Jim Long, a Senior Attorney for OCR in the Denver office made the presentation. He has been with the agency for 10 years, having prior experience as a JAG officer in the Army. He had the added experience of having experienced anaphylaxis from a wasp sting as a young man.

Jim started the talk with 3 rules:

1.            There are rules about this “stuff”
2.            The rules are your friends
3.            Follow the rules

Jim’s presentation covered the following two areas: Section 504 of the Rehabilitation Act that was created in 1973, and Title II of the Americans with Disabilities Act (ADA) created in 1990 which are read together. However Section 504 pertains to those institutions receiving Federal funds, while Title II pertains to all public entities.

OCR is part of the US Department of Education and enforces civil rights laws prohibiting discrimination in education programs on the basis of: race, color, national origin, sex, disability, and age. Religion is not a category. OCR is headquartered in Washington, DC and includes 12 regional offices across the US including the Denver office where Jim Long works out of.

Which schools are covered by 504 and Title II? Section 504 prohibits discrimination on the basis of disability by schools that receive Federal financial assistance; while Title II prohibits discrimination against people with disabilities by public schools (including public vocational schools and public charter schools).

OCR enforces compliance to Section 504, but rewards no damages. Section 504 is a civil rights statute and there is no funding for 504 Students. OCR has a database of recipients (schools) of federal funds.

Individuals with Disabilities Education Act (IDEA) is different. Many students are served under another federal law known as IDEA. OCR doesn’t enforce this. There are 13 specific disabilities covered under IDEA and it is a funding statute and not a civil rights statute. IDEA defines disability differently. To be protected under IDEA, a child must: have a particular disability listed in IDEA and need special education and related services.

What do school districts need to know about 504 and Title II?

Every year, each school district must: Identify and locate students with disabilities in the district who are not receiving a public education and notify parents/guardians of children with disabilities of the district’s duties under Section 504. Location is done from parents, teachers, doctors, Child Find, etc. A school district’s Special Education Coordinator is responsible for IDEA enforcement. A school district’s 504 Coordinator is responsible for 504 enforcement. A school district must have 1) a non discrimination statement, 2) a Section 504 coordinator and 3) a grievance procedure. Who the District 504 coordinator is must be published and that person must be adequately trained in 504 procedures.

A school district must provide a Free Appropriate Public Education (FAPE) to each qualified student with a disability in the school district’s jurisdiction regardless of the nature or severity of the disability.

What does Free and Appropriate mean?

Free means free!  No charging for costs related to disability, but school/district may charge usual fees paid by all students.

Appropriate means regular or special education and related aids and services designed to meet a student’s individual needs as adequately as the needs of non-disabled persons are met. It is equal opportunity for all students, not equal results. It gives students the opportunity to achieve.

Identification and Evaluation of Students

A school district has the unilateral responsibility to get/obtain information on the student’s disability. A disability does not equal diagnosis. A disability is a substantial impairment of a major life function. There is no cookie cutter approach. Two children both having food allergies and a 504 plan should not have the exact accommodations in a 504 Plan.

The school district must individually evaluate any child who, because of a disability, needs or is believed to need special education or related services.

When must the evaluation occur? Before the child’s initial placement in a regular or special education program. The evaluation is intended to answer two questions: 1) Does the child have a disability under Section 504/Title II? If so 2) What are the child’s individual education needs?

Regarding Question 1 above: does the student have a physical or mental impairment which substantially limits one or more major life activities? The ADA Amendments Act of 2008 no longer focuses on the disability but on what services a person needs. The 2008 amendments expanded the list of major life activities. Some of these are (but are not limited to):

Caring for oneself
Performing manual tasks
Walking
Seeing
Hearing
Speaking
Breathing
Learning
Working
Eating
Sleeping
Standing
Lifting
Bending
Reading
Concentrating
Thinking Communicating

Major life activities also include operation of “major bodily functions” such as:

Functions of the immune system
Normal cell growth
Digestive
Bowel functions
Bladder
Brain
Circulatory
Endocrine
Reproductive
Neurological
Respiratory

What is an impairment? Any physiological condition that affects a bodily system, or any mental or psychological disorder. A 504 Plan doesn’t have to have anything to do with a learning disability if a child has “just” the disability of food allergies. The question is: Does the student’s impairment substantially limit one or more major life activities? A temporary impairment like a broken arm is not a disability. An episodic impairment like diabetes or food allergies is  a disability because they substantially limit a major life activity when they are in an active phase. Conditions lasting more than 6 months need to be carefully considered.

Substantial Limitation does not mean severe restriction or inability in performing major life activity. Look to condition, manner and duration. Must consider the individual without mitigating measures such as an EpiPen or insulin to determine disability. The one exception to this is eyeglasses. There is no vision disability if eyeglasses correct the problem.

IDEA vs. Section 504/Title II

IDEA defines disability differently. To be protected under IDEA, a child must: have a particular disability listed in IDEA and need special education and related services. Under Section 504, a qualified student with a disability is protected regardless of whether the student needs special education.

Regarding Question #2 above: What are the child’s individual education needs?

Needs are identified by looking to a variety of evaluation sources, including: aptitude and achievement tests, teacher recommendations, physical condition, social or cultural background and adaptive behavior. Placement of the child must be by a group of knowledgeable persons knowledgeable of the evaluation data, knowledgeable about the child and knowledgeable about the placement options.

The group should answer the question: what is the child’s need related to the disability? (not to the diagnosis). This group should include the 504 coordinator, parent(s), teacher, school psychologist, etc. There are no unilateral decision in this area. If a parent disagrees with the group/team’s placement then the parent can go to due process. You don’t have to have an attorney for due process (nor does the school district). Due process has to do with the content of the 504. It is a procedural issue if the school is not following the 504 Plan. It is best to use a school district’s grievance procedure first. A parent has 180 days after the last act of discrimination to file with the OCR.

A 504 Plan doesn’t have to even be written, but it is strongly suggested to do so. If a child has no 504 Plan and “just” a Health Care Plan that outlines the accommodations, a parent should make sure to receive procedural safeguards (which outline what to do in case the plan isn’t followed). If there’s a need for accommodations, then you have to have a plan and it’s best to have it written. Call it whatever you like, (as Jim Long said, you can call it Fred (!) or a Health Care Plan or a 504 Plan) and include whatever is agreed upon by the group/team. Does every child with food allergies need a 504 Plan? It depends on if the disability limits a major life activity.

Placement is defined as appropriate educational services designed to meet the student’s individual needs. The Team carefully considers evaluation information from a variety of sources and all significant factors affecting the student’s ability to receive a FAPE. The Team documents all the information considered and does not rely on assumptions regarding persons with disabilities or classes of such persons. It’s about the individual!  Food allergic students should be integrated with other students.

