Transcript Managing Food Allergies in School Nutrition Programs

Institute of Child Nutrition
Managing Food Allergies in
School Nutrition Programs
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Topics for Today
 An Overview of Food Allergies,
 Reading and Managing Food Labels,
 Accommodating Students with Food Allergies,
 Avoiding Cross Contact, and
 Promoting Food Allergy Management in Your School.
Pre-assessment:
Test your food allergy
knowledge
Lesson 1: All About Allergies
All About Allergies
Objectives
 Describe a food allergy, its symptoms, and
treatments.
 Distinguish between food allergy and food
intolerance.
 Identify the major 8 food allergens.
 Demonstrate reading food
allergens on a food label.
What is a Food Allergy?
Food Allergy
An immune-mediated adverse reaction to a food
protein
Body’s Immune System
Body identifies a food protein as dangerous
creates antibodies (Immunoglobulin E (IgE)) against
the protein
EVEN A BITE can result in an allergic reaction.
How a Child Might Describe Symptoms
This food is too spicy.
My tongue is hot (or burning).
It feels like something is poking my tongue.
My tongue (or mouth) is tingling.
My tongue (or mouth) itches.
My mouth feels funny.
There is a frog in my throat.
There’s something stuck in my throat.
My lips feel tight.
My throat feels thick.
It feels like there is a bump on the back of my
tongue.
Allergic Symptoms
Trouble
swallowing
Shortness of
breath
Repetitive
coughing
Voice change
Nausea &
vomiting
Diarrhea
Abdominal
cramping
One or more symptoms
can occur within minutes
up to 2 hours and can be
MILD to SEVERE
Swelling
Hives
Eczema
Itchy red rash
Drop in blood pressure
Loss of consciousness
Death may occur
Anaphylaxis
A serious allergic reaction
Rapid in onset
May cause death
Food
Insect Venom
Medications
Latex
Medication to treat Anaphylaxis
An epinephrine autoinjector is used to treat
anaphylaxis.
Trade names for this
device include EpiPen,
Emerade, Twinject,
Adrenaclick, Anapen,
Jext, Allerject, and
Auvi-Q.
Picture courtesy of About.com
Reaction and
Epinephrine Concerns
 Where are the devices kept in the school; are they
accessible?
 Do you need to be trained to administer an
autoinjector?
 What if it inject the person, and they are not really
having an allergic reaction?
 How do substitutes know how to respond?
 Do the phones near you get an outside line to call 911?
 Will local EMTs have epinephrine when they arrive?
What is a Food Intolerance?
Food Intolerance
An abnormal physiological response to eating
Involves the Gastrointestinal System
 Food intolerance presents with symptoms affecting the skin,
respiratory tract, and gastrointestinal tract; individually or in
combination. Detrimental reaction (nausea, diarrhea, vomiting).
 Come on gradually, not life threatening, affect the body’s
organs
 Symptoms are often confused with food allergies.
Medical name: Non-allergic Food Hypersensitivity
Causes of Food Intolerance
 Absence of an enzyme to digest food
 Irritable bowel syndrome
 Food poisoning
 Sensitivity to food additives
 Recurring Stress
 Celiac Disease
Treatment is determined between the Licensed
Physician and the patient.
Celiac Disease
• An immune reaction in the small intestine only to eating
gluten, a protein found in wheat, barley and rye.
• There is no cure.
• Follow a strict gluten-free diet to manage symptoms and
promote intestinal healing.
• It is not considered life-threatening, but can have acute
neurological symptoms.
Food Allergy Background
 More than 3 million children have some type of food allergy.
 Prevalence of food allergies among children increased 18%
during 1997–2007.
