{"id":2257,"date":"2013-09-20T15:17:17","date_gmt":"2013-09-20T19:17:17","guid":{"rendered":"http:\/\/www.allergyhome.org\/schools\/?page_id=2257"},"modified":"2014-04-16T09:47:59","modified_gmt":"2014-04-16T13:47:59","slug":"food-allergen-exposure-in-the-school-setting","status":"publish","type":"page","link":"https:\/\/www.allergyhome.org\/schools\/food-allergen-exposure-in-the-school-setting\/","title":{"rendered":"Food Allergen Exposure in the School Setting: Evidence, challenges, and interventions"},"content":{"rendered":"
\n\n\n\n\n\n\n
Type of Exposure<\/td>\nRelevant Facts<\/td>\nPractical Challenges<\/td>\nPractical Interventions*<\/td>\n<\/tr>\n
\n
Oral Exposure<\/div>\n<\/td>\n
\u2022 There can be \u201chidden ingredients\u201d in foods.
\n\u2022 Labels and ingredients can change without warning. [1]\n\u2022 Items with advisory labels can contain allergens.[2]\n\u2022 Trace amounts can cause severe allergic reactions.
\n\u2022 Allergens can be detectable in saliva.[3]\n\u2022 All children are protected by law to have a right to a free and appropriate education in the least restrictive environment.
\n\u2022 Cross contact is presence of unintended allergen[1,3]\n
– Allergen contact with surfaces, food, and saliva are common sources.
\n– Exposure by mouth or mucus membranes is a common cause of reactions.<\/div>\n<\/td>\n
\u2022 Difficult to monitor outside food, especially if not labeled.
\n\u2022 Reading labels takes training, pre-planning, assigned personnel, and time allowances.
\n\u2022 Celebrations are common source of unlabeled food and cross-contact risk.
\n\u2022 Majority of allergic reactions in school start in classrooms.[4]\n\u2022 Allergic child can be targeted for being cause of potentially unpopular accommodations.
\n\u2022 Risk of bullying\/teasing. [5]\n
Additional consideration for pre-school\/early elementary<\/div>\n
\u2022 Young children can pass saliva to each other via age appropriate exploration.[3, 6]\n\u2022 Some schools children eat in their classrooms\/ learning environments.
\n\u2022 Supervision during meal\/snack time dependent on resources and staff.<\/div>\n

