of thoughtful, comprehensive, individualized food allergy policies within child care centers. Methods to improve further dissemination of effective policies should be a priority,” the authors write. u Leo HL, Clark NM. Addressing Food Allergy Issues Within Child Care Centers, Curr Allergy Asthma Rep, DOI 10.1007/s11882-012-0264-5.
Ask the Expert I am constantly worried about the care of my child’s epinephrine autoinjector. The manufacturer recommends storage at 77 degrees. We live in Texas, so that is difficult. I worry about exposure to temperature fluctuation. Can you provide any practical, common sense advice on auto-injector care? This is a great question, and one that countless other parents struggle with. While very few studies have rigorously examined the stability of epinephrine under “real-life” conditions, the general findings suggest that extremes of temperature should be avoided. So, for example, avoid leaving epinephrine in the glove compartment of a car on a hot day or in an uninsulated bag on the beach. Auto-injectors should be stored in locations with neutral temperatures, such as a fanny pack, purse, or cabinet. Some temperature change is inevitable, but simply avoiding those extremes in temperatures is the general recommendation. u Hemant Sharma, M.D., M.H.S. is the Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington, D.C. He is also the Director of the Food Allergy Program and site director for the National Institutes of Health Allergy and Immunology fellowship program. To access the full question-and-answer session that Dr. Sharma hosted for FAAN members, as well as sessions with other experts on a wide range of topics, log in to foodallergy.org, and click the Members Area link in the top right corner of the page. Our Ask the Expert service is provided as an exclusive benefit for FAAN members.
Food Allergy News
August-September-October 2012
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Food Allergy Awareness Week: A Great Success Thank you to all of you who joined our efforts during the 15th annual Food Allergy Awareness Week, May 13-19. Families across the nation got involved with food allergy education in their local schools and their communities. Visits to FAAN’s Facebook page increased more than 375% that week, and our friends shared our special status message more than 1,700 times! While we are continuing efforts to have Food Allergy Awareness Week recognized on the national level, we are pleased to report that 28 states issued official proclamations recognizing this special week this year. Thank you to all who got involved!
Answers to Diet Dilemmas “My teenager is allergic to peanut, tree nuts, and many seeds. She is interested in becoming a vegetarian. What are good protein choices for her?” Vandana Sheth, R.D., answers: Good vegetarian protein sources for a teenager allergic to peanut, tree nuts, and seeds would include beans, lentils, soy products (edamame, tofu, soy milk), seitan (wheat gluten), tempeh, dairy, and eggs (depending upon the strictness of vegetarian diet). The recommended dietary allowance for a teenage girl is roughly 46 grams of protein per day. A two-ounce serving of chicken or meat provides 14 grams of protein. Vegans can easily get protein from plant-based sources such as beans, lentils, legumes, tofu, seitan, and tempeh to adequately meet their nutritional needs. For examples of how much protein these foods provide, see the chart below. Plant-based source
Amount
Estimated protein provided
Cooked beans (black beans, kidney beans)
1 cup
14 grams
Tofu
4 oz.
11 grams
Soy milk
1 cup
7 grams
Quinoa
1 cup
9 grams
Seitan
3 oz.
31 grams
The key difference between plant protein and animal protein is that plant protein will also provide fiber and will be lower in fat compared to animal protein which will have no fiber and have fat and cholesterol. The following table offers a sample vegan menu that provides adequate protein. Sample Vegan Menu Breakfast
Lunch
Dinner
Snack
Whole grain, high fiber cereal Soy milk Fruit
Bean/lentil soup Salad Whole grain toast/tortilla Fruit
Brown rice or quinoa stir-fry Vegetables Tofu or lentils Fruit
Crackers Bean dip
Vandana Sheth, RD, CDE, is a spokesperson for the Academy of Nutrition and Dietetics and is in private practice in Los Angeles. She is a FAAN member as well as parent of a teenager with multiple food allergies.
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Food Allergy News
Ingredient Notice McDonald’s Representatives for McDonald’s shared that McDonald’s is offering a Rolo® McFlurry® dessert through approximately October 1, 2012. McDonald’s has been advised by The Hershey Company that the Rolo candies manufactured for the McFlurry are manufactured on the same equipment that also processes almonds. If you have a tree nut allergy, please note that all flavors of McFlurry desserts use the same equipment in McDonald’s restaurants. McDonald’s is also once again offering Frozen Strawberry Lemonade through approximately October 1, 2012, which is dispensed on equipment that also dispenses milk ingredients (specifically, yogurt). For more information, please contact the McDonald’s Customer Service Center at (800) 244-6227. Austin Company Austin Company would like you to know that Austin® Zoo Animal Crackers are being reformulated to contain whey, a milk ingredient. The addition of whey will be reflected in the “Nutrition Facts” ingredient statement and milk added to the allergen box, located near the ingredient statement. The reformulated products began to appear on grocery shelves in July 2012. Consumers with questions may contact the Austin Company toll-free at (877) 453-5837, Monday through Friday from 8:00 a.m. – 6:00 p.m. ET.
