Latest News in Effective School Allergy Management: Your Questions, Answered

WEbinarWEDNESDAYfinalLast month’s allergy webinar, “Latest News in Effective School Allergy Management,” was extremely popular; the response was wonderful—thanks to all who were in attendance! We had so many folks submitting questions during the 15-minute Q-and-A session at the end of the webinar that we didn’t have time to answer them all, but we know this information is important to you so we got in touch with one of our webinar moderators to help us answer the remainder of the questions. Many thanks to Sherry Coleman Collins, MS, RDN, LD, for taking the time to help us answer all of your questions about managing food allergies in schools!

If you missed the live presentation, you can access the archived allergy webinar online. Thanks again to all who participated!

Question #1: I have students who have allergies to a lot of foods: canned food, beef, pork, milk products, tomato products, soy, fish, shellfish, and nuts. I’ve noticed that many school products have soy in it, so having choices on hand to offer variety is very difficult. Big packaging of items also is difficult when these are not on the menu. What advice do you have for those of us facing this issue?

A lot of people want to know what to do when you have a child that’s allergic to many foods. It’s almost always possible to find a variety of foods that a child can eat safely; focusing on foods that are naturally free of the allergen or food is the key. For instance, when working to eliminate gluten, foods like fruits, vegetables, peanut butter, and fresh meats area all naturally gluten-free. Sometimes—and Cindy mentioned this during the webinar—the answer is going to be supplementing that child’s lunch or breakfast with food from home.

Question #2: Do you get a lot of questions from parents/nurses about food packaging that may have the voluntary statements about whether or not allergens happen to be present in the manufacturing facility? And how do you stress to the staff that it is important to check labels for all product substitutions?

Precautionary labeling, which is what this describes, is voluntary and is not standardized. Manufacturers must include those ingredients that are intended to be in a product, but not those that may be unintentionally included. However, manufacturers use good practices to help eliminate the chance of cross contact. Precautionary labeling should be considered, but it’s important to recognize the limitations.

First, communication is important. Communicate everything on the menu to the customer, which includes the parent, the student, and the staff. Make sure information is available and accessible in some way; online, or in the central office or manager’s office. Online is the easiest way, but not every small district will be able to do that.

Training is also important. The question is how do you get the information out there, but you also have to think about what to do with that information. Whether it’s the kitchen staff, the school staff, or the parent, they need to know what to do once they have the information. With the staff—especially the food service staff—making sure they understand how to read a label, and then what to do when they have read a label and found something that shouldn’t be served to the child.

Thinking further, what about foods that are processed “in a facility with” [allergens]—what do you do with that? The answer is that the risks with those foods are not as well-known. If a child has a food allergy, to the degree that you can, you must avoid the foods that are manufactured in the facility [with known allergens].

Question #3: What do you offer food allergic students during Grab & Go breakfast? And where is breakfast eaten?

It goes back to thinking about foods that are naturally allergen-free, and it’s always going to depend on what the child is allergic to; managing allergies is a child-to-child issue, because allergies are so very individual. If the child is allergic to something like eggs and milk, they could have a peanut butter and jelly sandwich for breakfast; as long as the bread is milk and egg free, that’s a safe food. Conversely, if the child is allergic to peanut butter, they could have milk and eggs for breakfast! It’s about making things as straightforward as possible, sticking with foods that are less processed; the shorter an ingredient list, the easier it is for an individual with food allergies to navigate.

Question #4: I have a student with both a wheat and a milk allergy. Do you have any suggestions for breakfast/lunch entrees outside of soy milk with rice crispy cereal and chef’s salads without a roll?

Thinking outside the box is important. Does a child need a “traditional” breakfast food or could you serve something else? Working with that child, depending on their age and food sophistication, it’s not like you’d be making special meals for twenty kids—you’re making a special meal for one child. Managing that one child’s needs can seem overwhelming to a certain extent, but keep it in perspective—it is one child, and I think that with advance planning it will get easier to have something safe for that child to eat, each time they visit the cafeteria.