Jim Long discussed the Court Case: U.S. Education Department Reaches Agreement with Memphis City Schools on Aids, Services for Students with Disabilities He stated that OCR does investigate complaints but it can also ensure compliance by completing a review which is what they did in Memphis. They screened all health care plan students to see if they were offered 504 Plans for food allergies. He suggested we bring this court case to the attention of our school districts.

The 504 Plan should be re-evaluated at least every 3 years or before a significant change in placement.

FAPE – Common Compliance Concerns

1)            Making decisions unilaterally instead of by the Team

2)            Making decisions that are not based on evaluation information or child’s needs

3)            Failing to implement IEP or 504 Plan

4)            Not affording parents procedural safeguards (a system regarding identification, evaluation and educational placement). Procedural safeguards include: notice, records review by parent/guardian, due process-impartial hearing with participation by parent and counsel (if desired) and a review procedure.

Jim also discussed the term ‘least restrictive environment’ in the question/answer session. He stated there is a careful balance of confidentiality between the school’s responsibility to implement the plan and the child’s need for privacy. The child’s disability may be announced to keep the child safe in some cases.

Reasonable accommodations is a concept for post-secondary education and employment places. Section 504 requires that the individual education needs of students with disabilities are met as adequately as the needs of students without disabilities. See Question 14 here.

FAPE is regular or special education and related aids and services designed to meet a student’s individual needs as adequately as the needs of non-disabled persons are met.

For children with food allergies going to college, a transition plan in the last two years of high school is suggested.

This write up pertains only to students with food allergies in COLLEGE.

Sending a child with food allergies off to college is a daunting task and there are many ways to prepare for such; however Jim Long and I spoke after the meeting and traded emails specifically about the OCR, college, food allergies and accommodations in terms of what is available for our children who are determined to have a disability. Information in this blog post should not be used to argue a specific issue that you may have with a college, but is provided here for informational purposes only.

While it might work for some students with food allergies to deal directly with the college cafeteria staff or college housing office to secure accommodations, this may not be the best route to take in the long run. This is especially true if the agreed upon accommodations aren’t in a written plan. The idea is to get a college to view our child’s food allergy as a Section 504/Title II issue and not just a dietary issue to be managed in the cafeteria.

The OCR website he suggested to review is: http://www2.ed.gov/about/offices/list/ocr/504faq.html

Mr. Long stated that a student with food allergies heading to college should begin with the school’s Disability Services Office (or whatever the school calls this service) to find out what medical documentation and/or other documentation will be needed for the child and what accommodations are recommended. He also suggested doing this long before the freshman school year begins.

Most colleges, according to him, receive some type of federal funds. A college is not required to provide FAPE (Free Appropriate Public Education), but they are required to provide reasonable accommodations. Not just academic accommodations, but also cafeteria accommodations can be included such as ingredient listings of foods and staff training on cross contamination.

OCR expects colleges to engage in an interactive process with students to determine the most effective way for the student to have an equal opportunity of an education. And some colleges will be better at managing this process and helping students manage their disability. That’s why it’s important to start with the Disability Services Office so that if there is an issue, the student has a plan in writing which can be the basis for any OCR complaint should it ever get to that point.

The college is required to provide accommodations unless 1) the accommodations are an undue burden administratively or financially on the entire institution or 2) the accommodation is a fundamental alteration of the program. (Such as a business major student saying they have a disability with math and therefore shouldn’t be required to take any math classes to major in business).

OCR doesn’t express opinions about hypothetical cases, particularly where they do not have all the facts and have not been involved in the interactive process with the student and disability services office to consider all the information available and determine what academic adjustments, if any, would be appropriate.  Generally, OCR does not tell schools which accommodations they must or may provide; they examine the process followed to determine what accommodations are or are not provided and whether they satisfy the requirement to ensure an equal opportunity for the student.  OCR is not the experts in determining which adjustments are appropriate for particular students with particular disabilities.  That said, there are some considerations OCR can identify.  First (assuming there is a qualified* student with a disability), the school would be required not to exclude the student from participation in the any of the school’s programs on the basis of the disability.  Then, the school may not provide services in a manner that limits or has the effect of limiting the participation of the student with the disability.  Of course, accommodations requested and provided must be reasonable.  So, depending on circumstances, it may be unreasonable to expect a school to publish all the ingredients of all foods made available through its food services program.  However, it might be reasonable to expect the school to make a number of foods available and identified as “peanut and tree nut free” or “dairy free” or “free of any seafood product” or something similar.  Again, it would depend very much of the facts of an individual case, about which OCR cannot speculate.

*Qualified individual with a disability means an individual with a disability who, with or without reasonable modifications to rules, policies, or practices . . . meets the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by the public entity.  28 C.F.R. § 35.104.

It was suggested, you may want to take a look at the Title II regulations (applicable to public schools and colleges—can be found on the internet):

28 C.F.R. Part 35, §§  35.130, 35.130(b)(1)(ii and iii), 35.130(d), 35.164.  The principles applicable under the Section 504 regulations are fundamentally the same.

Mr. Long hasn’t received any complaint yet from a college student with food allergies not receiving accommodations from a school. (He is in the Denver regional office which serves 6 mountain states.)  I told him that’s because most students just leave that particular college and go elsewhere! Also, I don’t think many students start with the school’s Disability Services Office. They usually start with the dietitian and/or cafeteria staff. He stated to ALWAYS start with the Disability Services Office.

Lastly, he said that once your child is 18 years old, the school’s Disability Services Office will only speak with your child…not with the parent, to develop a plan of reasonable accommodations.

There are many ways to deal with the school lunch. We have opted for Morgan to ALWAYS bring his own lunch. We are very mindful of eating nutritious food, and the school lunches in our school district are based on a different idea of nutrition! Additionally, with Morgan’s multiple food allergies it has always seemed too risky to attempt finding a safe school lunch.

However, we are probably among the minority of even food allergic parents in our school district. Many times I receive questions from food allergic parents wondering how to create a safe menu for their child to eat school cafeteria food.

My first question to them is what is the motivation? Is it important to YOU that your child participate by eating a school “hot lunch” or is it important to your child? If it’s important to your child find out why. They may feel more a part of the crowd, and that is certainly important. If your child really isn’t thrilled with the idea, then maybe it’s best to send in a lunch made from home.

If it’s really important to your child, your next step would be to contact the lunchroom staff. Your school district will likely have a supervisor over the cafeteria staff who could obtain ingredient information. You could review safe foods and watch for those as they are available on a monthly menu. If your school doesn’t provide such a menu, then you may need to rethink if it’s safe to send your child in to school to figure out whether a food is safe. Remember, looking at a food to determine its safety generally doesn’t work. And taste testing to see if a reaction ensues is horribly dangerous!

