Allergies and Food Sensitivities - Keeping our kids safe with Sherry Coleman Collins

Full Transcript

Dalia 

Hi, Sherry, thank you so much for coming on, I know that you have a really packed schedule. So I really appreciate it.

Sherry Coleman Collins 

Oh, thank you, thanks for the invitation. I'm excited to be here.

Dalia 

So many of the people that are in smaller districts don't have a dietitian on staff. But everybody is coming across a surge in special diet requests. It's everything from allergies to celiac disease, they're just a lot of people who don't have a background in nutrition, charged with the task of keeping their kids safe. So that's why I wanted to have an allergy management specialist on to help people understand what allergies really are and what they need to do to keep their kids safe. So first, could you tell me a little bit about how you came to be an expert in allergy management?

Sherry Coleman Collins 

Sure, yeah, I think that you're absolutely right in that food allergy management is one those things that schools are learning more and more all the time about because they have to they've got more students, you have allergies, they're experiencing more requests from parents, and other people in the community to make accommodations. And yet the information that's out there can be very confusing. So I'm really excited to be able to share sort of my experience and information about allergy management.  I'm a registered dietitian, nutritionist, and I started my career in pediatrics, I started in clinical pediatrics, at Children's Healthcare of Atlanta, here in the Atlanta area where I live and practice. And in that position, I worked a lot in the IBD clinic so and inflammatory bowel disease working with children of all ages, but primarily older kids and teenagers who have Crohn's and colitis. And in that population, there tend to be a higher number of people, you also have food allergies, or who have sensitivities or intolerances. So it wasn't just the allergies, it was all kinds of digestive distress around food. And so in that first job out of school, I really started to learn a lot about food allergies and adverse reactions to food, of all types, and it was a great experience, I loved that job and got to learn a lot about GI distress and disorders in general and how manipulating our diet can really make a big difference in alleviating symptoms, helping people feel more comfortable, and also be healthier in the long run. So it was a lot of fun. I learned a ton about food allergies and that job. And then from there, I actually went into school nutrition. So I worked for almost five years in school nutrition in one of the largest districts in the metro Atlanta area. In that job, I was one of the only people I may have been the only one who had specifically pediatric clinical experience. As a part of my position here, I got to take leadership in food allergy management, and really start to help craft some of our policies and procedures around management, and begin to educate both our staff and, and also parents and work collaboratively with other people within the school district. And in that position, as you know, and anybody who's listening who works in school nutrition knows that you get lots of requests for accommodating special dietary request, just as you mentioned at the at the top of the show. So I think that, you know, in that job, I learned a lot about both sides of managing special requests, so from the perspective of the director, or the supervisor, the manager who wants to make these accommodations that has their own set of restrictions and difficulty doing that.

 

Dalia 

When you were in that position, what were the regulations like around special accommodations? What were the requirements?

Sherry Coleman Collins 

So at the time, USDA required documentation from an authorized medical professional that indicated that indeed, the person had some sort of a medical need for a special diet. And in that request, they had to indicate what the condition was, what their request was, and if there was an appropriate substitute, they might indicate what the substitute should be. So for instance, an individual who has cow's milk allergy needs to be substituted with soy milk instead. So that would be what the specifics would be from the medical professional. And that could be a physician, or in some cases, it might be a nurse practitioner, or a physician assistant. I think even nurses in some places are acceptable personnel who can send them a note like that, in most of the cases. In most states, as I understand it, someone like a dietitian wouldn't necessarily be considered or a chiropractor wouldn't be considered but a medical professional. Although I think dietitians certainly are medical professionals, it's my understanding that they were not approved to provide that documentation.

Dalia 

Right. I think right now, if you aren't legally able to write prescriptions, that's the standard that they're using right now in Georgia. So if you couldn't, write a prescription for something. But I agree that it would make sense for dietitians to be able to complete the form

