focus on » Food Allergies ALLERGY MANAGEMENT: ABCs and 123s Especially for school nutrition managers, assistant managers and employees There are many terms, acronyms and definitions to keep track of when it comes to food allergy management. Know your ABCs and 123s with this handy list! • 504 Plan: A written food allergy management plan, created in collaboration with parents and other stakeholders, for a child whose food allergy qualifies as a disability under Section 504 of the Rehabilitation Act of 1973. • The Big 8: The eight foods that cause the majority of allergic reactions are often referred to as “The Big 8” and are peanuts, tree nuts, milk, eggs, wheat, soy, fish and shellfish. • HACCP: An acronym that stands for “Hazard Analysis Critical Control Point,” the food safety protocol required in school nutrition operations. HACCP reduces the risk of safety hazards in foods by identifying and controlling potential hazards at specific points as food items travel from manufacturing/processing, distribution, handling, preparation and service to consumption. • FARE: Food Allergy Research & Education (www.foodallergy.org) is considered the leading national organization providing education, awareness and advocacy on behalf of the 15 million Americans with food allergies. It offers a variety of toolkits and resources specific to managing food allergies in schools. • CDC: You have probably heard of the U.S. Centers for Disease Control and Prevention, but did you know that they offered the very first national comprehensive guide on school food allergy management? Access Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs via www.cdc.gov. 1 in 13 American children are affected by food allergies Source: Food Allergy Research & Education ￼Allergic Reactions: Myths & Facts MYTH: Most allergic reactions are caused by artificial flavors, dyes and other additives, not by a food itself. FACT: More than 90% of reactions are caused by foods, specifically The Big 8: peanuts, milk, eggs, soy, tree nuts, fish, shellfish and wheat. MYTH: An allergic reaction usually starts several hours after eating. FACT: An allergic reaction to food can trigger a variety of responses, ranging from mild to severe, within mere minutes, and it can last for several hours. MYTH: If the student doesn’t develop hives after consuming the allergen(s), the reaction is not really severe, and an antihistamine like Benadryl® can be administered. FACT: Hives are just one visible symptom of an allergic reaction; others include redness around the eyes, nausea and vomiting, sneezing, coughing and nasal congestion. Never administer medication to a student unless it is outlined in their 504 plan. If a student shows signs and symptoms of an allergic reaction, immediately notify the school nurse and proceed with treatment according to that student’s specific 504 plan. If there is no 504 plan on file, follow your school’s emergency procedures regarding calling 911. MYTH: Even smelling peanuts can trigger an anaphylactic response in a peanut-allergic child. FACT: An individual with a peanut allergy must ingest the protein in order to have an allergic reaction; smelling peanuts does not cause an allergic reaction. Inhaled peanut particles can cause anaphylaxis, but the mere odor of peanuts does not trigger an allergic reaction. MYTH: Allergic reactions get progressively worse each time. FACT: There is no way to predict the severity of an allergic reaction. Not only might a person exhibit different symptoms between two reactions (e.g., vomiting at one reaction, and troubled breathing during the next), a reaction can be the same—or less or more severe—than the previous one. Q & A: Allergy Answers From a School Nurse SN sat down with Health Services Coordinator Wendy Rau of Lincoln (Neb.) Public Schools to ask how school nurses can coordinate with cafeteria staff to keep kids with allergies safe. Q: How do you coordinate with students, parents and cafeteria staff to manage a child with food allergies? A: We start with communication with students and parents. We determine what that student’s reactions look like and get all the information about the allergy; for example, if there is an egg allergy, does that mean all eggs are out, or are menu items made with cooked eggs safe? We also have a plethora of forms, so we can get that information in writing. Information is linked to everyone—teachers, administrators, counselors and the school cafeteria. Q: Do you train staff to identify the symptoms of an allergic reaction? A: We always want allergy (or other special diet) training to be individualized for the student, but there are typical signs: the start of a rash, a complaint about an itchy or tight throat or vomiting. I have seen a couple of children have anaphylactic reactions and not one has looked the same. Q: Students, especially young children, might not describe an allergic reaction the way an adult would; are there words to listen for to identify a possible problem? A: Sometimes you will hear “It feels like a lump” or “I can’t get a deep breath.” Sometimes very young kids don’t know how to describe “itchy”—they might say their skin feels “funny,” or that they are hot. If we are aware of an allergy, we know to ask that child about what they ate that day. Q: What is the most important thing to keep in mind when managing student allergies? A: Communication is the key, and that piece goes both ways. Sometimes the cafeteria manager will find out something about a student’s allergies before the school nurse, and that will make them that first point person to get the process started. What Is Anaphylaxis? Anaphylaxis is a severe, potentially life-threatening allergic reaction during which symptoms can affect several areas of the body and present risks to breathing and blood circulation. Anaphylaxis usually occurs within minutes of a person consuming the allergen, although delayed and “second wave” symptoms can occur hours (or even days) after the first symptoms subside. Severe symptoms that may indicate anaphylaxis include: • Difficulty breathing • Reduced blood pressure • Swelling of lips, tongue and/or throat • Loss of consciousness • Chest pain • Trouble swallowing Understanding Allergies IT’S IMPORTANT TO UNDERSTAND THE DIFFERENCES between a food allergy, a food intolerance and a food sensitivity. A food