Cafeteria staff will need to be trained to not cross contaminate foods. Picking up different foods with spatulas can cross contaminate the entire kitchen. If peanut butter & jelly sandwiches are made in the kitchen, and your child is allergic to peanuts, you may need to opt out of school lunches on pb&j days.

You will also need to find out how the cafeteria will let you know if a product’s ingredients have changed. The menu may have been safe in September, but by February the safe bread roll may come with sesame seeds, for example. Our school district provides a parent meeting in the beginning of the school year for all families dealing with food allergies. Parents can read all ingredient labels of all foods served. The glitch is that there is no system yet available to tell the parents if the ingredients have changed during the school year. And there have been problems with that for the severely allergic children.

Lastly, the cafeteria staff will need to be trained how to properly clean up. If your child can eat a few menu items, you will be relying upon them to clean up after unsafe foods are made in the kitchen area.

It takes a lot of work, and I’ve known too many food allergic children to have reactions eating cafeteria food. Yet some families have managed to find certain safe foods for their child to eat at school, and all is going well. It’s up to each family to find what works for you. After meeting Sara Shannon whose daughter, Sabrina, died at school after eating cross contaminated cafeteria food, Morgan and I decided his food allergies were too severe to take the risk.

Your state or school district may have guidelines for schools regarding special dietary needs especially for those students with food allergies. Check out the resources available and be cautious!

AllerSchool and Allergen Free Eating at School

AllerSchool is a complete end-to-end solution designed for the management of food allergies in K-12 school systems. It helps food service departments and school dieticians to manage complex issues involved with serving everyday meals to students with varying combinations of food allergies and dietary restrictions. is an interview with one of the two creators of AllerSchool, Mr. Dilip Chopra.

Mr. Chopra, can you tell us how you came up with the idea of AllerSchool? Who or what was your inspiration?

The inspiration behind this project was my daughter, who has had food allergies since she was only a few months old.  When she started school, we quickly realized the absolute need to be able to look into the ingredients of the food items served at the school cafeteria. The process of securing reliable ingredient information was so frustrating. We, as a family, started thinking that there had to be a better way! It is not that the school authorities did not want to cooperate with us, but the process of getting accurate information was just not very organized in general. As the years passed by, we came across other parents in similar situations but with children that had different combinations of food allergies, as well as different levels of allergic severities.

It became clear that there had to be a system that could quickly identify problem ingredients and generate safe food choices without requiring parents to go through the cafeteria’s hundreds of ingredient labels. We also realized the challenge that school food officials were facing by trying to accommodate all of the different combinations of food allergies into their daily menus.

As a result, AllerSchool designed to help students and their parents identify safe meal options, taking into consideration each student’s unique combination, and to help the school districts efficiently manage the complex issue of serving their students safe meals. AllerSchool was made a reality with the help of my friend Atul Ahuja, the other co-founder of AllerSchool and the technology architect behind this effort.

Please tell us about AllerSchool and how it works ‘in action’?

AllerSchool is a comprehensive solution with a lot of ‘bells & whistles’, all aimed at making it easier for students with food allergies, their parents, and the school food services departments to efficiently identify safe food choices from existing meal options at the school cafeteria.

Basically, a parent/guardian registers their student and their food allergy restrictions and based on that unique combination of food allergies, the system securely logs the parents on to a ‘parent portal,’ where they can view safe options for their child from the school’s existing menu. The parents are able to view detailed ingredients and can place direct electronic meal orders with the school cafeterias days, weeks, or months in advance.

AllerSchool aids school’s food services departments by automating the complex process of identifying safe meal choices for their students with allergies. It eliminates the process of manually identifying ingredients, including their many food derivatives. These tasks can only be efficiently carried out with the help of automated systems such as AllerSchool.

What do you hope it will accomplish for school districts?

For school districts, AllerSchool has the potential to increase meal revenues by increasing the number of students purchasing meals at the cafeteria. It also can reduce the risks associated with serving the wrong foods, improve parental involvement, and increase operational efficiencies that come with automation. By simplifying some of the complex issues related to food allergies, we hope schools are able to offer more inclusive meal opportunities for a larger number of students with food allergies.

How many school districts are currently using AllerSchool? What do they think about it? Has there been any upgrades or improvements made based upon user suggestions?

The AllerSchool system made its debut in Colorado Springs District11 last fall. Since most school districts implement new systems at the beginning of the school year, we hope to have more implementations this fall. We are currently talking to several school districts across the country which have expressed an interest in the system.

Both parents and the food services departments have expressed great satisfaction with the system. Improvements based on user requests are an on-going process at AllerSchool. We are continually upgrading, improving, and adding new features to the system.

How do you ensure that if ingredients in a product change that parents and students will know this?

The system is  a web-based, “real-time” system. Ingredient changes need to be communicated from the school food suppliers to the school food services and, if there is a change in ingredients, the district officials must make the change in AllerSchool, which is then instantaneously is reflected in all information that is available to parents. The system is in no way designed to replace manual responsibility and diligence at different levels of the food distribution process. Diligence, therefore, is an essential element of the process.

Does your system address cross contact in the cooking process? If so, how?

The AllerSchool system is designed to identify, detect, and interpret potentially unsafe items for individuals considering their unique set of food restrictions. It is not designed to address the issues related to cross-contamination. That falls within the realm of exercising care and diligence that must be carried out during the cooking and preparing processes.

With the AllerSchool system, is peanut butter still being served in cafeterias with your system?

The AllerSchool system has a unique feature that assigns an “Allergy-Friendly Index” (AFI) ranking to all recipes that are served at a given school district. In a nutshell, this is an index ranking that is computed based on the overall macro-allergy profile of a school district. So if peanut products are on the planned menu for a district with a large number of students with peanut allergies, the school food services will see a very low AFI ranking and a “flag” for menu items with peanuts, peanut by-products, and peanut derivatives. It is then up to the school district to decide if they still want to offer peanut products. AllerSchool provides the tools to make such decisions.

Is there anything else you’d like to add?

We (along with D11) were selected as the semi finalists in the Operator Innovations Awards by the National Restaurant Association yesterday. Here is the news link for their announcement.

It is an honor considering we started as just a small grassroots effort and we were selected under the ‘Food Safety’ category for food allergies management nationally. The award also increases the awareness of the subject in the food services industry in general which can only help the efforts of our entire community including FAAN.

Dee, tell us about your daughter Laura. What did she like? What were her dreams for the future?

