Food allergies are abnormal immune responses to certain proteins in foods. The prevalence of food allergies among children has increased in recent decades. Reactions can range from mild hives to life-threatening anaphylaxis, which is treated with epinephrine. While schools are responsible for accommodating students with food allergies, families also have responsibilities like providing medical documentation and medications. Complete avoidance of allergenic foods is currently the only way to prevent reactions.

1. Food Allergy: Separating
Fact from Fiction
Stephanie Albin Leeds, MD
(Slides adapted from Mount Sinai Jaffe Food Allergy Institute)
March 31, 2016

2. Topics that will be covered:
-Food Allergy Basics
-Anaphylaxis Basics
-Myths and Facts

3. Food Allergy Basics
• A food allergy is an abnormal immune response to a food
protein.
• A food allergy results in an activation of the immune system
when a food protein is ingested, leading to the release of
histamine and other mediators to “attack” the food.
• A food allergy presents with allergic symptoms typically
within minutes to hours after ingestion.
• A food allergy can come from almost any food.

4. Increased Prevalence of Food Allergies
• From 1997 to 2007, the prevalence of reported food allergy increased
18% among children under age 18 years.1
• From 2004 to 2006, there were approximately 9,500 hospital
discharges per year with a diagnosis related to food allergy among
children under age 18 years.1
1. NCHS Data Brief; Food Allergy Among U.S. Children: Trends in Prevalence and Hospitalizations.
http://www.cdc.gov/nchs/data/databriefs/db10.pdf. Accessed February 17, 2016.

5. Food Allergies Can Be Life-Threatening
• There were about 2500 anaphylaxis-related deaths in the United States
from 1999-2010; most common cause was medication (58.8%), followed by
unspecified (19.3%), venom (15.2%), and food (6.7%)2 – however, food is
most common cause of anaphylaxis in pediatric population.
• It is estimated that up to 150-200 people die each year from food-induced
anaphylaxis.
2. Jerschow E, Lin RY, Scaperotti MM, McGinn AP. Fatal anaphylaxis in the United States, 1999-2010: temporal patterns and demographic
associations. J Allergy Clin Immunol. 2014 Dec;134(6):1318-1328.e7.

6. Food Allergy Basics
• There is no cure for food allergy– current research is looking
into immunotherapy (oral, sublingual, and epicutaneous), but
there are no FDA approved interventional therapies at this
point.
• Complete and strict avoidance is the only way to prevent a
reaction. Just one bite can cause a reaction.

7. Myth or Fact
Strawberries are a common cause of life threatening food allergy.

8. Common Food Allergens

9. Common Food Allergens by Age
Children
6% affected
Adults
3-4 % affected
Cow’s milk 2.5%
Egg 1.3%
Peanut 1%
Soybean
Wheat
Tree nuts
Fish
Shellfish
Peanut
Tree nuts
Fish
Shellfish
* Fruits and vegetables in
birch-allergic adults (25-75%)

10. Myth or Fact
If my child has only had hives upon eating peanuts, he does not need
to carry an EpiPen because he will not have a severe allergic reaction to
peanut.

11. Food Allergy Reactions
• Once a reaction begins, there is no way to know how severe it will
become
• Take all food allergic reactions seriously
• A previous reaction does not predict what your next reaction will be

12. Symptoms of a Food Allergic Reaction

13. Cutaneous Manifestations of Food Allergy

14. Myth or Fact
My egg allergic child with asthma accidentally ate some scrambled egg
and 15 minutes later developed wheezing but no other symptoms. I
should give him an EpiPen.

15. Anaphylaxis Basics
• Anaphylaxis is a severe, potentially life-threatening allergic reaction
1. Quick onset of hives/ swelling/ flushing
AND AT LEAST ONE OF THE FOLLOWING
• Respiratory symptoms (wheezing, coughing, difficulty breathing)
• Reduced blood pressure/ passing out
2. Two or more affected organ involvement after likely allergen exposure
• Skin (hives/swelling/flushing)
• Respiratory (wheezing/coughing/difficulty breathing)
• Cardiovascular (blood pressure drop)
• Persistent GI symptoms (recurrent vomiting)
3. Low blood pressure after ingesting a known allergen

16. Anaphylaxis Basics
• Symptoms can being within minutes or up to 2 hours after eating a
food
• For some people, symptoms will begin as soon as the food enters
their mouth, even if they don’t swallow the food
• Anaphylaxis does not result from smelling food- but it has been
reported from inhaling fumes during the cooking of allergen-
containing food

17. Anaphylaxis Treatment
• Intramuscular epinephrine- EpiPen or Twinject (all Auvi-Qs have been
recalled): PROMPT ADMINISTRATION IS KEY TO SURVIVING ANAPHYLAXIS.
FATALITIES HAVE RESULTED FROM A DELAY/FAILURE TO GIVE EPINEPHRINE.
• Call 911 and follow up in emergency department
• If patient is not improved 3-5 minutes after first epinephrine injection, give
a second injection while waiting for 911 responders
• 4 hour observation period

19. 3 Rs of an Anaphylaxis Plan
•Recognize symptoms early
•React quickly
•Review what caused the reaction
Every school should have a plan for managing allergies!

20. Myth or Fact
My child has food allergies and it is entirely the school’s responsibility
to make sure that they are safe from allergic reactions at school.

21. Avoid Accidental Exposure
• Read labels…foods, art supplies, soaps
• Prevent cross contamination in the classroom or lunch room
• Clean hands before and after eating or handling food with soap and
water- hand sanitizers do not remove allergens
• In the classroom, serve allergen free foods first-with clean hands or
clean utensils
• Plan for safe parties/celebrations/field trips
• Prohibit food trading and sharing

22. Family’s Responsibilities
• Provide written medical documentation
• Provide properly labeled medications and replace after use or
when expired
• Keep emergency contact information up to date
• Teach the child age-appropriate self management skills
• Work with school to develop a plan

23. School’s Responsibilities
• Create an environment where children, including those with food
allergies, will be safe and included
• Employ prevention and avoidance strategies
• Be prepared to handle an allergic reaction- create a plan
• Address teasing/bullying

24. Prepare for the Accidental Exposure
• Know the symptoms of an allergic reaction
• Review all emergency procedures and be sure you know when and
how to administer medications
• Keep information about your allergic student someplace where a
substitute will immediately be aware of it
• Test your food allergy plan- have a drill

25. Resources
The Food Allergy Research and Education
800-929-4040
www.foodallergy.org
The Food Allergy Initiative
212-207-1974
www.faiusa.org
Westchester Health Associates- Allergy and Immunology
1600 Harrison Avenue 281 Garth Road, Suite A
Mamaroneck, NY 10543 Scarsdale, NY 10583
914-777-1179 914-472-3833