 Allergic reactions to foods have become the most common
cause of anaphylaxis.(1,6)
 Food allergies affect an estimated 4%–6% of children in the
United States.1 (1, 2)
The Major 8 Food Allergens
Eggs
Milk
Peanuts
Fish
Tree Nuts Crustacean
Shellfish*
Soy
Wheat
Only one (1) way
to Prevent an
Allergic Reaction
Strict Avoidance
of Known Food
Allergens
Food Allergen Labeling and
Consumer Protection Act (FALCPA)
Food labels must declare major food allergens in
plain language: Milk, eggs, fish, shellfish, peanuts,
tree nuts, soy, and wheat
Either in the ingredient list by either of these two
methods:
“Contains” followed by the name
Example: “Contains: milk and wheat”
Parenthetical statement in the list of ingredients
Example: “albumin (egg)”
Label Samples
Contains…..
Parenthesis…
Recall Notifications
Subscribe to food
allergy recall notices
and a have system to
take action if you
serve the product
being recalled
www.foodsafety.gov
Precautionary Labeling
Not regulated
Not safe for people
with known food
allergies
“May Contain”
statement
“..made on
equipment that also
makes….”
Hide and Seek
Label Reading Activity
1. Work in small groups to read
product labels.
2. Identify major allergens in each
product and review food allergy
handout.
3. Select a spokesperson for the
group to share 2 observations with
the large group.
Lesson 1: All About Allergies
Review
 Describe a food allergy, its symptoms, and
treatments.
 Distinguish between food allergy and food
intolerance.
 Identify the major 8 food allergens.
 Demonstrate reading food allergens
on a food label.
What questions do you
have before we proceed?
Lesson 2: Reading and
Managing Food Labels
Objectives for Lesson 2
Discuss how to determine allergens
that are not the major 8, in bulk
items, and USDA foods.
Outline methods for managing food
labels.
Bulk Foods, USDA Foods, and
Not the Major 8 Allergens
 Read ingredient statements
 90% = Major 8
 SOP for handling bulk
 10% = Not Major 8
 Bulk and USDA – SAME
labeling requirements
 Examples:
 Prevent cross contact:
 Sesame
Multiple Lots
 Strawberries
Scooping out of bulk
 Mustard
Cleaning bulk containers  Sulfites
Strategies to Manage Labels and
Ingredient Lists
Communicating
Food Allergy
Label
Information
School Nutrition Staff
School Nurse
Students, Parents or
Guardian
Website , handouts,
other
Managing Allergies in a School
Video Clip
Lesson 2 Review
 Discuss how to determine allergens that are not
the major 8, in bulk items, and USDA foods.
 Outline methods for managing food labels.
Lesson 3: Accommodating
Students with Food-Related
Disabilities
Objectives for Lesson 3
 Review laws essential to accommodating
students with food allergies.
 Develop a food allergy action plan.
 Describe ways to work with distributors, brokers,
and manufacturers to purchase foods to meet the
needs of students with allergies.
Respect and Protect
Children with Food Allergies
 Civil rights and privacy must
not be violated
 Prevent a child with food
allergies from being singled
out
 Be alert to prevent and
address bullying from other
children and/or adults
Federal Laws
Rehabilitation Act
of 1973
Prohibits discrimination against qualified persons with
disabilities in programs or activities of any agency of
the federal government’s executive branch or any
organization receiving federal financial assistance.
[Examples of programs receiving federal assistance: National School
Lunch Program, School Breakfast Program, Fresh Fruit & Vegetable
Program, After School Snack Program]
Federal Laws (continued)
Individuals with
Disabilities Education Act
(IDEA) 1975, Part B 2006
Requires a free and
appropriate public
education be provided
for children with
disabilities aged 3-21.
Americans with
Disabilities Act (ADA) 1990
and 2008 Amendments
Broadens and extends civil
rights protections for
approximately 50 million
Americans with
disabilities.
Respect Privacy Laws
HIPAA
The Health Insurance Portability & Accountability Act (1996)
- Requires all medical records disclosed be kept properly
confidential.
- Gives the patient rights control how health information is
used.
FERPA
Family Educational Rights and Privacy Act (1974)
- Protects the privacy of health information entered into a
student’s record
Student’s Rights and Responsibilities
Rights
Be provided nutrition
services at school
without
discrimination.
Responsibilities
 Be proactive in allergy
avoidance.