Thanks Nicole for the opportunity to tell Laura’s story.  Laura, like most teenagers, loved being with her friends.  She loved God and was on the worship team at her church.  She had a passion for performing and took every opportunity to sing and dance on stage.  Laura never shied from the spotlight and didn’t mind standing out from the crowd.  Most of her wardrobe consisted of neon colors and clothing she had “improved” with scissors and puffy paint. But above all, Laura cared deeply for people and really invested herself in them. Whether it was staying up all night to make presents for her friends just to show she cared or donating her hair to Locks of Love or pouring her energy into promoting school music programs, she tried to make her little corner of the world a kinder and more beautiful place.

What was your daughter Laura allergic to? How old was she when you found out about her allergies?

Laura had many allergies.  She was allergic to trees and grasses, dogs, cats, dust, and peanuts.  Her peanut allergy was by far the most severe.  When Laura began eating solid foods, my mother gave her part of a peanut butter and honey sandwich, and within minutes her face was hugely swollen.  Later, before Laura turned 2, she had to be rushed to the hospital because she had trouble breathing.  It was at this time that she was also diagnosed with Asthma.

Had she ever eaten peanuts before? Did she experience an allergic reaction then?

Laura had infrequently come into contact with a few peanut products (candy, with peanuts or peanut butter) over the years.  Generally, she would spit them out because she was aware of her allergy and also because she just didn’t like the taste of peanuts.  On those occasions, she would take her inhaler and call me.  I would bring her Benadryl and in a while she would be better.

Did Laura understand about her peanut allergies? Did she carry an EpiPen?

She understood that she had a severe allergy to peanuts, and she took it very seriously.  I did leave an EpiPen with her middle school office, which was never used, but Laura didn’t normally carry an EpiPen.

Tell us about the camp that Laura attended. Had she been there before?

The high school group at her church did a Spring Break service project every year. They went to a camp in Northern California to prepare the camp for summer. They painted and cleaned and had a great time.  Laura had been at this particular camp before and was looking forward to it.

What happened on the day Laura died?

At lunch, one of the camp staff had prepared rice krispie treats with peanut butter, but nobody labeled the snack or informed the kids of the ingredients.  Laura loved rice krispie treats, and it never occurred to her that anyone would make them with peanut butter.  After she ate it, she went to one of her counselors and told him that she believed there were peanuts in the snack and that she was having an allergic reaction.  The counselor told her to go back to her room and lay down for a while.

(Just as a precaution, on the Friday before leaving for camp, I called Laura’s doctor’s office to see if I could get Laura in to renew her EpiPen, which had expired quite a while before this.  The doctor only worked half days on Friday and we were not able to get an appointment, therefore, Laura did not have an EpiPen with her at camp.  She did have her inhaler and I am sure she took that, but she was not given any additional medicine such as Benadryl.)

When she got worse, she went to her counselors again, and that’s when they realized that she needed medical attention.  They called the ambulance, which was several miles away.  Laura died on the way to the hospital.

Is there anything you would have done differently?

Aside from not letting her go at all, I would have required a nurse and EpiPens be available on site.  Laura had filled out her own application for the camp, which stated that she had a peanut allergy (as well as other allergies) and asthma, so the church and the camp were given information on Laura’s condition.

Has the camp done anything differently since Laura’s death in 2004?

I haven’t contacted the camp, but I hope that they would now review all allergies listed on campers’ application forms.

What advice can you offer to other parents of children with food allergies?

Be prepared for emergencies, and enjoy every minute you have with your children.

Thanks,

Dee

Nicole’s Comments: Thank you Dee for sharing this incredibly tragic story. I so appreciate you sharing what happened to your family because it helps those of managing food allergies to learn from you. Dee and I met recently and talked about Laura. Like many teens and children with food allergies,  Laura had never experienced anaphylaxis before this episode. It reminds us all that past allergic reactions are no indicator of future ones and potential severity. From Dee’s comments about what she would have done differently, I’m sure many of us can relate. In the 8 years since Laura has died, there is more education and awareness in many camps, but make sure to have your child’s Health Care Plan/Food Allergy Action Plan in writing; have EpiPens travel with your child always and as Dee said, “enjoy every minute you have with your children.”

Dr. Hemant Sharma is the Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington, D.C.  He is also the Director of the Food Allergy Program and site director for the National Institutes of Health Allergy and Immunology fellowship program.  Dr. Sharma obtained his medical degree from Columbia University, and completed his pediatric residency and chief residency at Duke University.  He trained in allergy and immunology at Johns Hopkins, where he also completed a degree in clinical epidemiology.  He is a regular contributor to a food allergy column in Allergic Living magazine and recently co-edited the “Food Allergy in Children” series for Pediatric Clinics of North America.

Dr. Sharma, thank you for helping us to learn more about asthma and food allergies. Dr. Ruchi Gupta’s recent research found that nearly 8% of US children under 18 have food allergies. Do you know of recent research that has determined how many children with food allergies also have asthma? In your practice, how many children have both?

Food allergies and asthma often do occur together.  Prior studies suggest that more than a third of children with food allergies also have asthma, and up to 8% of asthmatic children have a food allergy.  It is not uncommon for us to see something called the “atopic (or allergic) march” in children, where they start out in infancy with food allergy and then go on to develop asthma and hay fever later in childhood.

My son had Respiratory Syncytial Virus (RSV) at 3 weeks old. We heard that this would make him more likely to have asthma. Is this true? Is there any relationship between RSV and food allergies?

RSV infection in infancy has been shown to be associated with a higher chance of developing asthma later in childhood.  Interestingly, wheezing with rhinovirus (the common cold virus) in early childhood is actually a much stronger risk factor for later asthma than RSV.  It’s not entirely clear if these viruses cause asthma or are simply predictors of childhood asthma.  There is not any evidence for a connection between RSV and food allergy.

Is asthma the same as “reactive airways”? Is it medicated the same?

The term “reactive airways” is often used by health care providers to describe wheezing in early childhood, when it may not yet be certain whether that wheezing will resolve over time or develop into chronic asthma.  One of the hallmarks of asthma is reactivity or “hyper responsiveness” to triggers, which can lead to tightening around the airways during a flare-up.   Both “reactive airways” and asthma may be treated with the same medications, for example bronchodilators like albuterol, which help relieve this tightening around the airways.

Is there a different protocol for your patients who have just food allergies versus those who have both food allergies and asthma? How about children who have the atopic trifecta: food allergies, asthma and eczema?

The management of food allergies is similar whether a child has food allergies alone, or accompanying asthma and/or eczema.  Food allergen triggers should be avoided, and in some cases, this may help to improve eczema control as well.  In addition, emergency medications to treat food-allergic reactions should be available at all times, including epinephrine, antihistamine, and, if a child has asthma, albuterol.  For children who have both food allergy and asthma, asthma symptoms might certainly be part of a food-allergic reaction, but they are usually not the only symptom observed.

