For educators and school staff, Food Allergies in Schools focused on: 1. Facts about Food Allergies 2. Food Intolerances and Allergies 3. How to Figure Out Safe Foods 4. Avoiding Cross Contact Contamination 5. Creating a Food Allergy Plan of Action

1. Food Allergy Research & Education (FARE)
Nebraska Extension
Food Allergies – Keeping Children Safe at School

2. Do you have a food allergy?

3. Do you have a family member or friend
with a food allergy?

4. Do you have a student in your classroom
with a food allergy?

7. 15 million

8. Includes
5.9 million children (1 in 13)

9. Putting Food Allergies
Into Perspective
If the food allergy community
were a state, it would be the 5th
largest state in the U.S. by
population!
The number of people with food
allergies in the U.S. is greater
than the entire populations of
New York City, Los Angeles,
and Chicago combined!

10. Food Allergy Facts:
• Food allergies among children
increased approximately 50% between
1997 and 2011.
• The economic cost of children’s food
allergies is nearly $25 billion per year.
• Allergies to peanuts, tree nuts, fish or
shellfish are generally lifelong allergies.
• Cow’s milk, egg and soy allergies
typically begin in childhood and
eventually may be outgrown.

11. Food Allergy Basics
• A food allergy is an abnormal
response by the immune
system to a food protein.
• When the food is eaten, the
immune system releases
histamine and other
chemicals to “attack” the food.
• This results in the symptoms
of a food-allergic reaction.

13. Food Intolerances
• Digestive system
response
• More common than
food allergies
• Easy example would be
a lactose intolerance

15. Symptoms of Food
Intolerances
• Nausea
• Stomach pain
• Gas, cramps, bloating
• Vomiting
• Diarrhea

16. Gluten Intolerance
• Celiac sprue, Nontropical
sprue; Gluten-sensitive
enteropathy
• Condition that damages the
lining of the small intestine.
• Most avoid gluten - wheat,
barley, rye, and possibly
oats

18. What does it mean to have a
food allergy?
• No cure for food allergies
• Allergic reactions begin within minutes or up to two
hours after the food is eaten
• Anaphylaxis
• Food allergy, stinging insects, medication, and
latex allergy
• Epinephrine
• Biphasic reactions

19. How is a food allergy
diagnosed?
• Interview with an board-certified allergist or primary
care doctor
• Two most commonly used tests:
• Prick skin test
• Blood test
• Other tests:
• Oral Food Challenge
• Elimination Diet

20. Food-allergic reactions occur within
what time period after ingestion?
Reactions can happen in minutes, days or hours,
depending on the severity of the allergy.

21. Symptoms of Food Allergies

22. What is Anaphylaxis?
• Serious allergic reaction
• Rapid in onset
• Can cause death
• Requires immediate medical treatment
• Involves multiple systems in the body.

24. Epinephrine
• Epinephrine is the only medication that can
reverse the symptoms of anaphylaxis.
• Antihistamines should not be used to treat
anaphylaxis, but can be used for localized
reactions, such as hives.
• Prompt administration of epinephrine is
critical
• Epinephrine is prescribed as an auto-
injector devise
• Epinephrine is a safe drug, with the risks of
anaphylaxis outweighing any risks of
administering the medication

25. How a Child Might Describe a
Reaction
• “This food’s too spicy.”
• “My tongue is hot.”
• “It feels like something’s poking
my tongue.”
• “It (my tongue) feels like there is
hair on it.”
• “There’s a frog in my throat.”
• “ It feels like there are bugs in
there.” (to describe itchy ears)

26. Major Food Allergies

27. Wheat Allergy
• Wheat allergy is most common in
children, and is usually outgrown
before reaching adulthood, often by
age three.
• Look for alternate grains such as
amaranth, barley, corn, oat, quinoa,
rice, rye, and tapioca.
• Wheat has been found in some brands
of ice cream, marinara sauce, play
dough, potato chips, rice cakes, turkey
patties and hot dogs.

28. Peanut
• One of the most common food
allergies.
• About 25-40% of people who have
peanut allergy also are allergic to tree
nuts.
• Peanuts and tree nuts often come into
contact with one another during
manufacturing and serving processes.
• Peanut allergies tripled from 1997-
2008. 20-25% of those children do
outgrow it.