Sherry Coleman Collins 

You know I think that the same time, I think that, you know, dietitians we are not really considered diagnosticians, necessarily, right. So we're not really the people who are diagnosing food allergies. So make sense to me that the pediatrician or an allergist really should be the ones who are making that call, they're the ones who have the background to differentiate and provide the appropriate testing necessary to really diagnose an individual with a food allergy. So I did that for about five years, and for almost five years, and I loved it. And I learned a ton again, about you know, sort of the management piece on the at the ground level, right, how to bring people together, how to manage in the kitchen, how to deal with it in other places in the school, how to manage after school, because sometimes people forget about after school program and dinner service, you still need to be managing the allergens there. So I did that. And then and then after I left that position, I went to work for the National Peanut Board. And I worked for the peanut board for about three years, maybe something like that about three years. And then my son was born. And in the position I was in with the National Peanut Board, I really did a lot of things. I mean, my position was the Senior Manager of Marketing Communications. So I did lots of things, it wasn't just around food allergies, but the national peanut board has been very committed to understanding the issues is around food allergies, and food allergy management, while also being part of the solution. So you know, I really admire the approach that they've taken, recognizing that, you know, peanuts are one of the big eight, people are really concerned about it. And so they want to be part of the solution to helping to find answers for people who have food allergies, and also provide guidance for those who are just concerned in the in the community. So whether it's schools, or other people in community settings, you really want to understand and help people with food allergies. So I did that for a couple of years, three years full time. And then when my son was born, I went to consulting, and now I do lots of things. But one of the things that I still do is work with the National Peanut Board, because I really love their approach to helping empower people, you know, they've spent more than $20 million dollars of their own resources in the sort of effort to educate, support, and, you know, outreach and research for food allergies.

Dalia 

That's really helpful. It's nice to know that the agricultural marketing boards are employing dietitians and bridging that gap between what we may be hear from people who aren't qualified, just clearing up a lot of the myths about allergies.

Sherry Coleman Collins 

Yes, and I would say, not all agriculture boards, have a dietitian that works with them in this capacity, you know, not to not to knock anybody else. I mean, they're everybody's doing great work. But the national peanut board specifically, I think they're really the only ones who have fully engaged in the food allergy issue, in order to understand and support the food allergy community. And at the same time, like you said, really address misinformation, because there's so much out there. And it's confusing, not just for the food allergy community, but also for the greater public. People hear things and they end and they don't, they don't if they don't know any better, especially if it comes from, you know, from smaller voices, but within the food allergy community, if they hear certain things they believe it, you know, and some people feel like allergens of all type, but particularly peanuts, and treenuts shouldn't be served in any public points. And that's not really a reasonable request.

Dalia 

Right. Can you talk a little bit more about that?  We are seeing more people requesting that their facilities be classified as nut free. Did you have that issue while you were working in school nutrition? And how did you handle it?

Sherry Coleman Collins 

Yeah, that's a great question.  I hear from districts periodically, who are having that same request, and they want support, they need information. And, you know, in my position, I was a supervisor. And there were eight or nine of us who were supervisors, and we had a director and in our team, we were all solidly aligned, recognizing that bans of any sort, or not a reasonable approach to managing food allergies, because it's impossible to ensure that an environment can be truly free from any allergens. And so it creates a false sense of security. And even the experts in this issue, say the same thing. They say that, you know, calling yourself peanut free or treenut free, or nut free, really creates this unattainable expectation from the community. And then that can lead to, you know, sort of a lax approach to management where people think that the environment is completely safe, they're less prepared when a reaction does happen. So,  that was our approach, you know, we would talk to the parents talk to the administrators, whoever the request was coming from, and help them understand that, you know, it was impossible for us to do that. It wasn't necessary for us to do, that we were able to manage food allergens in a way that that helps reduce risk, there's no way to completely eliminate risk, it's impossible to do that in any case, right? There's always the potential that something could happen. And the reality is that a better approach is caution and preparedness. So training, training, training, I preached it, then I still preach it now, you know, training our people to understand how to prevent cross contact, how to identify allergens, what to do, if a reaction happens, you know, how to help a child choose safe foods, how to identify those foods. You know, fortunately, I think in school nutrition, I mean, to me, school, nutrition is the best environment for these kids, because they're in a place where there's a safety net, you know, people know a lot about food, they understand food safety, they care so deeply about these kids. I mean, I know, you know what this was, like, you know, we had schools that had hundreds and hundreds of kids participating in the National School Lunch Program, right. These kids would come through, and the, the cashier knew every single child by name, you know, I mean, this is a place where there's an investment in these kids, and everybody wants the same thing. They want these kids to be healthy and happy. And they want them to be able to learn and learn to self-advocate as well. So I think the school environment is the perfect place for that. And that was really the approach that I encourage and I still encourage today.