 Notify adult if:
 Ingestion of known
allergen
 Bullying because of
allergy
Tools Schools Use to Implement
Laws
Individualized
Education
Plan (IEP)
504 Plan
(Section 504 of the
Rehabilitation Act of
1973)
Accommodating
Children with Special
Dietary Needs in the
School Nutrition
Programs
Guidance from USDA
http://origin.www.fns.usda.gov/cnd/Guidance/special_dietary_needs.pdf
Preparation is the
Key to Success
Recognize:
Know the symptoms of an
allergic reaction, who is
authorized to administer
medication and where the
medication is stored.
React:
Quickly administer medication
or call emergency services,
delay could result in deadly
consequences.
Review
After an allergic reaction
emergency, review with those
involved what went smoothly
and what needs
improvement.
Food Allergy Management Plan
Five (5) priority areas1(4):
1. Ensure the daily management of food allergies in
individual children.
2. Prepare for food allergy emergencies.
3. Provide professional development on food allergies
for staff members.
4. Educate children and family members about food
allergies.
5. Create and maintain a healthy and safe educational
environment.
Food Allergy Action Plan
1 (5)
Recommended for each child with a known food allergy
Strategies to Accommodate
Students with Food Allergies
STEP 1
 Menu planning, label reading, follow HACCP principles
STEP 2
 Know the requirements for serving food to
students with special dietary needs.
 USDA FNS Guidance for serving children
with disabilities and special dietary needs
in child nutrition programs
www.fns.usda.gov/cnd/guidance/special_dietary_needs.pdf
School Meal Requirements
 Schools must make substitutions in the
reimbursable meal for disabled students whose
disability prevents them from consuming the
school meal as prepared.
 No extra charge
 A disability determination can only be made by a
licensed physician.
Step 3
Licensed
Physician
The Partnership
Communication / Education
Child’s
Safety
Family
Parents
Child
School
Administrator
Nurse
School Nutrition
Faculty
Others
Step 4: Accommodating Students
with Food-Related Disabilities
Step 4
 Implement the directives in the Special Dietary Form
signed by a licensed physician.
 If the form indicates the student has a DISABILITY,
School Nutrition Services is required to make the
accommodation.
 If there is no disability, the accommodation is
optional.
Licensed Physician Provides
 5 Key Elements
 What the disability is
 How it restricts the diet
 Major life activity affected
 Food(s) to be omitted
 Food(s) to be substituted
Accommodating Students with
Other Food-Related Disabilities
Food Related
Disabilities
 Diabetes
Other
Accommodations
 Texture
 Phenylketonuria (PKU)  IV
 Food Anaphylaxis
 Celiac Disease
 Tube Feeding
Allergenic Foods Accommodating
Students Activity
1. Work in small groups to identify the allergens listed on
the product ingredient statements from three
manufacturers.
2. Record on the activity sheet which product can be
served to which student.
3. Select a spokesperson for the group to share 2
observations with the large group.
Communication with Key Partners
 Work with distributors, brokers, and
manufacturers to purchase foods to meet the
needs of students with allergies.
 Get specifications, ask for clarification, develop a
relationship with your key partners.
 TIP: When getting information for USDA Foods,
call the manufacturer, not USDA or the State
Agency.
Lesson 3 Review
 Review laws essential to accommodating
students with food allergies.
 Develop a food allergy management plan.
 Describe ways to work with distributors,
brokers, and manufacturers to purchase foods
to meet the needs of students with allergies.
Lesson 4: Avoiding Cross
Contact
Objectives for Lesson 4
 Distinguish cross contact from cross
contamination.
 Demonstrate strategies to avoid cross contact.
 Discuss strategies to manage food outside of
the cafeteria.
Cross Contact vs. Cross
Contamination
Cross Contact
 Allergen accidentally
transferred from a food
containing an allergen to
a food or surface that
does not contain the
allergen.
 Cooking does not reduce
or eliminate allergen.
Cross Contamination
 Microorganisms from
different sources
contaminate foods during
preparation and storage.