My son has severe peanut & tree nut allergy – among several other foods – and mild asthma. I’ve read that two of the risk factors for fatal anaphylaxis are peanut or tree nut allergy and asthma. (The third being a delay in the administration of epinephrine). Why are peanut/nut allergy and asthma implicated with this higher risk of a fatality? What should my son be doing to mitigate this risk?

Certain foods, like peanuts and tree nuts, have been shown to be associated with a higher risk of fatal reactions.  The reasons are not entirely understood, but likely are related to unique biochemical properties of these allergens.  It is also important to note that fatal reactions have occurred to many foods other than nuts.  Asthma is another risk factor for fatal food allergy reactions.  This might be explained by delayed use of epinephrine since people with asthma might often reach first for their inhaler when they are experiencing breathing difficulty, and overlook other signs of anaphylaxis.  For patients with both food allergy and asthma who develop abrupt respiratory symptoms, it’s advised they assess whether other symptoms of anaphylaxis are being experienced, and if so treat immediately with epinephrine.

For years we thought that my son had outgrown his asthma. When we went to National Jewish Hospital a year ago, he had a Nitric Oxide test that our local allergist wasn’t able to administer in her office. We then found out he had likely had mild asthma all along and had gotten accustomed to a tight feeling in his chest. Our allergist’s testing methods weren’t refined enough to pick up the problem, and my son didn’t know he was having difficulties. Should we parents be looking for certain signs of asthma if our children have other allergy issues?

The most commonly used test to evaluate lung function in asthma is spirometry.  This form of lung function testing measures obstruction to air flow, usually before and after receiving a bronchodilator medicine, like albuterol.  Nitric oxide testing, instead of measuring obstruction, detects airway inflammation, which might be present in uncontrolled asthma.  While this test may provide useful information in some cases, it cannot by itself diagnose asthma, and is not a test that needs to be done for every child with asthma.  In fact, studies have not shown that using nitric oxide testing helps to improve asthma control, beyond relying on a thorough assessment of symptom frequency, need for albuterol and spirometry results.

There is more research recently to find a cure for food allergies. I’ve read that asthma kills 9 persons a day sadly, in the USA alone. What research is there to find a cure for asthma? Do you see any great new asthma medications on the horizon?

Research is also under way to identify new treatments for asthma.  Omalizumab (Xolair) is an example of a new asthma medication that has helped patients with severe allergic asthma, who failed to respond to other asthma treatments.  It functions by blocking the binding of the IgE antibody.  This medication is also being studied for potential use in food allergy.

Thank you Dr. Sharma!

In Boy Scouts, Bob became an Assistant Scoutmaster. Again, this allowed him to participate as an adult leader and to continue to allow Morgan to become self-sufficient around food. Boy Scouts do a lot more activities than Cub Scouts, so the need for food allergy awareness became even greater.

Here’s what Morgan says about preparing his Boy Scout Troop for his food allergies:

The first Troop meeting I went to I presented to our PLC, or the Patrol Leaders’ Council, which is the team of boys that leads the Troop. It took about 15 minutes, and I explained what food allergies are, what my food allergies are, and how the Troop can help keep me safe. I made the same presentation to the entire troop a few meetings later, and they were very accepting. It was awesome!

For every camping trip we have, I sit down with the patrol I will be eating with and we plan a menu as a whole. I then, with my Dad or Mom and perhaps some other scouts, go and shop for the food that is safe for me. People, even though they say they do, don’t understand food allergies and the risk cross-contamination is, especially on a camp out. There has been only one camp out, out of 5 years (almost 40 camping trips), that has been an issue, and it was only a miscommunication with a parent, who went and tried to buy safe food. In that case, I did bring my own, safe food, but I still participated in the camp out just like any other boy.

My husband, Bob, has even more ideas for how to keep your son safe in Boy Scouts:

I hope I can shed some light on managing food allergies from an Assistant Scoutmaster’s perspective. I have been in Boy Scouts for over 5  years and 3 1/2 years in Cub Scouts. I was also a Life Scout as a youth. You will come into challenges as most of the adults do not understand food allergies nor do they understand the true ramifications of what can happen to a Boy Scout if he were to ingest or come near certain allergens.

Every situation is different but my experience is the best tool I have at my disposal,  as well as education. The more educated they are about Food Allergies the more support you will receive. Most Scout parents all want to help, they just don’t know what to do.  I will share my experience as to Troop food from an adult’s perspective.  It is my experience in our Troop, the patrols set their menus. If Morgan happens to be that patrol leader, they are well aware in creating safe menus of no nuts, no peanuts, food made with any sesame, shellfish or fish.  Heck most of them would live on Pop Tarts and Mountain Dew if we let them, but we help them to insure they are making complete balanced meals as outlined in the Boy Scout Handbook.

It helps them attain rank advancement and they are required to plan a meal and cook a meal for their entire patrol. Morgan is the one that usually buys the food for a campout so he can read the labels of the food he is buying for the patrol. (They all pitch in the monies equally) This affords him to feel safe and empowered by being able to advocate for himself with the knowledge that what he is going to eat will be safe.  We make sure he gets to shop or he brings his own food when we backpack. Also even though other parents think they will buy the right foods, the problem is many times we have found that manufacturers change ingredients and do not tell anyone and the food now is not safe.

Other parents’ intentions are right, but their lack of knowledge is something they don’t know. In Scouting nuts can be a big factor because when you are backpacking or camping, most boys bring trail mix. They know not to sit near Morgan when they eat it and to wash their hands after, but they are aware to keep Morgan safe. Most of the boys (50+ in our Troop) are very supportive of Morgan and they work hard on informing him if they are eating nuts or something that he is allergic to. This works well.

Lastly, the only other thing you have to watch for is cross contamination. If you ever looked at a stove when a “Boy Scout” got done cooking, the HazMat team should be called in to clean it! In all seriousness, if someone is using a spatula from one pan and it goes in another, Morgan knows not to eat any of it, unless he knows ALL the food is safe.

Scouts and their parents are very supportive of Morgan with his allergies. It also helps now that Morgan is 16 years old, an Eagle Scout and a junior assistant scoutmaster in addition to being a good leader. They listen to him more. Morgan had always been a good leader in helping younger scouts achieve things, which is why I believe he gets a lot of respect from both the boys and the adult leadership team.

In terms of Boy Scout camps, such as Camp Alexander near us in the Rocky Mountains or the National Jamboree that Morgan attended in 2010 at Fort AP Hill in Virginia, a different set of issues are presented.