 <\/p>\n

Additional consideration for adolescent\/teenage students<\/div>\n
\u2022 Older students under less supervision and more reliant on self-management.
\n\u2022 Risk-taking, sense of \u201cinvincibility\u201d, peer pressure, bullying. [7,8]<\/div>\n<\/td>\n
\u2022 Non-food celebrations, activities, and rewards.
\n\u2022 Limited and pre-screened food projects in classrooms that do not contain the allergen; parent notification of all food projects or activities.
\n\u2022 Scrutiny of chosen foods before use.
\n\u2022 Safe snack stash in classrooms that allow food.
\n\u2022 Fresh fruits and vegetable snack alternatives.
\n\u2022 Adult assistance for food allergic children in selection of safe foods from cafeteria lines.
\n\u2022 No sharing or trading of food, drinks, or personal items.
\n\u2022 Appropriate cleaning of high-touch surfaces and hands.
\n\u2022 Consider encouraging parents of allergic children to send in all foods for child.
\n\u2022 Parent and student community education to create supportive environment.
\n\u2022 Encouragement to report any bullying\/harassment.
\n\u2022 No eating on school bus (exception for children medical conditions).<\/p>\n
Additional consideration for pre-school\/early elementary<\/div>\n
\u2022 Pre-school and lower elementary: no foods in classroom or selective allergen restriction as needed.<\/p>\n
Additional consideration for adolescent\/teenage students<\/div>\n
\u2022 Periodic check-ins to ensure continued self-management.
\n\u2022 Encouragement to report any bullying\/harassment.
\n\u2022 Support and continued education by school nurse and staff.<\/div>\n<\/div>\n<\/td>\n<\/tr>\n
\n
Skin Exposure<\/div>\n<\/td>\n
\u2022 Isolated skin contact on intact skin did not cause severe or systemic reactions when studied, although skin reactions can occur.[9,10]\n\u2022 Soap and water, and commercial hand wipes are effective for cleaning hands or surfaces, eg, table tops.[11]\n\u2022 Hand sanitizers are NOT effective in removing allergen protein residue.[11]\n\u2022 Young children frequently place their hands and objects in their mouth.[6]\nAge 1-2 yrs.: ~80 times\/hr
\nAge 2-5 yrs.: ~40 times\/hr
\n\u2022 Adults touch their eyes, nose, and mouth regularly.[12]<\/td>\n		\u2022 Limited resources and manpower to clean allergens and prevent cross-contact.
\n\u2022 Some non-edible items contain food allergens; eg, finger paint, play dough, shaving cream, paste, bean bags, furniture, pet food, bird feed.[29]\n\u2022 Skin exposure that can result in mucosal exposure in adults and children (eyes\/nose\/mouth).<\/p>\n
Additional consideration for pre-school\/early elementary<\/div>\n
\u2022 Skin exposure that can quickly turn into mucosal exposure or oral ingestion.[6,12]\n\u2022 Less effective cleaning skills (hands or eating surfaces).<\/div>\n<\/td>\n
\u2022 Same avoidance strategies as oral exposure above.
\n\u2022 Frequent hand washing with soap\/water or wipers before and after food handling or whenever hands are dirty.
\n\u2022 Appropriate cleaning of eating areas.<\/p>\n
Additional consideration for pre-school\/early elementary<\/div>\n
\u2022 Same avoidance as above.
\n\u2022 Adult supervision of hand cleaning.
\n\u2022 Adult responsibility for cleaning surfaces, toys, bus seats, etc.<\/div>\n<\/td>\n<\/tr>\n
\n
Inhalation Exposure<\/div>\n<\/td>\n
\u2022 Volatile organic compounds, not proteins, cause odor. [13]\n\u2022 Proteins cause most allergic reactions.[9]\n\u2022 Inhaling vaporized proteins from active cooking can cause severe allergic reactions and death.[9, 14, 15]\n\u2022 Most inhalation is not fatal.[14]<\/td>\n\u2022 Projects\/experiments involving burning\/heating of allergens.
\n\u2022 Field trips, volunteering, or internships in areas where foods are actively cooking or aerosolized if known or at risk for food allergy.
\n\u2022 Activities involve using food powders or grinding\/crushing fresh foods.<\/td>\n		\u2022 No activities that involve cooking foods, or using flours, powders and other small particles of food that can go up in the air.[9,13,14]\n\u2022 No food-related science experiments or classroom activities involving allergen.
\n\u2022 Prior clearance from principal and notification of school nurse for all field trips, especially in classes with known food allergic children.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

 <\/p>\n

*Adapted from NSBA, CDC Voluntary Guidelines, and MA state guidelines.<\/div>\n

As seen in Pistiner M, Devore C. The Role of Pediatricians in School Food Allergy Management. Pediatric Annals. 2013; 42(8):334-340.<\/a> <\/strong><\/p>\n

\n
\"Food<\/a>Food Allergy Education Table<\/a><\/strong>\n

Handy reference table that highlights teaching points tailored for specific groups - elementary school students, adolescents, families with and without food allergies, and school staff. Links are provided to relevant educational materials.<\/p>\n<\/div>\n

\"Staff<\/a>Staff Training: Food Allergies in School \u2013 What School Staff Need to Know<\/a><\/strong>\n

This 30 minute module is designed to assist the school nurse in staff training and increase food allergy awareness for all school staff including teachers, food service personnel, administrators, aides, specialists, coaches, bus drivers, custodians and others. <\/p>\n<\/div>\n<\/div>\n