29. Eczema Hives Asthma Runny nose
Digestive symptoms Anaphylaxis

30. Tiny Little Peanuts Can Trigger
• 1/250 of a peanut is enough to trigger a reaction (cutting
a peanut in half 125 times!)
• High cross-reactivity to tree nuts (almonds, walnuts, etc.)
• Peanut or tree nut allergies and asthma appear to
increase the risk for fatal reactions. Estimated that at
least ½ of deaths are result of peanut/tree nut
• Reaction may occur in minutes OR hours – so it’s not just
a lunch-room event.

31. Tree Nut
• Tree nuts include, but are not limited to,
walnut, almond, hazelnut, cashew,
pistachio, and Brazil nuts.
• These are not to be confused or grouped
together with peanut, which is a legume, or
seeds, such as sunflower or sesame.
• Tree nut proteins may be found in cereals,
crackers, cookies, candy, chocolates,
energy bars, frozen desserts, marinades
and barbeque sauces.

32. Milk
• Most common food allergy in infants
and young children.
• Nearly all infants who develop an
allergy to milk do so in their first year
of life. Most children eventually
outgrow a milk allergy.
• Individuals who are allergic to cow’s
milk are often advised to also avoid
milk from other domestic animals like
goats.

33. Milk might be found:
• Deli meat slicers
• Some brands of canned tuna fish
• Many non-dairy products
• Some specialty products made
with milk substitutes are
manufactured on equipment
shared with milk
• Some processed meats

34. Egg
• One of the most
common food
allergies in children.
• Sometimes found in:
baked goods, egg
substitutes, lecithin,
macaroni, marzipan,
marshmallows,
nougat and pasta.

35. Soy
• Allergy to soy generally occurs early in childhood and
often is outgrown by age 3.
• People with a soy allergy are not necessarily allergic to
other legumes.
• Soybeans and soy products are found in many foods:
baked goods, canned tuna and meat, cereals, cookies,
crackers, high-protein energy bars and snacks, infant
formulas, low-fat peanut butter, processed meats,
sauces, and canned broths and soups.

36. Fish and Shellfish
• Finned fish and shellfish do not come from related
families of foods, so being allergic to one does not
necessarily mean that you must avoid both.

37. Other Allergies
• A person can be allergic to virtually any food.
• Allergic reactions have been reported to:
• Corn
• Gelatin
• Meat (beef, chicken, mutton, and pork)
• Seeds (sesame, sunflower, and poppy being the most
common)
• Spices (caraway, coriander, garlic, mustard, etc.)
• Other common causes of severe reactions include:
• Medications
• Latex
• Insect Stings

40. Day-to-Day Avoidance Tips
• Strict avoidance of the food
• Careful and constant label reading
• Avoid cross contact
• Minimize risks in classroom setting

41. Label Reading
• Read every
ingredient statement
• Ingredients can
change
• Use the toll-free
number on products
• Websites many not
be up-to-date

42. Which of These Contains
Milk?
• Sherbet
• Hot dogs
• Cake mix
• Non-dairy
creamers
• Tuna fish
• Quick breads
• Gravy mixes
• Sauces
• Dips
• Chocolate
• Margarine
• Luncheon meat

43. Ingredients in Unexpected
Places
• Food examples:
• Sauces
• Hot dogs and deli meats
• Imitation butter flavor
• Potato chips/ popcorn/ rice cakes
• Water-added hams
• Low-fat peanut butter
• Read all food labels very carefully!

44. Ingredients in Unexpected
Places
• Other examples:
• Animal pellet food
• Beanbags
• Birdseed mixtures
• Tropical fish food
• Hermit crab food
• Read all labels very carefully!

45. Craft Supplies
• Soaps – may contain milk,
wheat, soy or nut extracts
• Dried pasta – contains wheat
and may contain egg
• Crayons – may contain soy
• Finger paints – many contain
milk or egg whites
• Modeling clay – may contain
wheat

50. “Contains” Statements

51. “Contains” Statement Policy
 Only required for allergens not clearly stated
in the ingredient list.
 Chef Boyardee Pizza

52. Warning Labels
May also say “manufactured in
a facility that also processes
peanuts”

54. Ingredients: ENRICHED FLOUR
(WHEAT FLOUR, NIACIN, REDUCED
IRON, THIAMINE MONONITRATE
{VITAMIN B1}, RIBOFLAVIN {VITAMIN
B2}, FOLIC ACID), SUGAR, PARTIALLY
HYDROGENATED SOYBEAN AND/OR
LIQUID SOYBEAN OIL AND/OR
PARTIALLY HYDROGENATED
COTTONSEED OIL, HIGH FRUCTOSE
CORN SYRUP, GRAHAM FLOUR,
BROWN SUGAR, COCOA
(PROCESSED WITH ALKALI), BAKING
SODA, CORNSTARCH, SALT,
CHOCOLATE, MILK (ENZYME
MODIFIED), NATURAL AND
ARTIFICIAL FLAVOR, SOY LECITHIN
(EMULSIFIER).

