Lee County Schools- Bringing Back the Peanut

Peanut Allergy Community Education Guide Bringing Back the Peanut



Letter from Our Team Amy Carroll, RD Coordinator, Food and Nutrition Services

Letter from Amy Carroll, RD Coordinator, Food & Nutrition Services 3


butter. Lee County had no choice but to seriously consider reintroducing peanut butter sandwiches as an item on our menus. Food and Nutrition Services knew and understood that there would be resistance to this proposal and fear from a variety of stakeholders including administration, teachers, nursing staff, parents, and students. It was because of this understanding that we wanted to take a collaborative approach to bringing peanuts back and would need representation from all departments. The primary focus of our message was simple – in taking into consideration the 8 major allergens and the very small percentage of students allergic to peanuts, the banning of one allergen might not be the most effective approach to allergy management; but rather a comprehensive allergy management plan. A plan that encompasses all allergens, includes accommodations available for all students with an allergen plan, promotes implementation of new safety features and protocols, provides training and makes certain proper procedures are in place should a reaction occur. Not only a reaction in the cafeteria, but in the classroom, on the playground, on the school bus, etc. This collaboration proved successful in allowing all parties involved to provide feedback and engage in healthy dialogue as how to best proceed with safely bringing peanuts back into our school kitchens. While still recognizing that peanuts are a common food allergen, our district has developed a plan that addresses all major allergens ensuring that all students are protected, while remembering that the vast majority of kids can eat peanut butter without any issues at all. In addition, a training video geared primarily towards elementary schools, and starring our very own students, has been filmed that will be shared in every classroom prior to the peanut butter roll-out. The School District of Lee County is excited to announce that peanut butter will officially be served again in our cafeterias beginning February 22, 2022.

Greetings and welcome to this special edition digizine focused on bringing peanuts back into schools. My name is Amy Carroll

and I work for The School District of Lee County in Fort Myers, Florida. We are the 32nd largest school district in the country with approximately 95,000 students. I am the Coordinator of Special Projects and Student Wellness for the Food & Nutrition Services Department and one of two Registered Dietitians on staff. Our school district has had peanut free kitchens since 2004. I am not sure of the particular reason why peanuts were removed, though it may have been prompted by the passing of the Food Allergen Labeling and Consumer Protection Act that year. This act required that food labels must declare if any ingredients listed are major food allergens. The media’s negative attention on peanuts at this time may have quickened the response. But this is all conjecture. In the fall of 2019, I was invited to visit a school in Orange County Florida and observed during their lunch period that peanut butter sandwiches were served. They were an absolute hit amongst the students. A simple, yet nutritious meal of a peanut butter & jelly sandwich, orange, and a milk was a true fan favorite. This prompted discussions in Lee County as to whether we should bring peanut butter back as a menu option. We were missing customers. There were 8 major allergens … why were we only banning one? Did this provide a false sense of security? We were peanut free kitchens, but peanut products were allowed tobebrought in fromhome inpacked lunches. However, after almost bragging about “peanut free kitchens” for well over a decade, we knew we were going to face some major obstacles. The conversation was shelved temporarily…and then Covid hit. Fast forward to the 2021-22 school year. School districts across the country are being affected by labor shortages, supply shortages, sky-rocketing costs and a stressed-out work force. School foodservice staff are being forced to get creative with the food that is available and affordable. One commodity item that checks both those boxes during this time is peanut

Making School Breakfast Cool (and Safer): Adopting Top Trends & Managing Food Allergens 4

From the School District of Lee County: Peanut Butter Reintegration Podcast & Video 6

Confused about Food Allergies?

So is Everybody Else. 8

Special Next Up Podcast: Peanuts Returning to Lee County 10

Common Questions About Peanut Allergies:


Amync@leeschools.net 2855 Colonial Blvd. Fort Myers, FL 33966 239-461-8449 Connect with Us!

Peanut Allergy Community Education Guide 2

Making School Breakfast Cool (and Safer): Adopting Top Trends & Managing Food Allergens

By Sherry Coleman Collins, MS, RDN, LD

Finally, peanut butter is a shelf-stable item that can be prepared the day before and requires no refrigeration, helping ensure a safer option for students when it comes to food safety. On top of all of this, peanut butter fits perfectly into food trends like vegetarian meals, plant-based protein, and ethnic flavors. Great examples of trends that can be reinterpreted for schools include bento boxes , smoothies , and overnight oats , just to name a few. School nutrition programs must continue to evolve to meet the sophisticated palates of student customers. Incorporating these hot trends will help elevate programs, making school breakfast as cool as a trip to the local coffee shop. Managing food allergies is also an essential part of providing safe school meals. Here are some tips for meeting the challenge at breakfast and any time of day: • Peanut foods, like all other common allergens, should be clearly labeled on menus and at

the point of sale to help students and staff work together to reduce the chance of accidental ingestion by allergic individuals. • Alternatives should be available when any allergenic food is offered to help students enjoy a meal that meets their specific needs. • Annual food allergy training for staff, including identifying and responding to allergic reactions, proper handling of allergens, and more, is an important way to be prepared to manage food allergens. Learn more about this topic and hear all the best practice tips offered by taking the training via the School Nutrition Association website on- demand at Adopting Top Food Trends & Managing Allergies at School Breakfast . While you’re there, check out SNA’s newly revamped Food Allergy Resource Center for information on serving and managing food allergens in K-12.


