Practice Consideration
Most accidental food allergy exposures occur within the home. However, literature reports age-related variations in the occurrence of accidental exposure outside the home, highlighting different challenges across life stages.
Managing food allergies outside the home requires careful preparation. A key aspect of this preparation is ensuring that the emergency management plan is well understood, including:
- Recognizing the signs of an allergic reaction
- Ensuring that emergency medications, particularly epinephrine (which is temperature-sensitive), are accessible and properly stored.
First, make sure the emergency management plan is understood, including:Common environments to review include restaurants, schools, athletic activities (e.g., soccer practice), social events (e.g., playdates or art classes), holidays, and travel (both domestic and international). Tools such as the Food Allergy Passport, available in both print and web formats, can assist children, primary caregivers (e.g., parents), and secondary caregivers (e.g., babysitters, grandparents) in managing food allergies outside the home. Additionally, Food Allergy Chef Cards are valuable communication tools, available in multiple languages through FARE, that can help mitigate risk by providing clear and concise information to restaurant staff. Registered Dietitians (RDs) and accredited practicing dietitians (APDs) often recommend printing multiple copies of these cards so that servers can carry them through the food preparation process, thus ensuring accurate communication with kitchen staff. Some hotels and resorts also employ this system to enhance safety.
School-Specific Considerations: In the U.S., schools are guided by voluntary food allergy guidelines, which can vary significantly by school or district. A 504 plan, available under civil rights law (Section 504 of the Rehabilitation Act of 1973), offers a formalized food allergy management plan for students in public and private schools.
It is important to set age-appropriate expectations. More information can be found here. For example, a 3 year old can be told he cannot eat something because it can make him very sick, but Mom will make sure he doesn’t miss out by providing a replacement.
Effective communication is crucial, as is assessing the child’s ability to advocate for themselves in different environments (e.g., whether they feel comfortable speaking up to teachers or in front of peers). Adolescents and teenagers are at higher risk for fatal reactions due to risk-taking behaviors and increased independence. It is essential that they understand the management plan and that their support team is aligned with it.
Consider individual personality differences as well; some children may confidently advocate for themselves ("I’ll check with my mom before I eat that"), while others may accept risky foods due to social pressures (e.g., prioritizing the enjoyment of a cupcake over the potential risk).
Every caregiver or environment change, such as teachers, substitute teachers, school nurses, bus drivers, and field trip supervisors, should be made aware of the food allergy and the associated emergency response plan.
College age
- College Resource Center – FAACT
- Preparing for College – FARE
- FAACT Teen Retreat
- FAACT Camp Tag (for ages 4-13 years)
Early Childhood Considerations: Preschools and daycare centers are only required to comply with 504 regulations if they receive federal funding. Allergy-free classrooms, lunchrooms, or schools are especially critical for this age group, as food allergens can more easily be transferred from unclean or partially cleaned hands to shared toys, leading to increased risk of accidental exposure.
Travel Considerations: When traveling, it is essential to bring familiar, safe foods for both travel and vacation days. Avoid consuming new or unfamiliar foods before flights. Always carry multiple sets of epinephrine auto-injectors (at least 2) or nasal epinephrine sprays (available as of September 2024 in the U.S. and Europe) to cover potential loss, damage, or use during an emergency. All emergency medications should be kept on your person, not in luggage or storage compartments. Prior to travel, identify nearby emergency rooms or urgent care facilities as part of emergency planning, which can be life-saving.
Holiday Considerations: During holidays, factors such as an abundance of new foods, crowded emergency rooms, and adverse weather conditions should be taken into account. Food poisoning risks from poorly temperature-controlled buffets should also be considered.
Social Expectations: Social settings can be fluid, and it is important not to attend or remain at events where you do not feel safe. There is no obligation to eat if it does not feel safe, and communication of needs should be simple and clear. However, it is also important to recognize that others may not always comply with these requests. Seeking support from a food allergy-educated dietitian or mental health specialist can help if social support is insufficient.
References:
- Rotella K, Oriel RC. Accidental Reactions to Foods: Frequency, Causes, and Severity. Curr Treat Options Allergy. 2022;9(3):157-168. doi: 10.1007/s40521-022-00314-5. Epub 2022 Jul 9. PMID: 35855411; PMCID: PMC9282141.
- Ciliberti A, Zaslavsky J, Morcott T, Bozen A, Samady W, Lombard L, Nimmagadda S, Nadeau K, Gupta R, Tobin M. Evaluating the Food Allergy Passport: A Novel Food Allergy Clinical Support Tool. J Allergy Clin Immunol Pract. 2023 Apr;11(4):1162-1168.e7. doi: 10.1016/j.jaip.2023.01.016. Epub 2023 Jan 27. PMID: 36716996.
- Welcome to The Food Allergy (FA) PassportTM! Accessed 9 September 2024. Available at: https://foodallergypassport.com/
- CDC Healthy Schools. Centers for Disease Control and Prevention. Accessed 9 September 2024. Available at: https://www.cdc.gov/healthyschools/foodallergies/index.htm