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Off to College – with Food Allergies

Posted By Allergic Living On 2010/06/30 @ 7:28 pm In Archives | No Comments

University is a time of great transition, especially for food allergic students navigating meal plans, shared kitchens and pub nights. Allergic Living examines how prepared students – and institutions – are to handle this brave new reality.

It was a lazy afternoon in the residence common room – students were studying for classes, watching TV or simply hanging out with friends. Christine Creese was hungry and grabbed the phone to call a familiar number. Months earlier, the 22-year-old had discovered a local Chinese restaurant that would deliver to her dorm at the University of Toronto. Despite serious allergies to peanuts and nuts, as well shellfish, kiwi and onion – Creese was able to eat the restaurant’s delicious pineapple orange chicken.

On the phone, she went through her usual explanation of her allergies, and got an assurance that her favourite was safe from cross-contamination in that kitchen. “When it arrived, I put a whole piece of chicken in my mouth and suddenly realized that it tasted different,” recalls Creese. She spit it out, and called the restaurant back. The restaurant had accidentally sent the General Tso peanut chicken dish.

A tingling began in her mouth. Soon, Creese’s tongue was itchy and she became hot and flushed. Friends in the common room sprang into action: one called 911 while another had Creese’s EpiPen at the ready. Creese, a third-year student, used her asthma inhaler while others ran out to flag down the ambulance.

She was about to administer her EpiPen, when the paramedics arrived. Creese would end up needing two doses of epinephrine to bring her reaction under control, and spent the rest of the day in hospital.

Creese, now 24, is generally mindful of her medical condition. Before starting her undergraduate degree, she took precautions including asking for, and being given, a single room since it is difficult to enforce a peanut-free shared room, and she feels that “infringes on the autonomy of the other person.”

Food allergic students entering university this fall face a similar need to develop their own safety strategies while adapting to a new, big and autonomous school environment. Of course, any freshman has a lot to adjust to: moving away from home, living in residence, going to class in lecture halls and finding one’s way around campus.

But for those with life-threatening allergies, there is an additional layer of change – there are no parents around to explain to the professors about allergies as they did with the teachers in elementary school, and perhaps high school.

Even the most cautious student with allergies will find an environment of shared accommodations and cafeteria and residence meals an adjustment. And not every allergic student will be careful all the time – science has proven that the late teens and early 20s are a time of the most impulsive decision-making.

Throw into the mix the introduction of campus pub life, new friends and potential romantic interests, and university remains a time of learning inside the class and out. But for the allergic, it is also a time of managing a new level of risk and of learning to speak up for oneself.

With the number of teens entering university with allergies on the rise, many institutions are examining what sort of protective measures they can offer students.

The range of policies among universities and colleges is vast, but there are some encouraging advances. Carleton University in Ottawa has eliminated nuts from the residence dining hall menu and this spring became the third campus in Canada to allow its Student Emergency Response Team – a 24-hour service of volunteers trained in advance lifesaving techniques – to carry EpiPens. The practice began at McMaster University in Hamilton, Ont.

British Columbia’s University of Victoria takes one of the most proactive approaches. Three years ago, a group of students met the UVic administration to ask for improved options for those with allergies and food sensitivities. The university agreed that change was needed.

Of a population of 2,400 students who live in residence, 1,600 eat daily at campus cafeterias and restaurants. The number in residence who informed the university administration of allergies and other dietary restrictions grew to about 24 this year from three in the fall of 2005.

Traditionally, first year students at UVic live in residence, and would only move into cluster housing – a self-contained environment on campus – in second year. “We see it as the next level,” says Gavin Quiney, Director of UVic’s Housing, Food and Conference Services.

“But as we found more and more people presenting allergies, we thought this is too risky to involve them in the large institutional food program.” As a result, first-year students with severe allergies are being allowed to move into cluster housing.

So Eric Champagne, a 17-year-old Calgarian with tree nut, peanut and seafood allergies, is now living in such an apartment with two other young men with severe allergies. “Kudos to them for a great solution that goes a very long way in allaying our fears,” says Eric’s father, Gilles.