Awareness | Advocacy | Education | Research
Allergy-Free Recipes
Our recipes in this issue are versatile enough to make for a great after-school snack or a fun treat to share at a Halloween party. For more allergy-free recipes, be sure to visit our website, www.foodallergy.org.
Key to Symbols: M – Milk-free E – Egg-free W – Wheat-free P – Peanut-free S – Soy-free N – Nut-free Note: Recipes calling for margarine will be coded as containing soy, although milk- and soy-free margarine is available at some grocers.
Banana Snack Wrap M, E, W, P, S, N u 1
(6-inch) corn tortilla strawberry jelly u 1 banana, peeled u 2 T. milk-free mini chocolate chips u 2 T.
Lay tortilla flat. Spread jelly on one side of the tortilla. Place banana in the middle and sprinkle with mini chocolate chips. Wrap tortilla around banana and serve.
Caramel Corn Snack Mix M, E, P, N u 2 T.
oil u 1 cup unpopped popcorn kernels u 1/2 cup milk-free margarine u 1 cup light brown sugar, firmly packed u 1/2 cup light corn syrup u 1 tsp. baking powder u 1/2 tsp. vanilla extract u 2 cups small pretzel twists u 4 cups crispy rice cereal squares Grease 9x13-inch baking pan with. Set aside. Preheat oven to 250°. Pour oil into a large pot over low heat. Add popcorn kernels and shake the pot gently until popping has slowed. Remove from heat and set aside. In large saucepan, over medium heat, combine margarine, brown sugar, and corn syrup. Bring to a boil, stirring constantly. Reduce heat to low and let simmer for 5 minutes. Turn off heat. Stir in baking powder and vanilla extract. Add popcorn, pretzels, and cereal to prepared pan and mix to combine. Pour margarine mixture over the popcorn mixture, stirring to coat. Bake 15 minutes. Stir. Bake 15 minutes more. Cool before serving.
Banana-Cranberry Oaties M, E, W, P, S, N u 1
cup oat flour u 1 tsp. baking powder u 1 tsp. ground cinnamon u 3/4 cup rolled oats u 1/2 cup dried cranberries u 1/3 cup rice milk u 1/3 cup safflower, sunflower, or grapeseed oil u 1/2 cup date sugar u 1 tsp. vanilla extract u 2 ripe bananas, mashed Preheat oven to 350°. Lightly oil a cookie sheet and set aside. Combine the flour, baking powder, and cinnamon in a medium bowl. Add the oats and cranberries and stir until well distributed. Set aside. Place the rice milk, oil, date sugar, and vanilla extract in a large mixing bowl and stir well. Add the bananas and continue to stir until well blended. Add the flour mixture to the banana mixture and stir to form a thick batter-like dough. Drop rounded tablespoons of dough about 2 inches apart on the prepared cookie sheet. Bake for 12 to 15 minutes or until lightly browned. Cool the cookies a few minutes before removing from the cookie sheet. Transfer to a wire rack to finish cooling. Serve warm or at room temperature. Recipe adapted with permission from The Ultimate Allergy-Free Snack Cookbook by Judi and Shari Zucker. Copyright © 2012. To order a copy, visit FAAN’s website.
Chocolate-Orange Cupcakes M, E, P, N Cupcakes: u 1 1/2 cups flour u 1 cup sugar u 1/4 cup unsweetened cocoa powder u 1 tsp. baking soda u 1/2 tsp. salt u 1/3 cup oil u 1 tsp. vanilla extract u 1 tsp. distilled white vinegar u 1 cup water Frosting: u 3 cups confectioners sugar u 4 T. milk-free margarine, softened u 3 T. orange juice u 2 tsp. orange zest u 1/2 tsp. vanilla extract u 3-4 drops orange food coloring Preheat oven to 350°. Line muffin tins with paper liners. Set aside. To prepare the cupcakes, combine dry ingredients.
Food Allergy News
Add wet ingredients and mix until smooth. Pour into prepared muffin cups and bake at 350 degrees for about 20 minutes, or until toothpick inserted in center comes out clean. Remove from oven and cool 5 minutes. Remove cupcakes from tin and cool completely. To prepare frosting, mix together all frosting ingredients until smooth. Spread onto tops of cooled cupcakes.
August-September-October 2012
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Halloween: To Trick-or-Treat or Not?
