School Nutrition Association

Milk, Eggs, Peanuts…Oh My!

Lesley Baradel, RDWesley Johnson, JD

Objectives

1. Food Allergies basics2. Current Laws and Regulations3. Implications for School Nutrition and Food 

Allergy Management

National Peanut Board

• Farmer-funded • $9 million for food

allergy research, education and outreach

• Scientific Advisory Council

• Registered Dietitian

www.nationalpeanutboard.org

Food Allergy

Food Allergy• Immune response• May effect multiple organ

systems– Gastrointestinal (GI)– Skin– Respiratory– Cardiovascular

• Can be deadly• Diagnosed by proper testing

by board certified allergist• Exercise-induced food

allergy

How Many People Have Food Allergies?

What do you think?• Adults – More than 3%• Children – About 6%What are the most common for

children?• Milk – 2.5%• Egg – 1.5-3.2%• Peanut – 1.2%

2. American Academy of Allergy, Asthma and Immunology. Available at: http://www.aaaai.org/media/statistics/allergy-statistics.asp#foodallergy

Common Food Allergy Reaction Symptoms

• Gastrointestinal – itchy mouth or throat, abdominal pain, nausea, vomiting, diarrhea

• Eye – Itching, watering, swelling• Skin – Hives, swelling, atopic dermatitis

(eczema)• Respiratory – Wheezing, repetitive cough,

laryngeal edema (swelling of the lips and throat), runny nose

• Generalized – Anaphylaxis*• Biphasic Response

*Anaphylaxis may involve several of the symptoms listed above and may also involve difficulty breathing, a drop in blood pressure, or loss of consciousness.

5. FAAN. Symptoms. Available at: www.foodallergy.org/page/symptoms1

What about the smell?

• Reports are anecdotal (self-report)• Studies have not reproduced life-

threatening reactions via inhalation or skin contact

• Hay fever-type reactions are possible

• Ingestion of the allergen has the potential for life-threatening anaphylactic reaction

6. Simonte SJ, et al. JACI 2003; 112:180-2. Available at: http://www.jacionline.org/article/S0091-6749%2803%2901120-5/abstract

The BIG 8

1. Milk2. Egg3. Peanut4. Tree Nut5. Fish6. Shellfish7. Soy8. Wheat

Where are the Big 8?

Why the Increase?

• Hygiene Hypothesis?• Environmental?• Food Processing?• Vitamin D Deficiency?• We don’t know.

“I’m not dirty, I’m challenging my immune system!”

Why not just ban ______?

• Not recommended– False sense of security– Focuses on enforcement, not education– Liability

• Where do you stop?• Who decides?• Customer service

School Allergy Management Guidance

• Food Allergy & Anaphylaxis Networkwww.foodallergy.org : School GuidelinesEveryone has a part to play:– Student– Parent– School

Team Approach is Essential

• Student• Parent• Teacher• Administrator• Foodservice Manager• School Nurse• Custodial Services• Lunchroom Monitors• Bus Driver/Transportation• ASP

Who Else?

Keys Include

• Collaborative Team Approach• Communication• Documentation• Emergency Action Plan• Training Everyone• Emergency Medication Availability• Comprehensive Management Plan• Foodservice – Plans, Training and Implementation

Food Safety in Schools

HACCP & SOP

• Food allergy managementeasily fits into HACCP– How is cross-contamination/cross-

contact currently prevented?– What separation techniques are currently

used?– Has staff been trained to wash hands

and change gloves between tasks?– What standard operating procedures

(SOP) exist or need to be written?

Preventing Cross-Contact

• Hand washing• Handling food allergens

– Receiving – On-site champion– Designate areas for:

• Storage• Preparation• Cooking• Service

– Prep potential allergens at the end of scheduled prep time

Cleaning Essentials

What About Cleaning?• Detergent and friction are adequate for removal on:

– Surfaces– Hands

*Sanitizer does NOT remove allergens*• Separate cleaning, if you have separate tables• Train staff

7. Perry TT, et al. JACI 2004; 113:973-6. Available at: http://www.inbio.com/US/images/pdfs/123_Perry_JACI_2004.pdf

Reaction Do’s

• Even if you do everything right, accidental exposure CAN happen

• Take every reaction seriously!• Respond immediately – follow the

Emergency Action Plan, such as– Call 911– Administer EpiPen or other

Emergency Medication

Resources

• Food Allergy Research & Education www.foodallergy.org

• School Nutrition Association www.schoolnutrition.org

• National Association of School Nurses www.nasn.org/ToolsResources/Anaphylaxis

• National Peanut Board www.nationalpeanutboard.org

Legally Speaking• Section 504 of the Rehabilitation Act of 1973 (Section 504)

• Mental or physical impairment that substantially limits a major life activity of ____

• Mitigation (epi‐pens, exposure limits, etc.)• Episodic conditions• Not all cases qualify – case by case analysis!

Is an Individual Health Plan Sufficient?

• Torrington (CT) Board of Education, 60 IDELR 295 (OCR 2012)

• Allergies = Assessment for Section 504 eligibility

• Not substantially limiting?  IHP sufficient• Substantially limiting?  Section 504 Plan• IHP can be major component of plan• Evaluation?

The Doctor’s Role

• Accommodating Students With Special Dietary Needs (USDA, 2001)

• Guidance for Food Staff• 7 CFR Part 15b –Physician’s Statement Required for Food Substitutions or Modifications

Discrimination Claims

• 34 CFR 104.4(a)• Districts cannot discriminate against students on the basis of their disability, exclude,  them from participating in or deny them the benefits of the school program

• Protective measures in all areas• Washington (NC) Montessori Public Charter, 60 IDELR 79 (OCR 2012)

Free, Appropriate Education

Must You Accommodate Every  Request?

• A.M. ex rel J.M. v. NYC Dept. of Educ., 112 LRP 3144 (E.D.N.Y. 1/17/12)

• Requested accommodation – heating child’s food in microwave

• Legal standard:  “Meaningful access to programs and services”

• Individualized determination!

Proactive Responses

• Individualized Planning + Generalized Planning• How to Handle Classmates?• If you put it into the Plan then you must implement!

• Allergy Free?  • Compare:

– Catoosa County (GA) School District, 57 IDELR 141 (OCR 2011)

– Virginia Beach (VA) City Public Schools, 59 IDELR 54(OCR 2012)

OCR on Disability Based Harassment 

• Dear Colleague Letter, Oct. 26, 2010• Previously – no deliberate indifference• Now – Proactive response• ID nature of the conduct• Harassment based on disability?• Steps to eliminate hostile environment, address its effects, take steps to ensure there is no recurrence

What Next?

• Universities facing ADA complaints

• Lesley University – DOJ Settlement over mandatory meal plan

• University of Washington, Tacoma –peanut/nut free classroom signs

Questions?