Dalia 

It really makes sense, because you need to have more than one line of defense, because let's assume that everything on site goes the way that it's supposed to go. What if something went wrong at the factory where your product came from? And the allergen has been packaged in it, it has nothing to do with you, you didn't do anything wrong. But if you're under the assumption that everything's just going to be perfect, and you're not prepared. Where's the epi pen? Like? Have you collaborated with the nurses? Do you know what to do? If someone starts to have a reaction, all of that should be in place.  I really hate the idea of people having that false sense of security and that potentially causing harm, because like you said, Everybody wants the best for the children, we want for our kids to be safe, that would just be so crushing for us to assume everything is fine, when in reality, you cannot have total control over the food environment, you can only have best practices and you need to have a plan B because anything can happen.

Sherry Coleman Collins 

Yeah, right. Absolutely. There actually is some evidence to you know, thinking about banning peanuts. In particular, there's some research that's actually shown there was a study out of Canada that was a cohort study that showed it compared rates of reactions in schools, and where reactions happened. And what they discovered was that there were more reactions in school that claim to be peanut free as compared to those that were not peanut free. So that's just one study. But it was, I think it was a pretty robust study where there were a lot of subjects in the study. And then there was a study out of Massachusetts that actually looked at rates of anaphylaxis and use of epinephrine. And they found something similar where the rates of epinephrine were actually no different between the schools that claim to be peanut free as compared to those that were not. So the goal is to reduce reactions. And the goal is to, you know, to reduce anaphylaxis and reduce risk, we're not doing that by claiming to be peanut free. So if that's not working, then we need to do something different, we need to do something that actually reduces risk. And so that there were a few things that they found did reduce risk, you know, one in particular was having an allergen free table or a peanut free table. You know, that's, I think one of those things, it's kind of a, I think that's what that age is age, specific, older kids don't necessarily need that. But young kids might benefit from that. Personally, I was never a fan of those, because I think that it creates a stigma for the child who's got allergies, and they've got to sit at this table all by themselves. You know, yeah, maybe they can bring a friend. But there's still that separation and I think there's no reason that and in a child who has a peanut allergy or milk allergy can't sit with all the other kids, you know, they just have to learn how to keep themselves safer. There's some very simple things they can do like, not sharing food is a big, big, big one. You know, never ever should they share food, because sharing food is one of the common ways that reactions actually happen.

Dalia 

That makes a lot of sense. You know, we don't like the idea of the kids having to sit alone. But we do have the managers clean and sanitize the table that their kids sit at, they sit with their friends, but they sit in the same spot every day. They're not isolated. But they know before they get there, where they're going to be sitting. And they've done classroom visits it where they've tried to explain to the kids not to share their food. It's not 100%. And especially the elementary school students like to kind of invade each other's personal space. It's a little tricky with the younger kids, like you said, it is an age specific thing. So you mentioned earlier that nuts, peanuts are part of the big eight. Can you tell us what the most common allergens are?

Sherry Coleman Collins 

Sure, yeah, that's a great question. So about 90% of reactions happen as a result of exposure to the big eight. So that would be milk, eggs, peanuts, tree nuts, the soy, fish, shellfish, and wheat. So those eight foods really, sort of cause most reactions, and most people 90%, approximately. But there are other foods that can cause reactions, any food actually can cause an allergic reaction, you when I first became a dietitian, I remember hearing about people who had really unusual allergies. And I thought, that's ridiculous, you can't be allergic to that it doesn't even contain protein. But the reality is that people can be allergic and even very seriously allergic to anything. So we have to assume that all allergen all allergies are important. We don't want anybody to feel uncomfortable. We don't want people to have life threatening reactions, for sure. But any reaction can be scary, especially for children. So those are the big eight. But we need to be mindful about other allergens if we hear about others, as well. And then when it comes to prevalence, and you know how many people are affected by the most common, it really is age dependent. Among very young children under five, the most common allergies are milk, and eggs. Those actually are more common than any others and much more common, in fact, most kids who have milk and egg allergies outgrow them. Although the rates of outgrown those allergies has declined over the last 10 years, maybe I think I haven't looked at the have to look back at the research Exactly. But, um, but there's been more kids who are holding on to those allergies longer than in the past and that's pretty significant.

Dalia 

What do you think that is linked to?