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alloween is often met with frustration (and longing) by kids whose candy collection may be off-limits due to food allergy concerns. For this reason – and others – many families are taking the focus off of sweets on Halloween. Some families celebrate with another activity rather than trickor-treat, such as a special event planned at a local family fun center, a spooky slumber party, or a creepy craft project. Another idea? “Host your own Halloween party,” offers Karen Ansel, M.S., R.D., a spokeswoman for the Academy of Nutrition and Dietetics. “That way you’re in control of the menu and can offer healthier items that are safe for your food-allergic child. You can plan nonfoodfocused activities like watching scary movies (age-appropriate, of course), decorating jack-olanterns, or a Halloween themed scavenger hunt.” Thanita Glancey, president of Loudoun Allergy Network, shares how her support group celebrated
Halloween without food last year: “We hosted our first annual NotSo-Spooky Halloween Bash. Kids (and parents) arrived in costume. We provided games, crafts, and a discussion on trick-or-treat safety. After the party, all the kids went home with a food-free goodie bag.” Gina Clowes, FAAN’s Vice President of Member Relations, offers trinkets instead of candy to trick-or-treaters on Halloween night. “I take my son to the local party store and we pick out a whole collection of tiny toys and party trinkets. The kids get so much candy when trick-or-treating that a little toy is a novelty. They’re safe for every food allergy and intolerance and we save any leftovers for classroom parties. Nothing goes to waste.” Do trick-or-treaters miss candy when it’s not offered? Not necessarily. Marlene B. Schwartz, Ph.D., Deputy Director for the Rudd Center for Food Policy & Obesity at Yale University, designed a study 1 investigating whether children would choose toys over candy on Halloween, if
given a choice. Nearly half of the children opted for toys. “Because Halloween is special (i.e., children dress up, walk around the neighborhood at night, socialize with other children and adults), nonfood treats may easily become associated with positive feelings,” Dr. Schwartz summarized. “As new items are associated with Halloween, they may be incorporated regularly and allow children to enjoy the holiday without an exclusive focus on candy.” If your child does trick-ortreat, that is okay, too. “While healthy alternatives are great, it’s also completely fine for a child to celebrate Halloween with a few sweets,” Karen said. “Foodallergic children and their parents need to be particularly vigilant. If a food doesn’t have an ingredient list or if you cannot verify every single ingredient that is in the food, steer clear of it.” Although Thanita’s support group offers food-free alternatives on Halloween, her kids still participate in trick-or-treating fun. “We have a strict No Eating While Trick or Treating rule. This way Trick-or-Treat continued on page 9
Time for Teen Summit Registration is now open for FAAN’s Seventh Annual Teen Summit! FAAN’s Teen Summit is a three-day, two-night conference for teens with food allergies and their siblings, ages 11-22. Teens and their parents come from around the country for a weekend of fun, education, and discussion of topics unique to teens with food allergies. It’s a great opportunity to share personal stories and make new friends who “get it.” This year’s Teen Summit will be held Nov. 9-11 at the Georgetown University Hotel and Conference Center in Washington, D.C. For more information, or to register, please visit www.foodallergyevents.org.
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August-September-October 2012
Food Allergy News
FAAN’s popular Trick-or-Treat for Food Allergy fundraising program is back this year! Designed for kids of all ages, this program offers a way to join in the Halloween fun while raising awareness and funds for food allergy. Instead of collecting Halloween candy, kids (and Mom and Dad!) collect coins to help support FAAN’s mission. To request a coin box, visit www.foodallergywalk.org/ halloweendonations, or call our office at (800) 929-4040.
Awareness
Trick-or-Treat , continued
we can be sure that unsafe candy isn’t accidentally consumed. Our children must also have epinephrine on them at all times, and must be with an adult who has a cell phone,” she writes. As for candy that is collected and cannot be eaten, have a plan for what to do with it. Many families have a trading system set up for their children to swap candy that contains their food allergen for treats that are safe for them, or will “buy” it from their children. Other families donate the unsafe candy to food pantries or send it to troops. However you choose to celebrate Halloween, have fun and stay safe! u 1. Trick, Treat, or Toy: Children Are Just as Likely to Choose Toys as Candy on Halloween. J Nutr Educ Behav. 2003;35:207-209.
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these are the most common adult food allergies. The foods involved follow patterns that reflect similarities in their major allergenic proteins. So, for example, birch-allergic individuals may develop reactions to related groups of nuts and fruits (e.g., almonds, apples, pitted fruits, and hazelnuts). This so-called “oral allergy syndrome” derives its name from the fact that symptoms are usually mild, limited to the mouth and throat, and typically occur only when fresh forms of the food are eaten. However, since these reactions can be serious, it is important to seek a diagnosis and advice from an allergist. New blood tests have been developed and are being evaluated that may help to sort out in some of these cases when a person is at risk for more severe reactions.
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On the Greens for FAAN
On par to raise funds: Shown here are participants in the 2012 FAAN Golf Classic at Ballyowen Golf Club in Hamburg, NJ on June 26. Teams raised more than $15,000 to benefit FAAN.