Even though Morgan has had contact reactions with his food allergens – especially fish and peanuts – we did not ever ask that none of these foods be served at the Camp. Instead, we figured out a way to prepare safe foods for him to bring with him to camp and made the EMT’s at the camp aware of his severe food allergies. With the great outdoors, he has never had a problem with contact reactions at a Scout Camp.

When Morgan attended Camp Alexander, he did so with his Dad for a few of the campouts. Then, he also attended the Camp on his own for a week. We always prepared all of his food at home and brought it to the Camp either frozen or refrigerated along with a “dry foods” bag. Then, Morgan prepared index cards of each specific item he would eat on each day and each meal. For example,

Monday Breakfast

Waffles & Syrup
Turkey Sausage
Banana
Orange Juice

We would discuss cross contamination and safe food preparation with the kitchen staff when we dropped Morgan off for camp. Most of the time, the camp staff would prepare his meal based upon his index cards, even heating it up in a microwave for him. The only time we ever had an issue was when Morgan ran out of food the night before he was to come home from camp. The chef prepared him more broccoli to eat with dinner, and he soon got a stomach ache after eating it. He was taken to the medic tent who gave him Benadryl because no breathing problems were evident, and he soon got better. We never figured out why broccoli would have made him feel sick, but chalked it up to either nerves on his part or lack or complete cleaning on the part of the kitchen staff. From that time on, I sent WAY more food than I thought he could eat in a week, so we never had to deal with that again!

When Morgan went to the National Jamboree in 2010 along with 42,000 other Boy Scouts and Scout Leaders, the preparation of food was much more difficult. We live in Colorado, and the National Jamboree was in Virginia. It would be impossible to send all the food for 10 days worth of camp prepared at home and shipped across the USA.

This time, my husband went out to Virginia on an airplane, rented a small hotel room with a kitchen, and prepared all of Morgan’s food. He then carted in 5 days worth of the food during the Jamboree, and did so again 5 days later. Their kitchen facilities were accommodating and kept the food refrigerated.
Since Bob was an assistant Scoutmaster, he was allowed to be at the Jamboree to do such. Many of the boys LOVED the food that Morgan ate, and thought it looked much better than the food they were eating! He became very popular during those 10 days for his Dad’s wonderful cooking!!
If your son wants to participate in Boy Scouts, I would encourage parental participation, especially on the part of Dad. It’s a great way to spend time with your son, and it also allows Dad to be part of the food allergy solution without your son feeling you’re hanging over him.

This summer Bob and Morgan will be participating in Philmont, a Boy Scout high adventure camp that involves 12 days of backpacking through northern New Mexico. Morgan will be bringing safe freeze dried food since no refrigeration is possible. We’ve already begun the process of speaking with the medical staff and preparing them and us for the adventure of a lifetime!

I’ve heard from many parents after this sad story hit the news. Many were concerned that no school could ever keep their child safe. There’s a lot to be learned from this situation. It’s my experience that children with food allergies can go to school AND can stay safe and be included! Here’s what we have found to work from preschool into high school.

Before the first day of school, every one of our son’s teachers has read his 504 Plan and Health Care Plan. They know what to do to decrease the chances of him coming into contact with his allergens in their classroom and the lunchroom. They also have been trained  how to administer his EpiPen.

• We provided multiple EpiPens to the school for the classroom, nurse’s office and playground monitor prior to our son being able to self-carry his medicine.
• We made sure our son, Morgan, knew exactly what he was allergic to. He wears a MedicAlert bracelet that details this also.
• We had an agreement that he ate only food that Mom or Dad packed for him or brought to school (for a party) when he was in elementary and middle school. He never purchased the school lunch or anything from a vending machine.
• Morgan, my husband and I educated his friends about his food allergies through classroom presentations and Cub Scout/Boy Scout meetings. Books like Allie the Allergic Elephant were read to the class so that his classmates could learn what an allergic reaction looked like and what symptoms could occur.
• We keep communicating …with the Principal, teachers, custodians, bus drivers, etc…education about food allergies isn’t a onetime shot. It needs to be brought up over and over again. And when the conversation does occur, we focus on being kind about the message that we all want to keep Morgan safe!

It doesn’t have to be complicated, but that doesn’t mean it’s easy! It does take a lot of preparation and communication with the school to keep your child safe.

Accidents do occur, so talk to your child about what they would do if someone offered them a food. Roll play situations. What would they do if someone sat in their allergen free zone in the cafeteria? Help them with options and solutions. What if someone teased them? Help your child learn how to become a good self-advocate.

Morgan’s friends watched out for him because they knew about his food allergies. We never kept his allergies a secret, and that has continued to work for us as he has aged into a teenager.

For those of you with children entering preschool or kindergarten in the Fall – it’s not too early to begin discussions with the school of your choice. Check out our e-book on Food Allergies & Schools and our Nut Free Zone posters to help raise awareness!

Lauren – can you tell me how old you are and what your allergies are? 

I am 14 years old and I’m allergic to all forms of dairy including goat milk.

Have you ever gone into anaphylaxis?

I have been in anaphylaxis over 40 times. If my EpiPen wears off I need more EpiPen before I reach the hospital. Sometimes I only need one EpiPen if it’s just a little contamination, but many times I need at least two EpiPens and then more meds at the hospital. If I do not take my EpiPen immediately I get VERY sick. In the last few years I have gotten better about taking my Epi right away and this helps me not get as sick as I used to get.

One time I swallowed a bite of cheese without knowing it was “real” cheese ( I thought it was my soy cheese that I always eat) and my throat hurt immediately, then I got a blister on my lip and then I got red all over my body like a sunburn. I was throwing up and felt very sleepy. I started wheezing. I began getting hives that burned all over. I was screaming that my back burned. All of this happened in minutes, and got worse until we arrived at the hospital. My parents said my eyes rolled in back of my head in the trauma room. They said the doctors were very helpful and knew exactly how to help me. I fell asleep. When I woke up I felt better and we spent two nights in the pediatric intensive care unit.

Tell me about your robot. How does it work? Can you see the students and teachers as you sit at home?

The Vgo works like Skype on wheels. I log on at home and then I drive my Vgo to class from home. I can see the teacher and the students, and can even work on group projects together or with a partner. If I want to raise my hand I press a key on my keyboard and a light on the robot flashes so the teacher can call on me.

How did you feel about your safety at school with your food allergies before getting your robot? And now?

I was always worried about what was going to happen to me that day…would the ambulance have to come to school again? Would I be careful enough? And now that I go to school with this robot I feel safer BUT I still want to go to school.

Do you participate in extra-curricular activities like sports, clubs or dances?