To further assist, the staff in food services will buy allergy-friendly foods at wholesale prices, keeping students’ costs lower. “This is their home and we need to be there for them,” explains Heather Seymour, the food services coordinator. The main cafeteria station also just implemented a no-nuts and no-peanuts policy in time for the fall semester.

Still, such accommodations are not yet the norm. Some of the top institutions of higher learning offer no special accommodations or directives for making substitutions in the meal plans. UWO’s nutritionist notes, however, that the food services staff does attend an annual training session with Anaphylaxis Canada on safe food handling, and that students are encouraged to work with the chefs and supervisors to ensure that safe options are available.

If you’re in residence at U of T, the administration recommends that allergic students work with the food services company to find appropriate dining choices. But as you must take part in the meal plan, this is not foolproof.

In residence, Creese asked the food services staff about ingredients at every meal. Yet in first year, she fairly often took ill after eating. Eventually, the student became the “meal plan fairy,” giving away her cafeteria tickets to friends.

Determined to spend the four years in residence, Creese had to pay for food she wouldn’t eat. “That’s $12,000 down the drain,” she says. But she ate well in her room: her mother lived 45 minutes away and was able to freeze meals that her daughter could microwave.

“It is difficult in university to create a safe environment,” says Creese, who is now married and completing a Masters of Science at the University of Guelph. “The [food services staff] were insensitive. Even the other food places on campus can be truculent when you ask about ingredients.”

Change may be slow, but it is coming as more institutions try to work out arrangements for students with allergies. Montreal’s Concordia University only has 200 kids in residence and while staff haven’t had to accommodate severe food allergies, the institution did remove all of the carpets in the dorms to reduce environmental allergens.

Last year, the Canadian Mennonite University in Winnipeg announced a scent-free policy, encouraging its students to avoid certain perfumed products in consideration of those with asthma or sensitivities to chemicals.

South of the border, the range of accommodation of food allergies at U.S. universities and colleges is similarly broad. Western Washington University in Bellingham, Wash., for example, does not collect allergy information when admitting freshmen.

New students with allergies are directed to the school’s registered dietitian, who states on the university’s website that while 3 per cent of the population think they have allergies, only 1 per cent have “true allergies”. (According to the latest medical studies, the incidence has in fact risen to about 4 per cent in the general population.)

But then there is the University of Michigan in Ann Arbor, which provides a lot of helpful information for students, including lists of unsafe menu items for different food allergies and tips on how to handle emergency situations at college.

Anne Muñoz-Furlong, CEO and founder of the Virginia-based Food Allergy & Anaphylaxis Network, says that in the past five years, U.S. universities have “made very positive steps” toward accommodating students with allergies. While FAAN offers a free food service training program for universities, it is really the students who are driving the issue, she says.

“The kids have created a need for schools to get on board. Any school that wants to stay competitive will have to become food allergy friendly.” Muñoz-Furlong notes that Brown and Cornell universities, in particular, have both worked with FAAN to develop proactive policies for allergic students.

Next Page: Attitude Adjustment

Attitude Adjustment

One of the difficulties of adapting to life in university with allergies is the degree of change. For Nadia Daniel, 19, it was downright overwhelming. Daniel was dealing with her dairy allergy and first year – and life in a new country.

In the fall of 2005, she moved to Peterborough, Ont., from her home in Aruba to attend Trent University. “In the beginning it was terrible,” says the biochemistry student, who’s now in second year. “You have to check everything you eat – and people just think you’re spoiled.”

In first year, Daniel suffered two major reactions. The second occurred in a chemistry lecture hall filled with 200 people. Feeling that she couldn’t inject herself in class, Daniel went outside and found an emergency booth. “I pressed the button and told them I needed to go to the hospital. They told me to call a taxi.” The emergency team finally agreed to come, but insisted on checking her heart rate before calling 911.

Daniel learned from this experience that she simply had to stop eating foods she hadn’t prepared herself. But this meant she would also have to cope with uncomfortable moments: “I was at the volleyball annual dinner and could only eat freaking toast. You hear people ask, ‘Is she anorexic or on a diet?’