Do adults tend to experience more severe reactions than children? Outside of oral allergy syndrome, which is not associated with anaphylaxis, there is some evidence that food-allergic reactions in adults tend to be more severe. Some factors that can influence severity include coexisting asthma (particularly if it is not wellcontrolled), exercise, alcohol consumption, the use of certain drugs including nonsteroidal anti-inflammatory medication (aspirin and related drugs), betablockers, and ACE inhibitors (angiotensin-converting-enzyme inhibitor). These are factors that should be considered by patients together with their physicians in the management of their allergies in the context of their overall health.
Are food-allergic children more likely to develop additional food allergies in adulthood? It seems likely that regular consumption of a particular food would tend to lessen the chance that a food would provoke an allergy as an adult, and that having a food allergy as a child would increase the likelihood of adult onset food allergy, but there are no data that I am aware Food Allergy News
of to address these fundamental questions. Additional gaps in our knowledge include things like the true prevalence of eosinophilic gastrointestinal food allergies, in particular eosinophilic esophagitis, or effectiveness of interventions like oral immunotherapy in adults with food allergies. These areas deserve more study. In addition, there are adults with highly specific and reproducible symptoms limited to the gastrointestinal tract, many of whom likely have non-allergic forms of food intolerances, but some of whom we may eventually learn have true food allergies. Fortunately, more attention is being brought to adult food allergy by groups like FAAN and academic thought leaders around the world. Several new research studies of interventions and diagnostics are targeting adults along with pediatric populations, and the future holds promise for addressing many of these important questions. u Wayne G. Shreffler, M.D., Ph.D. is the director of the Food Allergy Center and Section Chief of Pediatric Allergy and Immunology at Massachusetts General Hospital. He is also Associate Professor of Pediatrics at Harvard Medical School. Dr. Shreffler is a member of FAAN’s Medical Advisory Board.
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Research Update New Study Maps Food Allergies Children who live in urban areas are more likely to have food allergies than those who live in rural areas, according to the results of a new study funded by the Food Allergy Initiative. This study, the first to geographically map children’s food allergies in the U.S., was published in the July issue of Clinical Pediatrics. “We have found for the first time that higher population density corresponds with a greater likelihood of food allergies in children,” lead author Ruchi Gupta, M.D., said in a news release. “This shows that environment has an impact on developing food allergies. Similar trends have been seen for related conditions like asthma. The big question is – what in the environment is triggering them? A better understanding of environmental factors will help us with prevention efforts.” Gupta, an assistant professor of pediatrics at Northwestern University Feinberg School of Medicine and a physician at the Ann & Robert H. Lurie Children’s Hospital of Chicago (former Children’s Memorial), also led last year’s groundbreaking study that concluded 1 in 13 children have food allergy. Her future research will include trying to identify environmental causes for food allergy. Particularly noteworthy in this latest study are the findings for peanut and shellfish allergies – city kids were more than twice as likely to have peanut and shellfish allergies compared with kids in rural communities. Nearly 40,000 children were included in the study; their food allergies were mapped by zip code. The study tracked food allergy prevalence in urban centers,
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metropolitan cities, urban outskirts, suburban areas, small towns, and rural areas. Among the study’s findings: l In urban areas, nearly 10% of children have food allergies compared with 6.2% in rural areas. l Nearly 3% of children in urban areas had peanut allergy compared with 1.3% in rural areas. About 2.4% of children in urban areas had shellfish allergy compared with 0.8% in rural areas. l Food allergies were severe in nature across the U.S. (Nearly 40% of children with food allergies had already experienced a severe reaction.) The study also found the following states to have the highest overall prevalence of food allergies: Nevada, Florida, Georgia, Alaska, New Jersey, Delaware, Maryland and the District of Columbia. Other published studies have previously shown a higher prevalence of asthma, eczema, allergic rhinitis, and conjunctivitis in urban areas compared with rural communities. Scientists hypothesize that being exposed early in age to certain bacteria in rural areas could protect against hereditary hypersensitivity to some allergens, or that pollutants found in urban areas may be triggers for developing certain allergies.