Sherry Coleman Collins 

I don't think that we know exactly, but we do know a lot about the benefit of exposure early in life, right. So, you know, when we think about preventing food allergies, we know that early exposure to allergens tends to be beneficial. And particularly for peanuts, we actually have new guidance that came out in 2017. So it's not super new, but it's new, considering that for 20 years, we've been sort of focusing on avoidance, these newer guidelines now tell us that we should be introducing peanut foods as early as four to six months to help prevent peanut allergies later in life. And that's a complete shift from what we've thought about in the past. So is it that you know, kids aren't getting some of these allergens early in life. And then maybe, as they you know, the longer tail goes without exposure, for instance, to peanuts foods, the more likely they are to truly become allergic. So there's this window of intervention or opportunity for intervention in the first year, somewhere around that six month mark, that closes as we get older. So as these children who have this propensity toward allergy get older, the more likely they're more likely to actually develop and maintain that allergy.

Dalia 

So that is that is a little confusing, because I used to be under the impression as well, that it was only a reaction to a protein, and it had to involve your immune system. And there were only certain foods that were likely to cause the reaction. But now I'm hearing also that oral allergy syndrome is something we have to think about and you have anaphylaxis with that can you explain what that is? Or basically what is happening when you have an allergic response? And how could that involve basically any food?

Sherry Coleman Collins 

Yeah, so um, so the immune system, our immune systems, create something called IGE is an antibody that it recognizes certain foods, right. And so when we eat a food or exposed to food, then our bodies may create IGE. And in some cases, in probably in many cases, our bodies will create IGE. It's one of the immune responses that we have to foods or proteins or substances. And we never actually have any clinical reaction. That happens a lot. And so that's why like the blood tests and skin tests, they can't be relied on completely for diagnosis. Because sometimes people will have IGE, but they don't actually have an allergy. So if somebody has a positive blood or skin test, but they've never had a reaction, or they don't have any clinical reactivity, they're not considered to be truly allergic. There are a lot of conditions that fall under the umbrella of adverse food reactions, right, where you eat a food, and then you don't feel good, you have some sort of symptom that might be hives, or might be a stomach ache, or it might be vomiting, or it might be something more severe like anaphylaxis. And not all of these are considered to be true allergy. So when we think about food, and we think about IGE mediated reactions, or true food allergy, these are reactions that happened very quickly. They happen usually within minutes, but it can take up to two hours for those reactions to happen. So we want to be mindful in you know, as as dietitians, or as health professionals, helping people sort of try to figure out what's going on, we want to think about when was the last time they ate a food and then try to identify it from there. And yes, it can be those big eight that we mentioned, all of those big eight, you know, we talked about are all foods do have sort of persistent proteins in them. Proteins that don't necessarily change significantly with cooking, or, you know, their proteins are maintained and intact. And that's why they tend to be more probably tend to be more allergenic than some other foods. But even foods like pineapple, or, or banana, in some cases can cause reactions, particularly for people who've got latex allergy. And that's really sort of a cross reactivity thing that's probably happening where latex has a certain structure and it's protein has a certain structure, and then banana and kiwi and some of these other fruits have similar structure to their protein, and then the body sees it and thinks that it's a certain allergen and reacts appropriately. And so was that reaction look like? Well, it can vary, you know, some people who have reactions have very mild reactions and go we have you know, may have a small amount of, of hives, or they may have vomiting, or they may have suffered vomiting is, you know, very mild for some people that can be very severe. But for a lot of people, it's, it's transient, in that it goes away really fast, maybe they have a reaction, they don't even need treatment, they just feel bad, and then it goes away. But for some people, that reaction can escalate really quickly. And it can involve difficulty breathing, and in the most severe cases, it can actually affect the cardiovascular system and a drop in blood pressure can happen. And that's what we really think about when we're when we're thinking about anaphylaxis. But the good news is that anaphylaxis is pretty rare, and most reactions are more on the mild side.

Dalia 

Now, is it true that as you continually are exposed to your allergen that your reactions likely to get more and more severe?

Sherry Coleman Collins 

That's not true. It's a little bit of a misunderstanding around the science. You know, I think that we do know that instance, who have allergies are less likely to have anaphylaxis this, but older children who have allergies are more likely. So not that, you know, it's still relatively rare, but it's that a child, an older child who has a food allergy is more likely to have a very severe reaction than a very young child and instance, for instance, their infants reactions are more likely vomiting, an older child reactions more likely going to be skin reaction, like hives, although hives don't always happen. So but the number of times we're exposed to an allergen doesn't correlate with the severity of reaction. And in fact, we don't really have any good way of predicting those people who will have anaphylaxis as compared to those who will not, we don't really have a litmus test to determine who are the people who are most likely to have anaphylaxis. So we have to look at people's specific individual risk. And then and then their physician or their allergist can help guide whether or not they should have epinephrine. But the good news is that epinephrine does very effectively treat anaphylaxis when it's given quickly, and when it's when it's appropriately given.