To better cope with the transition, experts suggest that the most important tool for students with allergies is to be completely transparent about their health issues with the institution they choose to attend. Before classes start, students should contact the university and get as much information as possible.

Find out about meal plans and whether they are mandatory in residence, suggests Monika Gibson, Ontario coordinator of the Allergy/Asthma Information Association. Meet with the food services staff and ask questions: Are they trained to handle an emergency situation? Can they prepare your food in advance? The AAIA recommends finding out about the emergency protocol on campus and arranging a single room in a newer residence (which is more likely to have tile or wood flooring rather than dust-mite-filled carpeting). If moving, students should get a reference to a local allergist.

“Having an allergy is nothing to be embarrassed about,” Gibson says. “Number One, students have to take ownership of their conditions. Professors, roommates, classmates can’t help somebody if they don’t know what they’re dealing with, especially in a dormitory situation.”

As managers of their own allergies outside of the family home, it becomes the student’s job to remember to carry an epinephrine auto-injector and wear MedicAlert® jewelry, and to learn to make asking about ingredients just one of the daily routines of university life.

While doing her undergraduate degree at Brock University in St. Catharines, Ont., Erin MacNeil* came to understand the necessity of speaking up in social situations. At risk of anaphylaxis to nuts, egg, soy and with additional allergies to wheat, potatoes and banana, the Arts major found it very difficult to eat at her professors’ homes when students were invited over for a special dinner.

At one such meal, MacNeil ate food she wasn’t sure was safe. She did not have a reaction, but vowed not to do it again. Today, in graduate school, she has become skilled at refusing meals. “As an undergrad, I felt I was being demanding or bossy,” says the 30-year-old. “But I’ve become much better.

”While it is often considered safest to avoid residence, Joanna Clarke sought out the dorm life in first year at Halifax’s Dalhousie University. Now living in an apartment with friends and in third year, Clarke, 19, found residence an important experience because of the limits that her peanut and soy allergies put on her social life.

Such restrictions continue: “If there are peanuts served at a bar, I don’t go.” And she asks, “How important can one party be that it could cost me my life?” She made friends in residence who were sensitive to her allergies, and those friends became active in protecting her against exposure to peanuts. “A lot of them are more paranoid than I am. They’re really good about watching out for me.”

Careful, not fearful

Some universities have even gone so far as to identify students as “disabled” to underline the severity of their allergies. Morgan Hill, for example, last term finished a degree in agriculture at the University of Saskatchewan, where he was classified as such.

While not every allergic student would want this designation, it ensured that all of his professors were warned, in writing, about his peanut allergy and they were required to ask students not to eat peanut products during class. Hill now lives in Edmonton and works with farmers to introduce environmentally friendly practices.

He admits that college was still difficult at times. “The reason I chose to go to university was that I felt I could not live my life in fear that I was going to have an allergic reaction,” says Hill, who is highly sensitive to peanuts. “It was kind of living on the edge, but I survived by being careful, and living each day to the best of my ability.”

Hill’s no-fear approach is a common refrain among students who have lived in residence at university. All agree that with some effort, anxieties can be assuaged.

Larissa Teoh, 21, and her mother, Jo-Anne, have found a happy medium now that Larissa is in fourth year at Dalhousie University. Living in Hamilton, Ont., while her daughter went to school in Halifax was at first a concern for Jo-Anne. “Whenever there’s distance, it’s frightening. You can’t get there fast enough.”

Jo-Anne spoke to Dalhousie’s head chef and explained her daughter’s peanut and nut allergies, and was assured that peanut butter was only offered in small, individually packaged containers that were offered with plastic knives. She also managed to get a private room in residence for her daughter.

The adjustment to university is sometimes harder on parents than students. “I’m not sure how much I can let go,” says Sue Wicks, whose 18-year-old son, Peter, has just started university at Wilfrid Laurier University in Waterloo, Ont. Wicks, who lives an hour and a half away in Sarnia, is concerned about cross-contamination in residence, such as peanut butter residue in a shared kitchen.