I have done field hockey this year but I have to make sure I’m wiping everything down and I can’t go on the bus to away games and I can’t be around their snacks and I can’t do food events with them. I’m in karate also. I also am involved volunteering at the hospital and other philanthropies around my town that are safe. I also volunteer at our church (but I can only do certain jobs that are safe.)

How do you socialize with your friends?

When my friends come over they need to be sure and wash up and don’t have it on their clothes. When they come in and they don’t eat obvious dairy before they see me (like pizza cheese doodles or Doritos). Sometimes I go to other friends houses if they clean before I come. Sometimes I go places with them if there is a low risk of contamination while I’m at a place. But there is a high risk with most things. I try not to take high risks.

Melissa – when did you know that Lauren was no longer safe at school and that something needed to change?

We knew that Lauren was no longer safe in school when she went to one of her classes and walked into the room after they had a pizza party and her throat began to hurt. The teacher washed down everything correctly but it was still airborne and enough was still around to cause a significant reaction.  She took her EpiPen, the ambulance came and took her to the hospital and she was on steroids for a week that time.

Did Lauren have a 504 Plan and Health Care Plan prior to having the robot?

Yes she did, we felt that it was important to have a 504 & a Health Care Plan , but our needs became above and beyond what the school could handle. To keep her safe at school would mean to eliminate dairy. Also when she has a reaction she needs to take epinephrine immediately or she becomes way too sick. We could not take the chance that she would not get medicine immediately. Also her doctor said we should take her out of school before something happens that we can’t “get back” from.

How did you get the school to pay for the robot?

Lauren’s home bound supervisor was working hard on finding a way for Lauren to attend school safely. This past summer he was reading “Sports Illustrated” and read a story about a boy in Texas who went to school using a robot. He thought that this robot would be the safest way for Lauren to get to go to school. He went to the Asst. Superintendent to ask for her support to let him try this “robot” out with Lauren. He purchased the unit out of his home bound budget. His concern was having Lauren spend her freshman year in school.

What do you hope for Lauren as she ages through high school and goes into college and beyond?

Lauren wants to work, go to college, become a forensic scientist, get married and start her own family. Our hope is to find ways to keep her safe through living out all of her dreams.

Is there any hope for her dairy allergy to lessen?

Our hopes for Lauren is that the Chinese herbal treatment that she is on (from Dr. Li at Mt. Sinai Hospital in NY) will work! First the hope is that she will stop reacting from inhaled dairy, and then of course we wait for the day of the cure. In the mean time we continue to remind her to wash hands, keep her hands out of her mouth, remind others to wash hands, especially when they come in our home. And remind ourselves to  keep our eyes open for hidden dairy, or airborne dairy. Also we need to read labels over and over and find ways to live in a dairy laden world.

Is there anything else you’d like to add?

Dairy is in so many things…and in surprising places. Lauren has been in anaphylaxis so many times because of a combination of factors. First it was hard for our family to understand how sensitive she was….it started with eliminating dairy from my own diet so I could continue to nurse her but it went on to having to eliminate dairy from our home because I would contaminate her from the dishwasher items in addition to cross contamination issues. Dairy has been found in places I never would have thought of. We have had so many mistakes because we could not always grasp the seriousness of invisible dairy and because of human error…like manufacturers that make mistakes in labeling. We now know that more than 20% of medications have dairy. We find out things like that the hard way. Food labeling laws have made life MUCH easier for us. Restaurants like in Disney World makes our life easier when we go there. And people who “get it” also make life easier.

Thanks Lauren & Melissa!

Carlo, when we spoke last year, you were getting ready to attend the University of Chicago. You have allergies to Dairy, Wheat, Eggs, Peanuts, Tree Nuts, Soy, Sesame, Fish, Shellfish, Most Fruits and Some Vegetables. What did you find most difficult with eating in a dorm cafeteria on a daily basis?

What I’ve found most difficult is finding a good variety of protein for me to eat. There hasn’t ever really been a problem with there being food for me to eat, but there have been some difficulties with the variety of food, and I’ve been forced to have the same foods over and over, which although it keeps me fed, is somewhat frustrating. There’s always salads and some vegetables and fruits, but protein is harder to come by.

The dining hall is separated into various stations, each serving a certain type of food. There is a Euro Station–mostly carved meats (but almost always with sauces/dressing) and some sort of vegetables, the Halal Station, the Kosher Station, the Harvest Station that serves vegetarian dishes, the Pasta Station, the Salad Station, the Deli Station, the Pizza Station and the Grill Station. You can go around to any of the stations and take what you want, making a meal out of whatever any of the stations are serving that meal. I have to avoid most of these stations. The Pasta and Pizza Stations I pretty obviously must avoid, and the Halal Station and the Harvest Station frequently serve things I can’t have, because of their restrictions on certain types of foods. The Kosher Station occasionally serves things I can eat. The Deli Station is full of cross-contamination, as is the Salad Station.

The Grill Station is just a grill. It makes hamburger patties (you can add your own bun and toppings later), grilled chicken breast, and grilled cheese (which is prepared on a separate grill from the hamburgers and chicken). It makes these things for lunch and dinner every day, which provides a nice stability to the ever-changing options that the other stations offer.

Did you have any allergic reaction?

Thankfully, I have not had any reactions while at college. I think part of that is because I’ve been extra careful, perhaps even more than I usually am. A large part, though, has to be attributed to the dining staff, because they really are trained about cross-contamination and they are very willing to change gloves or use a separate pan. That said, I try to stay away from stations that could pose any sort of risk.

Did you find any other students dealing with similar allergies?

I haven’t really found anyone else with comparable allergies, both in number and in magnitude. There are a few people with intolerances (lactose intolerant) and maybe one or two people with peanut or tree nut allergies, but there aren’t very many people with allergies or anyone with allergies coming close to how many I have. That said, everyone I’ve met has been knowledgeable about food allergies or very interested in learning about them, so I’ve felt safe among my peers even though they don’t have allergies.

How do you feel about next semester and eating in the dorm cafeteria?

One of the things I’m doing over this break is meeting with my nutritionist at Mt. Sinai’s Jaffe Food Allergy Institute. Hopefully, I’ll be able to work with the nutritionist to develop strategies for me to successfully maintain a healthy diet eating in the dining hall. Then, I’ll take those recommendations and meet with my contacts at school, to work it out. I’m also going to sit down again with the dining hall staff and my contacts in the administration and see if we can’t get some of the things that have been proposed put into action. Other than that, I’m really looking forward to it. I’m excited for my classes and looking forward to Winter Quarter, despite the weather.

For your sophomore year, what living arrangements are you planning?