Dalia 

Okay, and you specified when it's appropriately given, how can you go wrong with how you administer epinephrine?

Sherry Coleman Collins 

So one of the one of the biggest problems with I think treating anaphylaxis of the people are afraid to get it right. So they're afraid of the needle or they're afraid it's going to hurt or they're afraid they're going to give it and the child doesn't need it, or the person doesn't need it. But the good news is that there's no contract indication that I'm aware of for giving epinephrine. I'm not a nurse or a doctor. But I've done a lot of I've done a lot of research, and I've been with a lot of people, I know a lot about food allergies, and definitely consider myself to be an expert. And I've never heard anybody say, don't give up an effort. In this case. In the case of food allergies, especially if someone thinks that anaphylaxis may be happening, or somebody has a history of anaphylaxis, and they know they've eaten allergen, giving epinephrine early. And appropriately meaning in the thigh, it should be given in the upper thigh and the outer thigh, it's an intra muscular injection, so it's got to go into the muscle. That's why it goes into the leg. So it should go into the muscle. And most people have auto injectors, right. So those auto injectors under the brand name like epi pen, they, they press against the thigh, the auto injector presses against the thigh, the needle comes out into the leg, and then it goes right back into the device. So you never, you never see the needle. It's very, it's not easy to accidentally, you know, poke yourself. It's actually pretty easy to administer. But it needs to be done quickly and administering epinephrine early is very effective at treating anaphylaxis. But no other medication treats anaphylaxis. So Benadryl won't treat anaphylaxis. So waiting, in the case of anaphylaxis, you asked about appropriate administration, waiting is one of the problems when somebody has anaphylaxis, we don't want to wait they need to have that medication quickly. 911 should be called right away, especially if epinephrine is given. Because in some cases, people who have anaphylaxis will have what's called a biphasic reaction, which means they'll have their anaphylactic reaction, they get treatment, they get better, and then they have another anaphylactic reaction. That happens, maybe 10 minutes, 15 minutes, 30 minutes later, they'll have a secondary reaction. Well, in some cases, they may not have a second dose advantage of epinephrine. And they may need additional support. And that's why you want to call 911 get to the hospital, so that they can get that supportive care if they needed and a second dose of epinephrine if they need it.

Dalia 

That's important to know. And another thing I wanted you to explain is, how likely is it for someone to have a reaction to their allergen if someone else in the room is consuming it. So I know sometimes, that's a concern.

Sherry Coleman Collins 

Sure. And I think that's, you know, it's really primarily, it's actually a myth, it's a misunderstanding and a myth that you can't be in the same space as someone who's eating an allergen. If you have an allergy. The reality is that the research doesn't support severe reactions like anaphylaxis happening just by being near the allergen. So someone could walk through the grocery store where their allergen is and not have a reaction, you know, people can be in the same room can sit next to someone who's eating a food. If you've got the allergy and not have a reaction, what the research shows is that skin contact may cause some localized reactions that might cause itching and redness at the site. But it won't cause even skin contact doesn't cause anaphylaxis when it comes to peanut butter. For instance, there was a good study that was done with children who had food allergies, that peanut allergies specifically, and then did two things with these kids, they had they applied peanut butter to the skin, and then they waited 10 minutes, and then they washed it off. None of those kids had any respiratory or systemic reaction. But they did some of them had some local reactions to itching and redness and swelling, which I think is expected, right, you would expect there to be some reaction. But none of them had systemic reactions. And then they had the kids smell a mixture of peanut butter and a masking agent, I think it was like mint and tuna fish to help cover the smell of peanut butter. So they didn't react, you know, they didn't think they were reacting, they didn't know what they were smelling. It smelled like tuna fish. So they say had them smell this, this food close to their face. And none of those kids had any sort of reaction at all. So none of them had any systemic reaction, none of them had any other kind of reaction. I think that you know, a lot of people are very, very anxious people have food allergies tend to be very anxious. Because having a reaction can be scary, you know. And if you're the parent of somebody who's got a potentially life threatening allergy, it's scary, and you want to do everything you can to keep that child safe. And I think so I think a lot of people ask for accommodations out of fear. And, and I can't put myself in their position, I don't have a child who has a food allergy. But what I can say is that the research doesn't support that those kinds of measures are necessary because the research doesn't support that just being in the same room is going to cause a reaction.