intolerance (such as to lactose) means your body lacks an enzyme necessary to digest certain types of food. A food sensitivity means you experience unpleasant reactions—like headaches or mild digestive issues—after eating certain foods. A food allergy is a condition in which the immune system reacts after eating a certain type of food. Reactions can range from mild to life-threatening. Special diets may be outlined for students with any of these medical conditions; they could be required in a 504 plan or other documentation required by the state or school district. Donna Myers SNA School Nutrition Employee/Manager Representative Kids With Food Allergies Need Our Attention Hello! I’m excited to represent you on SNA’s Board of Directors and share the perspective of our membership segment in the decisions that drive our Association forward. Please feel welcome to reach out to me anytime at email@example.com. I’m also excited to share some of my reflections with you in this new magazine column written especially for us. This month’s theme on food allergies is so important to cafeteria managers and employees. Every day, we face the challenge of serving all our students and protecting those who can get very sick if they eat the wrong thing. As a manager, I’ve learned a lot about the most common food allergens featured in this section, but I’ve also learned that children might have allergies to certain spices, vegetable oil, wheat, rice, sesame, fish, various fruits and vegetables—almost anything! Most states require schools to develop policies and procedures to ensure that we are making appropriate accommodations to help children and their families manage food allergies when they are at school. This might be through an Individual Health Plan or a 504 plan and such plans must be renewed every year. It’s a collaborative process: Physicians, families and school staff work together to come up with a plan for each student’s particular needs. If you don’t have a food allergy, it can be hard to imagine how you can get violently ill from eating the same food that isn’t bothering anyone else. Joanne Terry, a fellow SNA member from another Florida school district, told me that she personally has an allergy to onions and Swiss cheese. If she eats these, they can make her tongue swell and itch and feel like it is on fire. Then she might get hives, which makes her feel like a dog with fleas. Yikes! Making accommodations for children with special dietary needs—whether for food allergies or for various medical conditions, like diabetes (something Donna Kelley, a manager colleague of mine, must help a student with)—isn’t easy. It may mean ordering special foods, being very aware of ingredient labels, taking precautions against cross-contamination when preparing meals and so on. But it is so important that we take these steps and keep the health of all students our top priority throughout the school year! Allergies on the Ground [TIPS] From SNA Members “Students are key players,” says Jessie Coffey, RD, nutrition educator in Lincoln (Neb.) Public Schools. “We use a brochure that breaks down student responsibilities, parent responsibilities and teacher responsibilities. For example, we rely on students to come and talk to us right away if they are unsure of something on their tray.” “Don’t segregate the student unless absolutely necessary,” advises Jason Carter, child nutrition director, Siloam Springs (Ark.) School District. “Unwanted visibility can affect their social life and behavior. Work to protect the student, without isolating her from her peers.” “I have dealt with food allergies myself for 30 years, and my daughter has Type 1 diabetes. Managing the health and food issues around those things really opened my eyes,” remarks Sheree Satcher, foodservice director, Westwood (Texas) ISD. “Some of my students with allergies weren’t eating at school because parents didn’t know we were willing to accommodate their children’s special diets. Managers can help make parents aware that we are willing and able to find substitutions.” cross-contamination: CAN YOU IDENTIFY THE RISK? 1) ￼Using hand-sanitizing gels is just as good as washing your hands to avoid cross-contamination. True or False? 2) You don’t need to clean off a cooking surface (grill or griddle) after use because cooking destroys any allergens. True or False? 3) ￼￼It’s OK to use the same knife to cut tomatoes, peppers and cheese, as long as you wipe off the knife with a clean, dry towel in between uses. True or False? 4) ￼Keeping a completely separate set of dishes, knives, cutting boards and utensils greatly reduces the risk of allergen cross-contamination in the kitchen. True or False 5) As long as your disposable gloves stay clean, you do not need to change them in between tasks. True or False? Answers: (1) False. Using bar or liquid soap, along with water, is the best and most effective way to remove allergen proteins from your hands. (2) False. All cooking surfaces must be cleaned after use, as cooking does not destroy allergens. (3) False. When switching between tasks/foods, all utensils and surfaces must be washed with soap and water. (4) True. (5) False. Always change gloves when moving from one task to the next to reduce the chances of cross-contamination between foods. Common Allergens at a Glance IN ADDITION TO THE BIG 8 (peanuts, tree nuts, milk, eggs, wheat, soy, fish and shellfish), you may encounter other food allergens among the student body. For example, did you know that sesame is a common allergen, one affecting hundreds of thousands of Americans? In addition to the usual suspects—sesame oil, flour and paste—sesame is also found in many processed foods like soups, meats, energy bars, bread crumbs, vegetarian burgers and cereal. More and more students require gluten-free diets due to a gluten sensitivity or Celiac disease. Though not as common, allergies to seeds such as sunflower and poppy can also be very severe, causing anaphylaxis. While it’s true that a person can be allergic to almost any type of food, The Big 8 account for 90% of food allergic reactions. Other foods attracting attention in causing allergic reactions include corn, meat (beef, chicken, pork, mutton), certain spices (including caraway, coriander, garlic) and gelatin.
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