Introduction and Overview
Today more children are living with food allergies than ever before. In fact, the percentage of young children diagnosed with peanut allergies nearly doubled from 1997 to 2002. According to the Food Allergy & Anaphylaxis Network (FAAN), approximately three million children currently suffer from a food allergy, with 90 percent being caused by the major food allergens, which include milk, eggs, peanuts, tree nuts, wheat, soy, fish, and crustacean shellfish. Although the reason for this increase is unknown, food allergy management is becoming an urgent area of focus for schools. There is no cure for food allergies, so strict avoidance on the part of the food allergy patient is the only way to prevent a potentially serious reaction. With children consuming meals and snacks in school during the school year, it is extremely important for all levels of school personnel to be informed about food allergies and be actively involved in taking preventive measures that ensure the safety of their students.
In an effort to gather more information on food allergy management in schools, the International Food Information Council (IFIC) and the School Nutrition Association (SNA) recently conducted a Web-based survey in spring 2008 of 844 school nutrition professionals and district directors in the U.S. to learn what they are currently doing to address food allergies.
Survey Objectives
The objectives of the IFIC-SNA survey were to: 1) measure the prevalence of food allergies in schools and assess the change in prevalence over the last several years; 2) determine what proportion of schools have formal food allergy plans and who is involved in those plans; 3) identify key food allergy topics of interest and preferred educational formats; and 4) identify “best practices” for managing food allergies in schools.
Survey Findings
According to the results of the survey, 84 percent* of school nutrition professionals reported having children with known food allergies in their school. Approximately 54 percent of district directors said their district has a food allergy plan. And, many schools with formal food allergy plans in place have taken at least one of the following steps to respond to an allergic reaction: enacting their food allergy plan (22 percent); using the student’s epinephrine pen prescribed by his/her doctor (27 percent); calling 9-1-1 (25 percent); contacting the student’s parent or legal guardian (27 percent); or all of these (46 percent). Many school nutrition professionals also are taking action to prevent allergic reactions by reading ingredient labels (77 percent) and cleaning kitchen utensils to prevent cross-contamination (60 percent).
However, 21 percent reported that they do not have a formal plan for addressing food allergic reactions, and an additional 13 percent said they were unsure what they were supposed to do to respond to an allergic reaction.
In addition, most school nutrition professionals (80 percent) report collecting food allergy information from students at least once a year, which is critical in keeping track of new allergies and medications.
Moreover, 55 percent have provided food allergy education to parents and students, and 56 percent have provided education to foodservice personnel.
Several schools report that personnel from different departments are involved in food allergy management. In addition to nurses (85 percent), school nutrition professionals cited other foodservice workers (73 percent), foodservice directors (68 percent), parents (57 percent), and teachers (54 percent) as all being involved. Increasing awareness at all personnel levels is important because an allergic reaction can happen anywhere, inside or outside the school, including when students are on field trips, at class parties, and at after-school events.
The survey revealed that school nutrition professionals want food allergy education tools and training. When provided with a “wish list” of food allergy educational tools, school nutrition professionals selected several they would like to have, including a database with common food ingredient names for food allergens (65 percent); a best practices guide for implementing food allergy management programs (63 percent); educational materials for school nutrition professionals (63 percent); and food allergy identification materials (62 percent). Top training topics included reading food labels (66 percent), recipe preparation/menu substitution (56 percent), and preventing cross contamination (50 percent).
According to the survey, only 54 percent of district directors said their district has a food allergy plan, and only 12 percent said their entire state uses the same plan. As a result, survey participants were interested in examples of best practices that have been adopted successfully by other schools which they could adapt to their own school environment. Examples of best practices given by district directors included: creating an allergy response plan so all involved know exactly what is expected; providing alternative meals or substitutions for students with allergies; and identifying students with allergies through the use of the school’s Point of Sale system to help cashiers double-check the child’s meal choices. These are solutions schools can implement to improve their food allergy management practices.
Conclusion
Although food allergies are becoming a more prevalent issue in schools, addressing them consistently can be challenging. Nonetheless, a majority of school nutrition professionals and school districts surveyed have taken proactive measures to develop food allergy plans voluntarily without mandates or dedicated resources, which shows their concern about food allergies and their desire to do something to help prevent and manage allergic reactions in schools.
There currently are no consistent nationwide procedures for schools to follow to address food allergies in schools. Those schools and districts with formal food allergy plans often tailor them to individual students who have specific food allergy needs, which means that there are dozens of different food allergy plans being used across the country.
The survey also shows there is a need for food allergy education and training for many school nutrition professionals, as well as other school personnel involved in student health, safety, and overall welfare. Some common themes identified through this survey include 1) keeping open communications among all school personnel involved; 2) regular collection of food allergy information and keeping updated records; and 3) knowing what to do and where to find students’ food allergy information/medication when an allergic reaction occurs. By adopting practices that already have been successful in other schools, school personnel can be confident that these practices may be effective in helping to make their schools safer for food allergic children. For more information about food allergies visit the IFIC Foundation Food Allergy Resources page.
* All percentages have been rounded to the nearest whole number.
Spotlight on Food Allergy Best Practices
There are a few school districts that stand out for their innovation and effectiveness when it comes to food allergy management. One such district is Spokane Public Schools (SPS) in Spokane, Washington.
Following an allergic student’s death after consuming an allergen-containing food on a school field trip seven years ago, SPS wanted to do everything they could to ensure it would never happen again. Over the last seven years they have worked tirelessly to incorporate formal processes and procedures that must be followed for students with a life-threatening allergy of any kind.
Also, Washington state law requires all students with a life-threatening condition to have an Emergency Action Plan (EAP) on file before they can even start school.
SPS is a shining example for schools hoping to establish or improve a plan for the first time. The SPS Nutrition Services Web site (http://www.spokaneschools.org/NutritionServices/) has an Allergy Information / Special Diets page with links to forms, recipes, menu substitution ideas, medical response information, label reading information, nutritional information, and more.
An “Accommodation Check List for Care Team” (also on their Web page) is completed for each student with a life-threatening allergy and includes ways to prevent scenarios in which an allergen could be introduced to the child. The Check List involves all levels of personnel, and according to Doug Wordell, RD, the SPS Director of Nutrition Services, “Communication between departments is key. Our nurses coordinate the EAPs and do an excellent job, but it’s imperative that they have a good relationship with the other support services.”
Also having standard procedures for all students with a life-threatening condition takes the guess work out of the equation and simplifies the process. Wordell said, “It’s important to keep the process as simple as possible.” They also have a comprehensive document called “Guidelines for Managing Life-Threatening Food Allergies in Schools” that details each component of their food allergy policy. Other resources on their Web site support the Guidelines and help put the plan into action. The information is accessible to the public, so parents and other school personnel can see what SPS has done to address food allergies.
Doug Wordell, has been actively involved in the development, implementation, and ongoing improvement of food allergy management practices for the district. “We’re always learning; you’re never there,” Wordell said.
Mr. Wordell offered these final words of advice on managing food allergies in schools:
- Use Your Plan;
- Practice Your Plan; and
- Call 9-1-1.