 

Dalia 

Well, that's actually great news. Even if in your district, you don't have a problem with the accommodation, it raises anxiety for everyone, when you believe that that is a risk, because you can't control everything that comes into your school. So even if you have that documentation from a doctor and you decide to remove a product from that site, it's good to know that even if that product ended up in the building, due to something that was going on outside of the nutrition program that it would not cause a serious reaction. So that's a relief. So I had another question about the difference between food sensitivities and allergies. When we're getting our diet orders from physicians, we don't question them, because that's outside of our lane and we stay, you know, within our scope of practice, we're just there to execute the diet order. But just for our own information, when someone doesn't have an allergy, that they have a food sensitivity, what would be a reason why it should be accommodated from a health perspective, like something that only causes GI distress.

Sherry Coleman Collins 

Yeah, I mean, I think that's it, right. I mean, we one of the things, I think that I always stress when it comes to school nutrition. This was my focus when I was in school nutrition. And it's still my focus, when I talk to my friends who work in school nutrition is that, you know, you've got sort of two hats, right? You're, you're charged with safety and nutrition, you know, providing the safe, nutritious food and meals for these kids. But the other piece of that is you also want them to be happy customers, right? So you want them to come back and you want them to enjoy the food and have a good experience. And you want that for their parents. And I think our customers are our kids, they're becoming more and savvy, and they're interested in food and they want healthier options and tastier options. And they want global flavors. So there, you know, this kind of this all this is not divorced from providing safe options to right. So it's the, it's the request, in my experience, you know, it's a request was a medical request, then we always accommodated that request. Because we have to write the physicians written the note, we have to do that. But also because it's the right thing to do. And I think that's the same thing with a sensitivity, you know, it's like, we're  going to do everything we can to provide options for these kids to have food that they enjoy, and that makes them feel good. So we don't want to serve food to a child that's going to make them feel bad. And even if it's not an allergy, you know, if it's as soon as it's going to make them feel bad, we don't want them to eat it. So how can we help by partnering with the parents to help the child learn to choose things that are going to make them feel good, and that they're also going to enjoy. So in our district, we had the option to create an alert that would flash red on the screen if a child had a food allergy. And then we could put in a note that would come up sort of a pop up that was white. So it wasn't quite as you know, urgent looking, but it was a reminder, hey, don't forget, you know, Sally's not supposed to eat wheat. And you know, it wasn't, it wasn't as big of a deal because it wasn't about, you know, the potential for anaphylaxis. But it wasn't about mind to the cashier that hey, make sure that Sally's not getting things she's not supposed to get. And then if and when things happened, we would you know, work with a family to try to help modify that child's menu, most of the time in a district that has offered versus serve, you're going to be able to make enough choice for that child so that they can choose things that are going to be better options for them without necessarily purchasing foods that are outside of what you're purchasing for the rest of the students. Does that make sense?

 

Dalia 

Yes, absolutely, that does right for us sensitivity, not an allergy. When it comes to reliable testing, this really isn't something I wanted to know, in reference to who are we going to accommodate and who are we not going to, but just for individual people who may be think they haven't sensitivities, you mentioned that a skin test maybe wouldn't give you super accurate results, because you can have a reaction that doesn't actually lead to problems that it may read as a reaction but it doesn't mean you need to avoid it. What is a reliable test if you have questions about your own diet, and what you may be, are having negative reactions to?