As far as where students eat their meals, it doesn’t really matter where students eat—in the classroom, the cafeteria—it’s a matter of cleaning and sanitation. If they are in a shared space, or at their desk in the classroom, it doesn’t matter as long as it’s cleaned before and afterward, and you’re going to be doing that anyway; when you’re making something clean, you’re making something safe [for a child with allergies].

Question #5: When you use the point-of-sale to list a student’s allergies, do people generally include only the life-threatening ones?

I think—what Cindy said during the webinar, and in my experience—is that often times they do both, but the way they do it might be different. In most POS systems you can set up an “Alert” or you can set up a “Note.” With life-threatening allergies we often see them categorized as “Alerts” and the screen flashes red when the notice comes up—that triggers the person who sees it that it’s a big deal, and to pay attention. A note might be a preference, or a non-life threatening situation like when a student wants to avoid something; also, when you don’t have documentation but you’ve heard through someone—the child, or someone else—that the child does have an allergy, but you don’t have anything official, I’ve seen that go in as a note.

Question #6: What should you do about labels that claim “no allergens”?

I’ve never seen that, and in fact there is a law called the Food Allergy Labeling and Consumer Protection Act that requires manufacturers to include allergen information; if the food contains an allergen, it must be on the label. However, a manufacturer may claim the food doesn’t contain the “big eight” major allergens. This could certainly be the case, but it’s important to recognize that nearly 200 different foods have been claimed to cause allergic reactions. Knowing what food allergies exist in your student population is important, and every allergy should be taken seriously.

Question #7: How do you handle the difference between allergy and intolerance, especially regarding milk?

Allergic reaction can cause serious reactions, whereas intolerances will only cause discomfort. You want to avoid both, but they are not of equal risk to students. When you have a medical note about the condition, you are required to accommodate both.

Question #8: Do either of you request annual updates to the student’s Medical Statement to Request Special Meals and/or accommodations, even if there might not be any changes?

A lot of districts request them every year, and if they don’t get them they will follow-up with the parents to see if there have been any changes. If the parent says there are no changes, but we haven’t been to the doctors, the districts continue the same protocols they have in the past. Sometimes it can be expensive, and especially in low-income areas, families don’t go to the doctor every year; it’s ideal for health of the child if they can, but that can’t always happen. No matter what we do in a school environment, it’s best to err on the side of caution for the child with allergies. In my experience we follow protocol from the year before, and update when we receive new information.

Question #9: What is suggested for Provision 2/CEP schools who don’t use point-of-sale, to be able to identify students with allergies as they come through the line?

That was something Cindy was talking about [during the webinar]. That can be a real challenge. You can certainly use a roster, and try to identify the children that way. With older kids it’s a little easier, because they know their allergy and they are much more self-sufficient with management; having an allergen-based meal for them, and having it be easily identified—maybe with a differently-colored bag or colored tape or sticker—they only need to request it when they come through the line.

With younger kids, if you know you have children who are very young and will participate in grab-and-go, or Provision 2 meals, one way to manage that is to have those children receive their meals in a different location that is more easily monitored; you can have a point-of-sale or a roster specifically for those children [with allergens].

Question #10: How do you handle students who claim to be allergic to gluten?

There is no test to test for gluten allergy at this point, so it’s tough to talk about “gluten allergies,” although our knowledge about allergies is always changing and growing. Every claimed allergy goes back to appropriate documentation. If a student has documentation from a doctor that they are allergic to any food, as a school nutrition program you have a responsibility to follow that. You may disagree with something that is written down, but if they have documentation from a physician about an allergy, you have to treat the child according to that.

Question #11: Do either of you have board policies written that address the key areas you discussed during the webinar? Is there language in your School Wellness Policies as well that you can share?

  1. Portland Public Schools Administrative Directive on Life Threatening Allergies
  2. Spokane Public Schools Nutrition Services: Allergies—Life Threatening
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