 Cooking does reduce or
eliminate
microorganisms.
Avoid Cross Contact – Potential
Sources
 Food handling and preparation
 Insufficient handwashing
 Insufficient cleaning
 Shared equipment and utensils
 Cutting boards, counters
 Griddles
 Splatter or steam from cooking
 Salad bars, buffets, serving stations
Avoid Cross Contact – Prevention
Ideas
 Color Coding
 Isolate ingredients containing allergens
 Individual preparation of menu items with
allergens
 Sticker or color code wrapped food
 Standard Operating Procedures for handwashing
and cleaning
 Include allergen risk assessment in the Food
Safety Plan based on HACCP
Standard Operating Procedures
Clean and Sanitize
Clean with soap, hot/warm water, and friction;
WILL REMOVE ALLERGEN RESIDUE
Sanitize to reduce microorganisms that cause disease;
WILL NOT REMOVE ALLERGEN RESIDUE
Write, train, follow, monitor, and verify SOPs
Examples of Sanitation SOPs
 Of particular importance for managing
food allergens.
 Examples:
 NFSMI’s HACCP-based Cleaning and
Sanitizing Food Contact Surface SOPs
 NFSMI’s Serving Safe Food to Student
with Food Allergies SOP
Food Safety Plan based on
HACCP
Biological
Bacteria
Viruses
Parasites
Chemical
Allergens
Pesticides
Sanitizers
Food additives
Physical
Plastic
Glass
Metal
Radiological
Heavy metals
Contamination
of water supply
GOAL: Control/prevent/minimize food safety
hazards that may cause illness or injury
Step by Step
Avoiding Cross Contact Activity
1. Work in small groups to put the
ingredients in order of preparation to
prevent cross contact.
2. Identify opportunities for cross
contact and consider if cross contact
could occur in your school.
3. Select a spokesperson for the group
to share 2 observations with the
large group.
4. Record findings on the handout.
Strategies to Manage Food from Outside
Sources and Outside the Cafeteria
Outside food
sources contracted
to serve in the
cafeteria
 Restaurants
 Caterers
Nutrition Services
food served outside
the cafeteria
 Breakfast in
Classroom
 Fresh fruit and
Vegetable Program
 After School
Program
Outside food sources
served outside the
cafeteria
 Pot lucks
 Classroom
projects
 Club/Sports
events
Reduce the Risk
Food from Outside Sources Activity
1. Work in small groups to determine how to provide services
to a child with known life-threatening food allergies.
2. Each group has a different child and a different
situation.
3. On the flip chart paper, record the actions
you would take to provide for the child.
4. Select a spokesperson from your group
to share the situation and the actions.
Lesson 4 Review
 Distinguish cross contact from cross
contamination.
 Demonstrate strategies to avoid cross
contact.
 Discuss strategies to manage food outside
of the cafeteria.
Lesson 5: Promoting Food
Allergy Awareness
Objectives for Lesson 5
Identify food allergy resources to
promote awareness in schools.
Outline Methods to Boost Food Allergy
Knowledge and Awareness
 Determine knowledge level and training
needs for school nutrition staff and school
colleagues.
 Verify process to respond to product recalls
due to allergens.
 Brainstorm what action to take after
attending this course.
 Identify food allergy resources.
Food Allergy Training
CDC Recommendations for Schools
 Provide professional development on food
allergies for staff
 Teach all children, parents, and families about food
allergies.
RESOURCES
USDA
CDC
RESOURCES (continued)
National Education Association
(NEA) Health Information Network
National School Boards Association
Managing Food Allergies in
Schools - Video Summary
Lesson 5 Review
Identify food allergy resources to
promote awareness in schools.
Roundtable Discussion
Gallery walk
Roundtable Discussion
Post-assessment
Test your food allergy
knowledge
Training Wrap-Up
 What questions may I answer for you?
 NFSMI Evaluation
 Make sure you sign the class roster
Institute of Child Nutrition
www.theicn.org
800-321-3054
[email protected]
National Food Service Management Institute
The University of Mississippi