Sherry Coleman Collins 

Sure, well, there is no testing, there are no tests that are considered to be evidence based, reliable tests for food sensitivities, there just aren't. There are a lot that are marketed. But none of them are peer reviewed and approved and recommended by the medical professionals that I work with in food allergy and in GI, none of those tests that are that are on the market that claim to be able to diagnose food sensitivity actually have been proven to do that. So I would say don't spend your money on those tests. Because there's no evidence that there are reliable way for you to diagnose that. My recommendation if you think you've got a food allergy, or if you're having an adverse situation with you know, sort of an adverse reaction is first rule about food allergies, true food allergy, go to the allergist, you know, talk to them about your symptoms, you know, first keep a diary of what you're eating, and what your symptoms are. So that you can be able to say, you know, whenever I eat this food, this is what happens. And that's how we know a food allergy is a food allergy. It's reliable, it happens every time you eat the food. If it's not happening, every time you eat the food, it's probably not, it's not going to be an allergy. And it probably isn't even a sensitivity or an intolerance. Because if you're able to eat the food, you probably don't have a true, you're not having an immune reaction of some sort. But, you know, I think that's the first step is to keep that food diary so that you can start to correlate the food with your reaction. And then and then you know, if that's if it's not an allergy, you know, you may benefit from seeing a GI doc, because they may be able to uncover something else, maybe it's not the specific food that you're eating, maybe there's something going on in your gut, that means attention, you know, things like Crohn's and colitis can be difficult, and even IBS, right can be doing difficult to diagnose. And they have some similar symptoms to food allergies and intolerances with bloating and diarrhea and, you know, sort of the cyclical issue with GI distress. That's not necessarily connected to specific foods, it's more about dysfunction in the gut. And so you know, if you're constantly trying to manipulate your diet, you may not be you may not actually be, you know, doing yourself any favors, because you may never uncover the issue if you're constantly trying to do it by yourself. So I'd say you know, see the allergist, the GI Doc, see a dietician who specializes in digestive health and food allergies, and walk with that person through the process of trying to get to the bottom of what's going on.

Dalia 

That is really great advice. What advice would you give families who are trying to help their children navigate food allergy management, especially newly diagnosed people, maybe an elementary school student?

 

Sherry Coleman Collins 

Well, I mean, I think this is such a great question. And I think that it's a place where a dietician who works in food allergies can be such a benefit and a partner to families. You know, I've worked with a number of families who have children with food allergies to help them understand some of the basics around management, you know, doctors are amazing. And the allergists that work with these families are amazing, but they have very limited time. Right, they don't have time to do all the deep training and education that parents need. So to me, you know, one of the biggest things that I communicate with people, you need a multidisciplinary team. It's not just the allergist know it's going to also be the nurses who can help you with, you know, with clinical trials, if their trials that are coming to help with the sensitization for instance, you need a dietician who can help you understand the nutrition side of it, you know, reading labels, finding proper alternatives, ensuring that the child doesn't have nutritional deficiencies because children who've got allergies, especially who've got multiple food allergies are at higher risk for having nutrient deficiencies and growth faltering. And so we want to try to prevent that. And so I think helping parents create this team is a really important part of that. The other part of it that I've mentioned a little bit, but I think it's so important to talk about, is the psychosocial part of it. So having, you know, a child psychologist as part of the team, or a counselor or therapist, who can both work with the parents, and with the child to manage anxiety, because it can be a very fearful experience, you know, if you're, I can't even I can hardly even imagine being in a situation with a lot of these parents, where they've seen their child have a very severe reaction, and they thought that their child might die. That is terrifying. And that fear can stick with you for a long time. So I think having somebody you know, who's a professional in mental health, walk alongside you to help you sort of manage that fear and reduce that fear. And the more people know about the facts around management, the more they become self advocates, the more comfortable they become with the truth versus the myth around exposure, and what can cause anaphylaxis versus what cannot cause anaphylaxis, I think the more comfortable people feel, and that goes for both in the school environment and then later on in college, you know, I think that it's incredible to see families who have taken that route of really creating this multidisciplinary approach, self-advocating approach with a child, who then becomes a college student who's able to navigate their life and feel confident and travel and do all the things. And those kids whose parents maybe took a very, very conservative approach. And we're very hands on and much less able to let the child advocate for themselves, and then the child goes to college and doesn't really know how to navigate on their own. And that I think, is a scarier situation.

Dalia 

Absolutely, I can see that this is another way where the nutrition department participates in the education of the students, because this is information that they're going to need to function throughout life. So if you see the parents needing help figuring out how to communicate with the child, how to navigate, that would be a time for us to maybe step in and make some recommendations about what other resources they could look at so that their child becomes self-sufficient, because they won't always be there to help them and we won't either.

Sherry Coleman Collins 

I think, you know, one of the things that I always said, and then I, that I, that I still say now is get the kid involved as early as possible, all right, teach children to self-advocate as early as possible. So when a child is coming in to a new school, or maybe they just been diagnosed, or each year, parents should have a meeting with the administrators and the food service director, or the manager, whichever works, whatever is appropriate in that district. Sit down and have that conversation and have the child participate in at least part of the conversation. Maybe the child doesn't need to be you know, at six years old, they may not be able to participate in the whole conversation, but they should be there in order to meet the manager and to meet the staff and to and to know if that child has a question, who did they talk to? Who can they ask for? You know, who can they ask for more information? Or who did they tell if they think they're having a reaction? You know, creating that self-awareness and self-empowerment as early as possible, can only benefit the child.