56. Cross Contact
• Cross contact occurs when proteins from
one food are transferred to another food
through:
• Food preparation tools
• Work surfaces
• Breading
• Fried foods
• Spatter or steam from cooking foods
• Unclean hands or gloves
• Double dipping into jars

57. Causes of Accidental
Exposures
• Not reading ingredient
label to be sure food is
allergen-free
• Cross-contact during
cooking
• Food trading
• Inaccurate labeling

58. Minimize Risks
• Ask parents to provide a complete lists of foods
and ingredients to avoid
• Prepare food for the child with allergy first
• Designate two people responsible
• Designate a shelf in the pantry/ refrigerator
• Keep “safe” snacks/ nonperishable “safe” lunch

59. Minimize Risks
• Create an allergy-free
table
• Place “neat-eaters” by
the child with allergies
• Discourage trading
food
• Wash hands with soap
and water after eating

61. U.S. Federal
Government
Releases
Guidelines for
Food Allergy
Management in
Schools and Care
Centers

62. Create a Plan
• Have clear medication instructions from the child’s
parents and doctor
• Have written procedures/ post emergency numbers
• Practice your plan/document trainings
• Check medications regularly
• Get medical help immediately
• Evaluate plan after a reaction occurs

63. Create a Plan
• 3 Rs for handling an allergic
reaction
• Recognize the symptoms
• React quickly
• Review what caused the
reaction and how well the
emergency plan worked

64. Be Prepared
• Practice injection technique using an auto-injector
trainer
• Review Food Allergy & Anaphylaxis Emergency Care
Plan frequently
• Every state in the U.S. has legislation in place allowing
students, with appropriate consent, to carry their
prescribed epinephrine at school.

65. Minimizing Liability
“The best protection against liability is to focus on risk
reduction, not waivers.”
Ellie Goldberg,
Education Rights Specialist

66. Minimizing Liability
• A food allergy is considered a disability under the
law
• Students that have certified food allergies do not
need to receive all meal components.
• Schools may not charge more for meals for children
with a certified food allergy for meals or snacks
• Federally funded food programs
• Signed medical statement

67. Minimizing Liability
• Meet with the parents
• Speak to school staff
• Meet with emergency medical
personnel
• Create a written plan
• Best protection against
liability is staff training and
education
• Teach the children
• Accidents are never planned;
develop a plan for handling
them before you need them

68. Create a Positive Climate
• Make children feel secure and
safe
• Address bullying
• Avoid isolation
• Have clear rules and
expectations
• It’s NOT OK to share food!
• Strategies to reduce exposure
to allergens

69. Resources:
• Food Allergies and Anaphylaxis, The Food Allergy and
Anaphylaxis Network
• Food Allergy Training Guide for Restaurants and Food
Services, The Food Allergy and Anaphylaxis Network, 2004
• Child care and Preschool Guide to Managing Food
Allergies, The Food Allergy and Anaphylaxis Network, 2005
• (www.foodallergy.org)
• Managing Food Allergies in Schools – The Role of School
Teachers and Para-educators, National Center for Chronic
Disease Prevention and Health Promotion, 2013
• Managing Food Allergies in Child Care, National Food
Service Management Institute, University of Mississippi,
2014

70. Questions?

71. Extension is a Division of the Institute of Agriculture and Natural Resources at
the University of Nebraska–Lincoln cooperating with the Counties and the
United States Department of Agriculture.
University of Nebraska–Lincoln Extension educational programs abide with the
nondiscrimination policies of the University of Nebraska–Lincoln and the United
States Department of Agriculture.
Amy Peterson MS RD
Extension Educator – Polk County
amy.Peterson@unl.edu

72. Extension is a Division of the Institute of Agriculture and Natural
Resources at the University of Nebraska–Lincoln cooperating with the
Counties and the United States Department of Agriculture.
University of Nebraska–Lincoln Extension educational programs abide
with the nondiscrimination policies of the University of Nebraska–
Lincoln and the United States Department of Agriculture.