REFERENCES<\/strong><\/div>\n

1. Mu\u00f1oz-Furlong A. Daily coping strategies for patients and their families. Pediatrics. 2003;11(3):164-166.<\/p>\n

2. Hefle SL, Furlong TJ, Niemann L, Lemon-Mule H, Sicherer S, Taylor SL. Consumer attitudes and risks associated with packaged foods having advisory labeling regarding the presence of peanuts. J Allergy Clin Immunol. 2007;120(1):171-176.<\/p>\n

3. Maloney JM, Chapman MD, Sicherer SH. Peanut allergen exposure through saliva: assessment and interventions to reduce exposure. J Allergy Clin Immunol. 2006;118(3):719-724.<\/p>\n

4. McIntyre CL, Sheetz AH, Carroll CR, Young MC. Administration of epinephrine for life-threatening allergic reactions in school settings. Pediatrics. 2005;116(5):1134-1140.<\/p>\n

5. Lieberman JA, Weiss C, Furlong TJ, Sicherer M, Sicherer SH. Bullying among pediatric patients with food allergy. Ann Allergy Asthma Immunol. 2010;105(4):282-286.<\/p>\n

6. Tulve N, Suggs JC, McCurdy T, Cohen E, Moya J. Frequency of mouthing behavior in young children. J Expo Anal Environ Epidemiol. 2002;12(4):259-264.<\/p>\n

7.\u00a0Sampson, M.A., Munoz-Furlong, A., Sicherer, S.H. Risk-taking and coping strategies of adolescents and young adults with food allergy. J Allergy Clin Immunol. 2006 Jun;117(6): 1440-5. Epub 2006 May 11<\/p>\n

8. Monks H, Gowland MH, MacKenzie H, et al. How do teenagers manage their food allergies? Clin Exp Allergy. 2010;40(10):1533-1540.<\/p>\n

9. Simonte SJ, Ma S, Mofidi S, Sicherer SH: Relevance of casual contact with peanut butter in children with peanut allergy. J Allergy Clin Immunol. 2003;112(1):180-182.<\/p>\n

10. Wainstein BK, Yee A, Jelley D, Ziegler M, Ziegler JB: Combining skin prick, immediate skin application and specific-IgE testing in the diagnosis of peanut allergy in children. Pediatr Allergy Immunol. 2007;18:231-239.<\/p>\n

11. Perry TT, Conover-Walker MK, Pom\u00e9s A, Chapman MD, Wood RA. Distribution of peanut allergen in the environment. J Allergy Clin Immunol. 2004;113(5):973-976.<\/p>\n

12. Nicas M, Best DJ. A study quantifying the hand-to-face contact rate and its potential application to predicting respiratory tract infection. J Occup Environ Hyg. 2008;5(6):347-352.<\/p>\n

13. Kim JS, Sicherer SH: Living with food allergy: allergen avoidance. Pediatr Clin North Am. 2011;58(2):459-470.<\/p>\n

14. Roberts G, Golder N, Lack G. Bronchial challenges with aerosolized food in asthmatic, food-allergic children. Allergy. 2002;57(8):713-717.<\/p>\n","protected":false},"excerpt":{"rendered":"

Type of Exposure Relevant Facts Practical Challenges Practical Interventions* Oral Exposure \u2022 There can be \u201chidden ingredients\u201d in foods. \u2022 Labels and ingredients can change without warning. [1] \u2022 Items with advisory labels can contain allergens.[2] \u2022 Trace amounts can cause severe allergic reactions. \u2022 Allergens can […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2257","page","type-page","status-publish","hentry"],"yoast_head":"\nSchools @ AllergyHome.org - Helping Schools Manage Allergies<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.allergyhome.org\/schools\/food-allergen-exposure-in-the-school-setting\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.allergyhome.org\\\/schools\\\/food-allergen-exposure-in-the-school-setting\\\/\",\"url\":\"https:\\\/\\\/www.allergyhome.org\\\/schools\\\/food-allergen-exposure-in-the-school-setting\\\/\",\"name\":\"Schools @ AllergyHome.org - 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