October 2004

“School Foodservice and Food Allergies: What We Need to Know” is a brochure for school foodservice professionals which discusses food allergy management in the school foodservice setting.  It provides background information on the Big 8 food allergens (milk, eggs, peanuts, tree nuts, fish, soy, wheat, and shellfish) and offers tips on how to read food labels for food allergen information.  It also explains the symptoms of a food allergic reaction and how food allergy differs from food intolerance, as well as what to do in a food allergy emergency situation.

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Allergies affect the lives of millions of people around the world. Pollen from trees, grasses and weeds, a friend’s cat or dog, even the presence of dust can make people itch, sneeze and scratch almost uncontrollably. But what about that seemingly innocent peanut butter sandwich, glass of milk or fish fillet? According to Pediatrics, approximately 4 to 8 percent of young children suffer from food allergies.

Strict avoidance of the offending food is important in the prevention of a food-allergic reaction. School foodservice personnel can help prevent food-allergic reactions in school-aged children by managing the menu and specific dietary requirements of students who have food allergies.

Food allergies can be life threatening. The following information is specifically designed to help school foodservice professionals manage food allergies in schools. This information will help school foodservice professionals to be aware of the big 8 food allergens (milk, eggs, peanuts, tree nuts, fish, soy, wheat, and shellfish) and will also provide information on how to identify these potential allergens on food labels.  In addition, this hand-out will enable explain school foodservice professionals to recognize the symptoms of a food allergic reaction and how this differs from a food intolerance, as well as what to do in an emergency situation.

What is a food allergy?

A food allergy is a reaction of the body’s immune system to a protein in a food. The reaction can be a serious, life-threatening condition and should be diagnosed by a board-certified allergist.

What are other food reactions or sensitivities called?

Other food reactions or sensitivities to foods are known as food intolerances. Food intolerances are reactions that are generally localized, temporary, and rarely life-threatening. The most common food intolerance is lactose intolerance—a reaction that involves the digestive system. If a child who is lactose intolerant eats or drinks milk, he or she may experience gas, bloating and in many instances, uncomfortable abdominal pain.

Which foods cause food allergies?

The eight most common food allergens—milk, eggs, peanuts, tree nuts (i.e., almonds, pecans, etc.), soy, wheat, fish and shellfish—cause more than 90 percent of all food allergic reactions.

The following is a sample list of ingredients and their commonly-used names, provided by the Food Allergy & Anaphylaxis Network (FAAN):

DID YOU KNOW?

It is estimated that upwards of 200 deaths occur in the U.S. each year due to a food allergy reaction.

Many products may include offending ingredients that may surprise you. For example, Worcestershire sauce contains anchovies and/or sardines—both are fish. Hot dogs and many deli meats may use milk or soy as binding agents. It is imperative that you read labels carefully, thoroughly and regularly as ingredients sometimes change. A comprehensive list of ingredients should be updated in your school cafeteria prep area on a regular basis.

What are the symptoms of food allergy?

Symptoms of food allergy differ greatly among individuals. Allergic reactions to food can vary in severity, time of onset, and may be affected by when the food was eaten.

Common symptoms of food allergy include skin irritations such as rashes, hives and eczema, and / or gastrointestinal symptoms such as nausea, diarrhea and vomiting. Sneezing, runny nose and shortness of breath can also result from food allergies. Some individuals may experience a more severe reaction called anaphylaxis.

What is anaphylaxis?

Anaphylaxis is a rare but potentially fatal condition in which several different parts of the body experience allergic reactions simultaneously. These may include itching, hives, swelling of the throat, difficulty breathing, lower blood pressure and loss of consciousness.

Symptoms usually appear rapidly, sometimes within minutes of exposure to the allergen, and can be life threatening. Immediate medical attention is necessary when anaphylaxis occurs. Standard emergency treatment often includes an injection of epinephrine (adrenaline) to open up the airway and blood vessels.

What should I do if I believe a student is having a food allergic reaction?

The first step is to implement the student’s food allergy action plan.

A free plan may be downloaded from FAAN’s website, www.foodallergy.org.

In an emergency situation, dial 9-1-1. Get medical assistance immediately!

It is important to know what to do in an emergency situation. Coordination among foodservice with the school nurse, principal, teachers, and the health care provider can make a difference in a child’s life. Develop and know your food allergy emergency plan today.

FOR SCHOOL FOODSERVICE PERSONNEL:

It is important for the school foodservice professional to be an integral part of the student’s food allergy emergency response plan. Here are a few suggestions of how to get involved.

Be included in meetings with the student who has food allergies, their parents, school nurse, teachers, principals, counselors and health care provider. Be able to recognize the student and become familiar with his or her emergency medical information and specific food allergy.

• Ask parents to provide you with a copy of the signed medical statement from the physician outlining appropriate meal substitutions.
• Know where emergency medications such as epinephrine (EpiPen ®) are stored and how they should be administered in case a student has an allergic reaction in the school cafeteria.
• Keep food allergy information in a handy place in case there are questions about any special diet.
• Learn how to read labels and review menus with parents of students who have food allergies to determine what if any, menu items need to be substituted.
• Avoid cross-contact of foods (which occurs when two foods come into contact with each other, causing their proteins to mix). Use separate utensils for jams, jellies, and peanut butter and wash them thoroughly with warm, soapy water.
• Work with a Registered Dietitian or other qualified nutrition specialist to manage dietary substitutions.

For additional strategies, see FAAN’s School Food Allergy Program, a multi-media program designed to assist schools with creating a policy for food allergy management. The program is free while supplies last. Contact FAAN for more details.

For more information on food allergies, recipes, and management plans, visit the following organizations.

School Nutrition Association (SNA)
www.schoolnutrition.org

Food Allergy and Anaphylaxis Network (FAAN)
www.foodallergy.org

International Food Information Council (IFIC) Foundation
www.ific.org