High Rates of Allergic Reactions in Young Children with Food Allergies Young children with milk and egg allergy experience nearly one reaction per year, according to a new study published in the journal Pediatrics. The team of researchers from the Consortium of Food Allergy Research (CoFAR), which has been following more than 500 milk- and egg-allergic children since infancy, also found that less than one-third Food Allergy News
of reactions deemed severe were treated with epinephrine. “This study reinforces the importance of educating parents and other caregivers of children with food allergy about avoiding allergenic foods and using epinephrine to treat severe foodallergic reactions,” said Scott Sicherer, M.D., a member of FAAN’s Medical Advisory Board, professor of pediatrics, and chief of the Division of Allergy and Immunology at Mount Sinai School of Medicine. Among the reasons cited by caregivers for not giving epinephrine were being too afraid to administer the medicine and failing to recognize the reaction as severe. Nearly 90% of allergic reactions were caused by unintended ingestion, label reading errors, cross-contact, and mistakes made in food preparation. In more than one-third of the accidental exposures, the reaction occurred because someone other than the parent or child provided the food. Additionally, the vast majority of severe reactions cited in the study were caused by ingestion, rather than skin contact or inhalation. Researchers also learned that 11% of reactions were attributed to purposeful ingestion of known food allergens – a finding that the study’s authors referred to as “unexpected and worrisome.” “In some cases, reactions occurred to a food that was given in a larger amount than before, which is a nuance worth considering when taking a medical history of young children with possible food allergies. Reasons for these exposures need further exploration but may reflect parental testing for resolution of allergy,” the authors wrote. Fleischer DM, Perry TT, Atkins D, Wood RA, Burks AW, Jones SM, Henning AK, Stablein D, Sampson HA, Sicherer SH. Allergic reactions to foods in preschool-aged children in a prospective observational food allergy study. Pediatrics 2012; DOI:10.1542/peds.2011-1762. Research continued on page 11
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Legislative and Advocacy Update Standing Order Epinephrine In 2012, two more states (Virginia and Maryland) have enacted legislation pertaining to schools having an emergency supply of nonstudent specific epinephrine. While the Maryland law allows schools to stock epinephrine, the Virginia law will require schools to have to do this. Currently, standing order epinephrine legislation is being considered in New Jersey (A.2734, which would require) and Pennsylvania (HB.2067, which would allow). Unfortunately, standing order epinephrine legislation died in Florida, Hawaii, Kentucky, Louisiana, and Oklahoma in 2012 (the legislative sessions ended before the bills could be enacted). At the national level, FAAN’s School Access to Emergency Epinephrine Act (S.1884 in the Senate, HR.3627 in the House) continues to gain support. This bill,
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Survey Reveals One-third of First-time Reactions With Anaphylaxis Symptoms Treated With Epinephrine Anaphylaxis is often poorly recognized and under-treated when looking at the management of firsttime food-allergic reactions among children, according to a study recently published in the journal Pediatric Allergy and Immunology. In conjunction with the Kids With Food Allergies Foundation, researchers surveyed more than 1,300 parents to study the management of foodinduced anaphylaxis in children. Approximately 76% of the responses reported reactions that met the criteria for anaphylaxis. Among the findings:
which would offer grant incentives to states that adopt laws requiring standing order epinephrine, now has 35 co-sponsors in the Senate, and nearly 80 in the House. Please help us get this bill passed! If you haven’t already done so, ask your representative and your two senators to co-sponsor this legislation today. (Sample letters are available on the FAAN website.)
State-Specific Legislation Legislation related to allergen awareness in restaurants (modeled after the recent Massachusetts law) was passed by the Rhode Island Senate and House, and went into effect in late June. This legislation is due to the efforts of 17-year-old FAAN member Danielle Mongeau. Congratulations, Danielle! Landmark legislation in Pennsylvania (HB.2265) calls on that state to develop guidelines for child care centers for managing children with life-threatening food allergy. The guidelines would cover
l Just
34% of likely anaphylactic reactions were treated with epinephrine l Of those that were treated with epinephrine, the medication was administered by emergency room staff in 56% of the cases, followed by parents (20%), paramedics (9%), primary care physicians (8%), and urgent care centers (6%). l Epinephrine was administered within 15 minutes of onset of symptoms in just 26% of cases. l After being treated for a likely anaphylactic reaction, just 42% of parents reported being referred to allergists and only 34% of parents were prescribed epinephrine auto-injectors. Of those cases in which the patient was treated with epinephrine, Food Allergy News
a range of topics, including the administration of an epinephrine auto-injector; the storage and accessibility of the device; reasonable accommodations that will help reduce the risk of allergic reactions; and emergency protocols. While a number of states have published food allergy guidelines for schools, Pennsylvania would be the first to do so for child care centers. Legislation in Massachusetts (H.3959) would clarify that epinephrine can be kept in locations throughout the school, such as lunchrooms and classrooms (as opposed to only being kept in the nurse’s office). This bill was passed by the Massachusetts House and, at press time, was being considered by the Massachusetts Senate. If you live in any of these states mentioned above, please contact your local legislators and ask them to support these bills. If you’d like to get legislation introduced in your state, please contact FAAN. u
47% were prescribed epinephrine auto-injectors. l Epinephrine was more likely to be given to children with asthma or to children with peanut or tree nut ingestion. The study also concluded that infancy, milk, and egg triggers, along with gastrointestinal symptoms, were associated with under-recognition and treatment of anaphylaxis. Researchers noted recall bias and the self-reporting nature of the study as potential limitations of the study. u Jacobs TS, Greenhawt MJ, Hauswirth D, Mitchell L, Green TD. A survey study of index food-related allergic reactions and anaphylaxis management. Pediatr Allergyand Immunol 2012; DOI:10.1111/j.1399-3038.2012.01315x.
