Summer camp is a time for children to have nonstop fun indulging in their favorite activities. For children with food allergies, going away to camp is not a simple decision, yet many parents have worked successfully to enable their children with food allergies to have these enriching experiences. Janet Erlich, whose two children are severely allergic to milk products and eggs, admits to feeling anxiety when they go away to camp but, she says, "My children love camp. It's the highlight of their year."
Today approximately 11 million people are affected by a food allergy, roughly 3 million of whom are under the age of eighteen. Chances are you will have a camper with a food allergy. The following will provide information and tips for ensuring that your campers with food allergies have a safe and happy camp experience.
What Is a Food Allergy?
A food allergy is an abnormal response by the immune system to a food protein. The immune system is designed to protect the body from harm, but in the case of food allergy, it is trying to protect the body from something that is actually benign — food. When a food that the immune system believes to be harmful is ingested, massive amounts of histamine and other chemicals are released to attack that food. However, instead of protecting the body, the histamine and other chemicals can actually cause harm, especially with a severe reaction.
The type and severity of a food-allergic reaction can vary from person to person, even for the same food — one person might get hives after drinking milk while another might have swelling of the mouth. For some people, merely touching a food to which they are allergic, or inhaling the steam from cooked foods like shrimp, will cause a reaction. Some individuals may only have mild reactions; others may have a history of severe reactions. Therefore, treatment plans must be individualized for each camper.
To Which Foods Are People Allergic?
While any food can cause an allergic reaction, in the United States just eight foods account for 90 percent of all allergic reactions: milk, eggs, peanuts, tree nuts, wheat, soy, fish, and shellfish. Tree nuts include walnuts, pecans, almonds, Brazil nuts, cashews, pine nuts, pistachios, and more. Children are most commonly allergic to milk, soy, eggs, peanuts, wheat, and tree nuts.
There is no cure for food allergy — avoidance is the only safe course of action. The highest-risk situation for an allergic reaction occurs when patients are eating away from home. Individuals who are allergic to peanuts or tree nuts — and have asthma — are at higher risk for a severe reaction. A study of fatal food-allergy induced anaphylaxis showed that children and teens, ages ten to nineteen, are at the highest risk for experiencing a severe or fatal allergic reaction. Factors may include: not carrying their medications; not recognizing early symptoms; and treating anaphylactic reactions with asthma inhalers instead of epinephrine.
The Food Allergy & Anaphylaxis Network (FAAN) believes that awareness, education, and cooperation between the staff, parents, campers, and the physician are the keys to successfully managing food allergies at camp.
Work Together to Prevent a Reaction.
Before camp starts, begin by communicating with parents to find out if any campers have food allergies and, if so, ask them to fill out a Food Allergy Action Plan (FAAP), signed by their doctor. If the camper is allergic to more than one food, have them fill out one FAAP per food. The FAAP will tell you what foods the camper is allergic to, what symptoms to look for, and what medications to give to treat reactions (a copy of this form is available for download at www.foodallergy.org ).
Review the FAAPs with your medical director before camp begins — you will need to work carefully with campers, parents, and staff to identify risks and develop strategies to avoid a reaction. Discuss where medications will be kept and who will administer them.
Involve the camp staff in preparation and prevention. Begin by making your staff aware of how serious a food-allergy induced allergic reaction can be — many people do not realize that for some, ingesting even small amounts of the food to which they are allergic can cause a reaction.
Ask parents for guidance in determining what foods their child may eat, which foods need to be avoided, and how to identify them. Milk, for example, is a common ingredient in other foods, such as deli meats or canned tuna fish.
Some parents ask to read the ingredients for foods to be used at camp; others prefer to supply the camp with their child's food. Do not rely on a list of "safe" foods provided by the parents. Some institutional-size products contain ingredients that are different from the regular-size products — therefore, all ingredient listings should be reviewed.
Work with the kitchen staff to rearrange food preparation and serving areas to avoid cross-contact. Cross-contact occurs when a small amount of food allergen is mixed in with other, "safe" foods. Dipping a knife used to spread peanut butter into the jelly jar, for example, could cause a reaction in a peanut-allergic individual if they eat the jelly afterwards. Cross-contact can also occur during cooking if the same spatula is used for allergen-containing foods and allergen-free foods. Although invisible to the eye, there may be enough protein on the utensil to cause a reaction.
Enlist the help of your campers with food allergies to plan for meals — some prefer to be the first on the buffet line (before there is a chance for cross-contact). To avoid cross-contact with allergen-containing foods, you may wish to use disposable knives and other cooking implements, prepare food such as sandwiches on a paper plate, or line a section of the counter with paper that can be discarded after preparing foods to which the camper is allergic. Putting jelly in a plastic squeeze bottle will prevent cross-contact with peanut butter.
Develop an Action Plan in Case of a Reaction.
No matter how hard you work to prevent a reaction, there is always a chance that something may go wrong. Prepare your staff to handle such an occurrence — they must quickly recognize symptoms, treat the reaction, and transport the camper to the emergency room should an allergic reaction take place. Additionally, you may have a child who experiences his or her first reaction while at camp. Planning ahead for these allergic emergencies will ensure that all reactions are handled quickly. Speak to your camp's medical director to develop a written policy for handling these situations.
Your camp action plan should include:
Invite the camper's parents to provide guidance as you develop your plan or to provide any information about the usual course a reaction might take. Be sure you discuss your emergency action plan with your medical director. Ask the parents or medical director to teach you how to use medications, such as nebulizers for asthma or EpiPen® for anaphylaxis.
If the camp is in a rural location, keep in mind that ambulance and emergency crews may be volunteers; therefore, additional plans for transportation and additional medication may be required. Determine in advance how far it is to the nearest hospital and how long it may take for an emergency crew to arrive. Find out if they normally carry epinephrine and whether you need to use any special terms, such as anaphylactic reaction, when calling the dispatcher. Keep a cell phone handy for use in case you or another staff member must drive an allergic camper who is having a reaction to the hospital.
Much like fire drills, food allergy reaction drills can save lives. Rehearse what the staff will do in different situations — assign roles to key staff members as appropriate. Continue to practice drills until everyone knows and performs his or her part smoothly — time is of the essence in treating allergic reactions. Have your legal counsel review your emergency plans and determine whether they fall within the legal and regulatory bounds that apply to your state.
Always follow up an allergic reaction with a call to the camper's family and a review of how the reaction occurred, what worked, and what needs improvement. Finally, don't forget to have medications refilled as soon as possible after the reaction.
In summary, food allergies are increasing. Therefore, at some point, it is likely that you will have a camper who has a food allergy. Strict avoidance of the food is the only way to prevent a reaction. Working in partnership with the child's parents, physician, your staff, and other campers will enable you to develop a plan to keep these children safe. Millions of children have food allergies, thousands attend camp safely each year — awareness, education, and cooperation are the keys to success!
Bock S. A., Muñoz-Furlong A., Sampson H. A. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol 2001; 107: 191-3.
Sicherer S.H. Diagnosis and management of childhood food allergy. Current Problems in Pediatrics. 2001; 31: 39-57.
Yocum M. W., Butterfield J. H., Klein J. S., Volcheck G. W., Schroeder D. R., Silverstein M. D. Epidemiology of anaphylax