She trusts her son, but stays rooted in reality. Asked whether Peter carries his EpiPen at all times, Wicks replies: “Would I like him to? Yes. Does he? No.” But she has made it clear “that at no time will he ever be able to get so drunk that he doesn’t know what he’s putting in his mouth.”

Peter is a bit more Zen: “I’d like to be able to control how the food is cooked,” he says, noting that he’ll be aware of whether others use and properly clean his cooking utensils. “But I’m not that worried.

”Especially with food allergies, university is a time of coming of age; there are many things that a parent no longer controls. One of Jo-Anne Teoh’s worries was the pubs and alcohol that contains nut products. “That was another milestone: If your friend says, ‘Here, try this drink,’ Larissa might not think of it.”

Jo-Anne worried about cross-contamination and accidental ingestion of peanuts, but her daughter was more sanguine. “I know people are very helpful and accommodating,” she says. “If you live life in fear, being nervous about something you cannot control no matter where you are, you aren’t living at all. I grew up with this allergy, my mom taught me well, and I know how to take care of myself. If you don’t know how to take care of yourself, then I’d be worried.”

She may display the confidence of youth, but Larissa is right: preparation and allergy awareness are two of the keys to a safe university experience with food allergies. That, and remembering Mom’s good advice – speak up about those allergies.

*Name changed by request.

Next Page: The College Check List

The College Check List

From The Food Allergy & Anaphylaxis Network

Food Services

A Few Months Before School Starts…

  • Schedule a meeting or a phone conference with the director of food services and get information about available services. Ask questions about food preparation and serving procedures and the risk of cross contact. Can students bring their own food into the dining halls?
  • Find out about food served at the stadium and dorms, as well as at other locations. Many universities have fast-food restaurants on campus. If you plan to eat there, visit these locations and ask for ingredient information.

Once You’re There…

  • Avoid foods that pose a high risk from cross contact, such as cereals, baked goods, and ice cream top- pings, if you are allergic to peanuts or tree nuts. A good rule is to avoid desserts prepared away from home.

Residence Life

A Few Months Before School Starts…

  • Contact the department of residence or student life to discuss your allergy and the medication that is used to treat a reaction.
  • Consider buying or renting a combination refrigerator/ freezer/microwave to keep in your dorm room. This will allow you to prepare your own food.

Once You’re There…

  • If you have a roommate, discuss your allergy with him or her. You may also want to give your room- mate and/or hallmates a lesson in administering an EpiPen® or Twinject™ if you have one prescribed
  • If your roommates eat the foods to which you are allergic, use caution to avoid cross contact. Wash counters and utensils thoroughly.
  • Keep plenty of safe snacks on hand so that you don’t arrive hungry to a social situation.

Campus Security/Public Safety Office

A Few Months Before School Starts…

  • Meet with campus security to discuss the protocol if you should have a reaction. On some campuses, students are instructed to call campus security instead of 911 in case of emergency so that campus security can direct emergency services where to go. Find out the emergency protocol.

Medical Services

A Few Months Before School Starts…

  • Ask your doctor to provide a letter documenting your food allergy restrictions, symptoms, instructions for medications, and procedure for treating a reaction. FAAN’s College Food Allergy Action Plan is an easy way to collect this information.
  • Ask your doctor to recommend a primary care physician and an allergist near your college.
  • Meet with the college’s health centre to discuss emergency procedures. Ask them about the location of the closest hospital. Contact the emergency service that serves the campus and find out what medications they carry.
  • Make sure you have your medical insurance card. For U.S. residents, know any restrictions on your medical insurance coverage.

Once You’re There…

  • Make several copies of your Food Allergy Action Plan and post it in the dorm’s kitchen, next to the phone in your dorm room, and next to the phone in your Resident Adviser’s room.
  • Make sure you wear/carry medical alert identification. This can be done by wearing a piece of jewelry, such as a MedicAlert® ID bracelet, or by carrying a card in your wallet.
  • Carry your medications with you at all times!

The Food Allergy & Anaphylaxis Network (2006). Reprinted with permission. View here [1].

First published in Allergic Living magazine (c) Copyright AGW Publishing Inc.

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