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Poster Contest Winners Thanks to all of you who sent in your posters for this year’s contest! All of the posters we received were colorful and creative which made it tough to pick just few winners! Check out the first-place winners below, and be sure to visit our website, www.foodallergy.org, to see the second and third place posters, too. Ages 4-7
1st: Kate, age 7, Michigan
Brother Travis (6) allergic to peanuts
2nd: Lily, age 7, Virginia
Allergic to barley, latex, Amoxicillin
3rd: Mehar, age 5, California
Allergic to tree nuts, milk, critic acid
Ages 8-11
1st: Ashton, age 10, Virginia Allergic to peanuts
2nd: Rachel, age 8, Canada Allergic to peanuts, dairy, egg
3rd: Kylie, age 9, Indiana
Allergic to peanuts, tree nuts
Important Note Regarding the Food Allergy News for Kids Newsletter Thank you for allowing your children to share their stories and photos in our Food Allergy News for Kids newsletter throughout the years! The pictures and materials we receive continue to line the walls of our office, reminding all who see them the reason why we work so hard every day to educate, advocate, and push for a cure. In July, we mailed our last printed issue of Food Allergy News for Kids. This newsletter will be replaced with three new and improved digital publications for children, to be released in 2013. Each publication will offer food allergy education and advice from leading experts, and games and activities that reinforce key messages. We are excited about these plans and we are currently working on a fun and engaging line-up of kid-friendly experts who will contribute material.
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A Special Insert of Food Allergy News
Prepping for Preschool: A Parents’ Emotional Resource When Their Child Has Food Allergies By Kristen W. Kauke, MSW, LCSW
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reschool is a big milestone for both parents and children. It brings separation, and changes in routine, environment, and peer group. While change can be exciting, it can also feel unsettling. Moreover, if your child has a food allergy, this milestone may feel like a ton of bricks. Parents can prepare themselves, and in turn, prepare their children in the following manner: first, regulating their own anxiety; then supporting their child’s emotions.
Regulating Anxiety There is a fine line between being safe and being overprotective. Parents must cope with anxiety vs. over-controlling their children. Research shows that relaxation techniques can regulate anxiety. Make time to breathe deep from the belly. Channel anxiety into a good workout. Distract by scheduling something fun or pampering. Be kind with yourself and know that some level of anxiety is normal, but not permanent. When coping with your own anxiety, ask yourself the following: How likely is a reaction? How do we deal with risks? In answer to the first question, reactions are likely when the allergic protein has entry to the body via eyes, nose, or mouth. The
risk of a serious reaction due to skin contact is dramatically less. It is helpful to remember where the risk for our child can be managed. In response to the second question, parents can minimize risks by having a plan in place with the school and educating their children (more on this step below). FAAN has some great articles regarding obtaining a formalized school plan (504 Plan, applicable in preschools that receive federal funding, or similar), as well as a terrific download for a Food Allergy Action Plan to outline how to recognize and treat an allergic reaction.
Supporting Children’s Emotions Preschool-aged children are more likely to describe anxiety by citing physical symptoms or communicating feelings through behavior. Physical symptoms might include headache, backache, tummy ache or “butterflies,” or even fatigue. Behaviors that communicate anxiety include difficulty sleeping, clinginess, difficulty concentrating, irritability, overreacting, or being antsy. It is normal to see some anxiety when your child starts preschool due to the new routine, new environment, and new peers. Managing their food allergy is just
one of the many issues they may be juggling. To make your child’s transition to school easier, and to empower your child, arm him or her with role models and knowledge. Kids at this age learn through imitation, so providing role models is important. Children love to mimic characters in stories. They might also enjoy talking to slightly older peers who can share their experience of transitioning to preschool. Help your child to understand the symptoms of a food-allergic reaction. Provide realistic information without creating paranoia. You might consider approaching your child with the following framework: “One way to be the boss of your safety is to understand what a reaction might feel like and to know how to tell your teacher. Just like if you’re coming down with a cold, you tell Mommy that your throat hurts or your nose is getting stuffy, and I give you medicine to make you feel better. At school, if your skin or throat ever feels itchy, or your throat feels tight and funny, or your tummy hurts and feels sick, or you have coughing and trouble breathing when you’re not sick, tell your teacher right away and she can get you the medicine that will help you to feel better.” Create rituals to begin teaching a child how to manage a food allergy and how to safely eat away from home. Teach your child to keep their hands out of their eyes, nose, or mouth, and to always wash hands before and after eating. Additionally, teach your child to ask, “Did my mom say this was safe for me?” if someone other than Mom or Dad offers them Preschool continued on page I-2
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Preschool , continued
food. This question may prompt an unaware, but well intentioned adult to read labels and ask appropriate questions that might avoid an unsafe situation. Separation anxiety is common at this age, but practice being away from a parent for a short period of time helps children to overcome this phase. Have a slow progression of being away from your child. Allow them practice eating under someone else’s supervision while you run an errand so you both know they can do it!