At the University of Chicago, the dorms work in a house system (kind of like Hogwarts). In your first year, you are placed into a house that contains ~40-100 people, first through fourth years. You can stay in that house for all four years, if you would like, or you can move off campus starting your second year. I’m planning on staying in my house, because I love the people in it and living on campus makes everything significantly easier. I may, however, start going to the grocery store more frequently and making more of my own meals to avoid the dining hall. I would, in that case, change my meal plan from the unlimited (which is mandatory for all first years and really nice) to one that more fits the changed situation.

Did you go hungry on any given day because of a lack of safe food?

Thankfully, since the Grill station is always open and serving plain chicken breast and plain hamburger patties, there was never a day where I went hungry. There were certainly days where the lack of variety was frustrating, or two or three day stretches where the only safe food for me would be from the Grill station, but I was never walking around constantly hungry, except as much as all college students on the go do, but that’s just the nature of dining hall food.

Based upon your experience, what would you tell a current high school senior with food allergies looking at college?

Really, the best thing I can say to a high school senior is that food allergies don’t need to be another thing stressing you out. The entire college process is an arduous one, and you don’t need another stressor. Pick a school that you think is the best fit for you academically and socially. All the schools I considered and all the schools that my friends with food allergies go to have been pretty good about dealing with food allergies. Don’t let food allergies dictate what college you go to. You will be able to work with the dining services staff, or just go around them and provide for yourself, if need be. I’m not going to lie and say it will be a walk in the park, but you can successfully and safely manage your food allergies in college. It isn’t easy, but nothing about living with food allergies is. That doesn’t mean that it isn’t possible, and that especially doesn’t mean that your food allergies will hold you back from having a happy, successful, normal life. Don’t let your food allergies add yet another stress to an already stressful process and don’t let your food allergies stop you from doing what you think is best for you academically and socially.

Again, I hope these help!

All the best,

Carlo Steinman

A university website that states,” We can handle virtually any food allergy” was not sufficient for us to feel comfortable with our child living in the dorm and eating in the cafeteria. We wanted to visit the school, eat in the cafeteria, talk with the dietitian on staff, discuss ingredients being listed for all foods and determine the menu selections for each meal in addition to discussing academics. It takes more effort to find a school that meets your child’s desires for a major and for food allergies, but it’s well worth the time to ensure safety, enjoyment and a career destination.

Finding the “Right College”

Our daughter, Michaela, graduated from high school in 2009. She has celiac disease along with multiple other severe food intolerances (beef, pork and lemon to name a few). She didn’t really know what she wanted to major in, but she had a general idea of a Liberal Arts major, so that helped our search. I suggest looking for colleges with a major in mind, and not with food allergies as #1 on your list of priorities. If your child decides that they want to major in a field that’s not offered at a particular college (that you chose for its food allergy expertise), then you have to start the food allergy education process over with another school when your child transfers. Choose a major and then take a look at the cafeteria!

Michaela knew that she wasn’t interested in moving out of state. If your child does want to go to a school out of state, looking for a local allergist would likely be necessary prior to enrollment. The maturity of your child is a large factor in moving far away and making this a positive experience. Moving a long distance away from family is difficult for children who don’t have food allergies – managing food allergies on top of this big change may be more than what some kids can or want to handle. Asking your child, “What’s the ideal situation for you to go to college?” might yield some very interesting answers!

Visit Colleges and Universities

Michaela  had participated in numerous one week and two week music camps through her high school years at several universities in Colorado. This gave her first hand experience of how the cafeteria works and what living at the school for an entire semester could look like. Sadly, she found that only one school – the University of Denver – was able to cook for her safely. All of the other schools either weren’t able to provide three safe meals per day or weren’t willing to try. One school had a gluten free menu for lunch and dinner, but not for breakfast. Another said, “we can cook anything you need,” and then had a menu of only 3 items – all of which included wheat. She ended up bringing her food for the entire one week camp and keeping it in a refrigerator utilizing a microwave to heat it. This can work for one week, but for an entire semester this would be onerous!

A friend and her gluten-intolerant daughter visited a college campus and asked the cafeteria manager what they do for students with celiac disease. The manager said, “We keep all peanut butter on a separate table!” It can be frightening the lack of understanding about food allergies and celiac disease in a college cafeteria where your child will basically be “eating out” for three meals a day.

We also went on campus visit days to numerous universities across Colorado. In the cafeteria, we searched for ingredient listings, talked with the dietitian on staff, and determined the menu selections for each meal. What we found was that the more expensive the tuition, the more likely a college/university cafeteria was to work with us. A large, public university that feeds 5000 students a day is very unlikely to accommodate a student with food allergies. One such school told Michaela that she was welcome to live in an apartment her freshman year. She gave that some thought, but decided that adjusting to college classes plus having to grocery shop and cook for herself was more than what she wanted to take on at 18 years old.

Many school cafeterias have students on work/study working in the cafeteria and this can make training about food allergies and EpiPens more difficult. Ask about the cafeteria workers when you visit a campus; watch how meals are served (same spatula used for serving all dishes?) and how plates are washed. All of this will help you and your child know where problems could occur.

Food Allergy Aware Colleges

I am currently participating in a committee looking into best practices of food allergy aware colleges for the Food Allergy Initiative (FAI). The University of Michigan (see link here) has probably one of the best systems for food allergy students. This is truly a food allergy aware college!

A food allergy aware school personalizes the experience of dining in the cafeteria; they don’t require living in the dorm freshman year (they allow for apartment living if your child is up for this!); they provide ingredient listings for all foods in the cafeteria; they have an aware chef and they have nearby EMTs and a hospital.

I have a listing of food allergy aware colleges here for the USA. I wish I had more schools listed; however most students with food allergies are in the grade school years! Those students with food allergies in college are leading the way and educating universities about how to manage food allergies in the college cafeteria setting. If you have experience with a college, please email me with their information!

Many Ways to go to College with Food Allergies

Michaela decided to stay home her first year of college and then moved out to rent a room in a house near her school, the University of Colorado at Colorado Springs. This allowed her to get a repertoire of menu items that she learned how to cook, and she adjusted to college slowly. This was the perfect solution for her.

I know of students who went to college and lived in a single dorm room so they at least didn’t have to deal with a roommate bringing in unsafe foods. Others I know brought a microwave and refrigerator and prepared all their meals in their dorm room. Still others worked out safe menu items with the school cafeteria.

In other words, there are many ways to go to college with food allergies!

As a parent, it’s easy to want your child to have the same experience you had with school – maybe join a sport or live in a sorority house. Our suggestion is to allow your child to create his/her own experience. It’s likely to be far different from yours, but that’s okay. And it might have been different even if your child didn’t have food allergies!