Dalia 

That makes so much sense. This has been so informative. Thank you so much for taking out the time to come on, there are a lot of takeaways here. What was something that kept coming up with your staff?  Was it one ongoing issue?

Sherry Coleman Collins 

Yeah, I think there were a couple of things, I think, you know, we were very intentional about training. So I think our staff was pretty well trained. By the time I left, I felt like we had, you know, created a good approach and plan. And so I felt like they got the management part really, really well. The part that I think is always the trickiest, and is the hardest is the communication piece. Communicating both internally with the school staff, and outside of the kitchen, communicating with teachers, and with administrators, sometimes, if that communication isn't already be good, then you add on top of it, the anxiety around allergy management, it can be even harder. And then also communicating with the parents. Sometimes that can be really hard to the parents are very highly anxious, or if they're making requests that you can't accommodate like a ban, you know, those times I think were the most difficult and there are the things that I think require the most of us and also require the most regular attention. And my my suggestion to them was always the same, you know, first is be proactive, if you know you have a child coming in, who has food allergies, go ahead and reach out to those parents and say, Hey, you know, I'm so and so the manager, I'm the director of this district tonight, know that you have a child who's coming in with a food allergy, we're really excited to meet her. Can we talk about what we do, can we tell you about what we do in our district to help reduce the risk? Then you know, you're reaching out to them, you're going to make them feel so much more comfortable if you initiate that conversation than if you know, if they've got to come and talk to you later on, because something happened. If they've got a concern, if you've opened that door, already, they're going to be much more likely to have that conversation with you. And I think the same thing happens internally. So if you're the manager at a school, and you've been trained on food allergies, tell your principal, tell your you know, tell your teachers, hey, I want to let you know that we've been trained on food allergies, and here's what happened, you don't necessarily have to give them all the details. But the more you let them know that you know, the, the more comfortable they're going to be with you. And the more they're going to trust you. And really at the end of the day, when it comes to these parents who've got children with food allergies, it's about trust, they want to trust that you're going to take care of their child, you know, as well as they can or close, you know, you're never going to be able to do it like they can because you know, I'm a mom, I get it. But you know, they want to they want to know that they can trust you with their child.

 

Dalia 

Yeah, I can see communication being hugely important in this area and so many areas of customer service communication is a weak spot. But this would really help smooth over a lot of the issues that come up with allergy management and all the districts because sometimes you really are accommodating, but you can't seem to get that across to the parent, they still, they don't believe you because they don't trust you because you didn't put in the work to build that trust, of course they're going to be skeptical and keep asking you to prove that you're doing what you claim you're doing. So that’s definitely something to try and address before it gets away from you before it becomes an issue. That relationship should already be in place. So that's a great tip. We've covered so much territory, this is something that honestly, you can study forever. I know for everybody, you become an expert in the areas that you work in the most. And that's one of the things that’s tricky in school nutrition when you're doing a million different things. It's hard to get really strong in every area, you can't necessarily specialize in everything. So I appreciate you coming in as an expert to share this information with us. If people would like to follow you, where's a good place to find you on social or on the internet?

Sherry Coleman Collins 

Oh, thanks so much. You know, I'm so people can find me in two different ways. Definitely, they can find me on my personal professional handles @dietitiansherry but also @peanutrd on Twitter on Instagram. I would like to share a couple of other resources that are food allergy specific. https://peanutallergyfacts.org/ On that website, we've got a section that's just for school nutrition, has great information, with videos and links and some best practices for food allergy management. I helped develop that, that resource. And we've got some amazing people in school nutrition who also contributed. The School Nutrition Association https://schoolnutrition.org/learning-center/food-allergy/ also has a food allergy resource center that's accessible by anyone. So you don't actually have to be a School Nutrition Association member, although I recommend it, in order to access these resources. On that website, there's a ton of information about frequently asked questions on food allergies and food allergy management. And so both of those resources are specifically for school nutrition professionals, and I think answer a lot of the most common questions that people have. And of course, if people want to reach out to me, they can do that. And you know, I mentioned how they can find me on social media. And that's the best way to connect with me as well.

Dalia 

Great.

Thank you so much.

Sherry Coleman Collins

My pleasure.