Gifts in the Growing Pains Preschool is a time when children begin to explore their environment independently. By encouraging children to engage in new tasks, parents help their children to promote a sense of competence, a sense of self. The risk of hindering a child’s exploration at this age is development of shame and self-doubt. Knowing this stage is essential to their self-esteem might help us to manage our own anxiety about letting go. As the transition to preschool looms closer, keep a proper perspective. Remember that children cannot grow without taking risks. The goal is not to eliminate all risks in life, but to keep them manageable. It has been said that courage is risk-taking without being reckless. Courage is an amazing gift we can give our children. u Kristen Kauke is a Licensed Clinical Social Worker who practices in IL. She was diagnosed with food allergies as an adult and is the mother of two sons with anaphylaxis to peanuts, egg, milk and soy. She is a regular presenter at FAAN’s food allergy conferences, and helps individuals cope with anxiety due to severe food allergies.
Principal’s Perspective: Great Beginnings to a New School Year By Paula Naegle
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mplementing a food allergy management plan at my middle school requires a team effort, and I know that our staff takes their cue from me when it comes to being dedicated and committed to keeping our students safe at school. I have made it very clear to our staff that our school nurse and first aid safety assistant are not the only two people in the building who are charged with this responsibility. If there is exposure to a food allergen, it will likely happen in a classroom, the cafeteria, on a field trip – anywhere other than in the health office. In order for our team to be successful, we need to make sure every staff member is on board with his/her role in keeping students with food allergies safe at school. Teachers have so many competing demands on their time and attention, so I make it a point to appeal to their hearts as well as their minds when we review our school’s proactive steps to protect students who have food allergies. To do this, I read aloud a story that was written by one of our students telling about being in preschool when a substitute teacher, who did not know about his food allergies, offered him a granola bar containing peanuts. He ate it and had anaphylaxis. The story focuses our staff on the reason why we work as a team to protect the lives of our students. Each year we have new staff members who need to be brought up to speed on what can happen if a child who has food allergies is exposed to Perspective continued on page 1-4
Bullying and Food Allergies Did you know October is National Bullying Prevention Month? A study conducted by FAAN and the Mount Sinai School of Medicine found that 48% of school-aged children (age 10+) with food allergies reported to have been bullied, harassed, or teased. While most of the incidents involved verbal taunting, more than half were physical and included waving, throwing, or touching the victim with the food to which the victim was allergic (see Food Allergy News, Aug./Sept. 2010). If you suspect your child is being bullied, the www.violencepreventionworks.org website (home of the Olweus Bullying Prevention Program) offers these tips to support your child: l Allow your child to talk about his or her bullying experiences. Write down what is
shared.
l Empathize with your child. Tell him or her that bullying is wrong, that it is not his or her
fault, and that you are glad he or she had the courage to tell you about it.
l Check your emotions. A parent’s protective instincts stir strong emotions. Although it is
difficult, step back and consider the next steps carefully.
l Contact a teacher, school counselor, or principal at your school immediately and share
your concerns about the bullying that your child has experienced.
l Work closely with school personnel to help solve the problem. l Encourage your child to develop interests and hobbies that will help build resiliency in
difficult situations like bullying.
l Teach your child safety strategies, such as how to seek help from an adult. l If you or your child need additional help, seek help from a school counselor and/or
mental health professional.
For additional tips and more information, visit www.olweus.org.
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will vary among schools, so talk to your college-bound students to determine what he or she is comfortable with and then contact the college housing office to discuss accommodations.
Dining Services
Life after High School: Preparing for College with Food Allergies
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his time of year, many students are starting to think about life after high school, and families are beginning to visit college campuses. When it comes to food allergies, the differences between college and high school are tremendous and may seem overwhelming, but FAAN is here to help. It is becoming more common for colleges to recognize that students with food allergy may need certain accommodations; in fact, a student’s food allergy is sometimes brought to the attention of the college disability office, which in turn will help the student and his/her family better prepare for college life. There are three issues that are key to college students with food allergy: housing, dining services, and emergency response.
Housing Many colleges are willing to make special housing accommodations for students with food allergy. Such allowances may include: l a single room; l living off campus; l an opportunity to correspond with prospective roommates prior to the start of the semester; l permission to have his/her own microwave and/or refrigerator; and
Did You Know?
Your college-bound, food-allergic student may be eligible for accommodations under Section 504 of the Rehabilitation Act of 1973. The Office for Civil Rights (OCR) in the U. S. Department of Education has information posted at www.ed.gov/ocr/ transition.html that explains the rights and responsibilities of students with disabilities who are preparing to attend postsecondary schools.
College Network
FAAN’s College Network is a searchable database to find out who to contact to get answers to your questions about managing food allergies on campus. The database includes College Representatives and Student Ambassadors, who can provide valuable insight to share about living with food allergies at their college or university. The website is located at www.faancollegenetwork.org. l an
opportunity to have a car in order to drive to a restaurant or supermarket. Determining which, if any, of these accommodations are provided
Determining whether your teenager will be able to safely eat food provided by the college depends on collaborating with the college dining services, along with the college’s registered dietitian(s), or RDs. Most colleges have RDs on staff who are available to meet with parents and incoming students to discuss various dietary issues, including food allergy. In fact, many colleges, upon learning that an incoming student has a food allergy, will actually refer the student directly to an RD. In the event that your teenager prefers not to eat food prepared by the college, discuss with the RD or dining services director the option of “opting out” of meal plans.
Emergency Response It is very important to understand how emergency response is handled by the college. Some campuses have their own ambulance services and EMTs, while other campuses utilize ambulances/EMTs provided by the town or city. Contact the college campus security office and discuss how emergency response is conducted. Keep in mind that some types of ambulances/EMTs may either not be equipped with or authorized to use epinephrine, so ask about out how to ensure that epinephrine and the appropriate personnel arrive at the scene in the event of an allergic emergency. u
The Consortium of Food Allergy Research (CoFAR) was established by the National Institute of Allergy and Infectious Diseases to conduct studies to answer questions related to food allergies. Researchers developed a food allergy educational program to help parents of children better understand and manage food allergies. The materials are available free on their website, www.cofargroup.org, under the Food Allergy Educational Program tab. Food Allergy News
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No food or food items are allowed in classrooms. This includes any experiments, demonstrations, or labs that use food items containing allergens. This also includes celebrations with food, such as birthday treats, culture-related feasts or taste-tests, and food rewards and incentives. Peanut-free table for students with food allergies and friends to sit at in the cafeteria is available. This table is cleaned by our custodians with soap and water and a special mop and bucket that are kept separate from the other cleaning tools and used only for this table. Cafeteria and student store sells only nut-free foods and snacks. Any food items used for student recognition must be nut-free. For students who have other food allergies, we will substitute another item or privilege. Substitute teacher folders contain “Medical Alert” information regarding specific students in the class who have life-threatening food allergies. A photo of the student who has food allergies and the student’s emergency health plan is included.
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All teachers, support staff, and bus drivers are trained to recognize the signs and symptoms of anaphylaxis, and how to administer epinephrine.
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We exclude the food, not the child. We educate staff on how a child with food allergies may feel when there is discussion on why food is not allowed in the classroom. We August-September-October 2012
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the allergen at school. Both new and returning staff must be reminded why we take precautions and are hypervigilant about our “Safe at School” practices. Afterwards, we discuss our “Safe at School” practices. Following is a list that we review at the first faculty meeting to ensure all staff members are informed of our proactive measures and trained on emergency measures to be taken in case of anaphylaxis: are sensitive and careful about what we say when we talk about these issues, making sure we express concern and care about the student who has food allergies. I also read aloud the story about the student and the granola bar (described above) to parents at our first parent advisory meeting in September. I use this opportunity to teach parents about food allergies and to ask for their help in keeping our kids safe at school.
Zero Tolerance for Bullying Guidance counselors teach lessons in classes about food allergies and the danger of exposure to allergens at school. Deans address bullying of students with food allergies in their discipline orientation the first week of school. We have information in our student handbook regarding our safe
practices to protect students who have life-threatening food allergies. Periodic and timely reminders are given to staff throughout the school year to make sure we are vigilant about our practices. For example, holidays such as Halloween, and Christmas are times when teachers may “forget” and allow candy in classrooms. The beginning of a new semester is another time to remind staff about safe practices as teachers are planning lessons, labs, experiments that may contain food items. Please share your school’s best practices with us as we all work to keep our kids safe at school. Here’s to a fabulous beginning of a new school year! u
Paula Naegle is the Principal at Del Webb Middle School, Clark County School District, in Henderson, NV. In October, she will receive the Cultural Diversity Foundation’s Golden Hand Service Award.
Foodallergy.org The Education section of FAAN’s website offers free school-related articles and documents, including our “Back to School Toolkit” that provides convenient links to many of our free downloads, and School Guidelines for Managing Students with Food Allergies, developed in partnership with several professional associations to outline the responsibilities of the family, the school, and the student. AllergyReady.com This website, created as the result of a collaborative effort among FAAN, the Food Allergy Initiative, Anaphylaxis Canada, the Canadian Society for Allergy and Clinical Immunology and Leap Learning Technologies, hosts a free, interactive online course designed to help school staff prevent and manage allergic emergencies.
Food Allergy News