National Peanut Board is always looking for ways to support school nutrition

school breakfast can be a challenge! First of all, there’s not much time in the morning between the time a child arrives on the bus and when the first bell rings. Moreover, while lunch service is staggered over a couple of hours or more, all students arrive at the same time in the morning. Here are some ways schools serve breakfast to overcome those barriers: • Traditional café service • Breakfast-in-the-classroom • Via carts positioned around the school building Most people agree that starting the day with a nutritious breakfast ensures that children are ready to learn when the bell rings. Across the country, schools serve millions of school breakfasts each school day to help fill that gap. In order for schools to meet slimmargins, it’s essential that those breakfast meals are delicious and affordable; so that kids actually eat them. Fortunately, peanut butter is also a nutritious food that kids love!

professionals as they work to serve nutritious and safe meals to their students.We’reproudtohavepartnered with the School Nutrition Association for a new webinar, Adopting Top Food Trends & Managing Allergies at School Breakfast , now available for school nutrition professionals on demand. School breakfast is one area where we believe peanut butter has great potential to help school nutrition experts adopt some popular trends, while meeting student’s nutrition needs. In the webinar, Donna Martin, Ed.S., RDN, L.D., SNS, FAND and school nutrition director in Burke County, Georgia, and I help answer common questions about serving peanut butter products during school breakfast – and to show how peanut butter can fit regardless of how breakfast is served. Serving breakfast at school seems straight-forward. After all, schools are already serving lunch every day. Yet,

Peanut Allergy Community Education Guide 4

An update from the School District of Lee County

LeeSchools TV Podcast Ep. 52: Kandy Messenger on Peanut Butter Being Back on the Menu



Peanut Butter Reintegration in the School District of Lee County 2 min

Peanut butter is a great source of protein with heart-healthy unsaturated fat that keeps children full and ready to learn. Starting February 22nd this delicious snack will be added to the school lunch menus across the School District of Lee County. Safety is always our number one priority. In an effort to manage food allergies our schools have fully trained staff and will implement new protocols to help prevent allergy related incidents: • Schools will ensure that all records are updated to reflect student health status. • A peanut allergy list will be shared with cafeteria managers to be uploaded into the point-of-sale system during meal times. • Foods containing peanuts will be properly labeled and placed in a special pan so the product is easily identifiable. • When students go through the lunch line and input their student ID number, there will be an alert if the student has a registered peanut allergy. P

• If an allergy is alerted the cashier will then proceed to remove the item from the child’s plate and replace with an alternate menu item. On the rare occasion that a student has an allergic reaction, despite these protocols, our staff is fully trained to identify signs and implement our emergency action plan. Parents can help by ensuring that their child’s allergic reactions are listed in their child’s health status at the school. Parents can upload the information directly into Focus and also speak with their school nurse. We also ask that you speak to your children about food safety and the importance of not sharing food with others. And, remember, hand washing with soap and water is a great way to prevent cross-contamination. Together we can safely reintroduce peanut butter as a delicious option for protein into our schools.

For this episode of the Lee Schools TV Podcast, we spoke with Kandy Messenger, Director of Food and Nutrition Services, on our district putting peanut butter back in schools, the effects of COVID-19 on the food supply, and the dedication of our food and nutrition workers to our students.

Confused about Food Allergies? So is Everybody Else.

By Caroline Young Bearden, MS, RD, LD, RYT

for Disease Control and Prevention (CDC) help better define the extent of the food allergy problem. To date, no comprehensive study has been done to determine food allergy prevalence in the U.S. Here are the committee’s recommendations and how you can start to implement them in your own life: 1. Choose healthcare providers wisely. Avoid clinicians who are using non-standardized and unproven procedures to test for allergies, such as applied kinesiology and electro dermal testing, according to the report. NASM recommendation: Physicians should use evidence-based procedures to diagnose food allergies. There is not one, simple test for food allergies, the committee said. A skin prick test and a medical history can help determine the likelihood of a food allergy, the committee said, but sometimes, the oral food challenge, or the supervised, gradual ingestion of doses of the potential allergen, is necessary to confirm a true food allergy. 2. Learn the current research. Read about the latest evidence-based research on early introduction. While the National Institute of Allergy and Infectious Diseases (NIAID) guidelines are not expected to be released until 2017, check out the American College of Allergy, Asthma and Immunology’s (ACAAI) recommendations. TheNational Peanut Board’s provide an easy-to-read graphic. NASM recommendation: Public health guidelines should have consistent and evidence-based advice for doctors and families about early introduction of allergens to infants when they are about 6 months old and no younger than 4 months old. 3. Cut through the clutter. Clear up any misconceptions about food allergies by reading evidence-based information.

industry to the public, in order to clear up misconceptions about food allergies. They suggested that authorities such as the World Health Organization consistently update guidelines on food allergy diagnosis, prevention and management, based on strong, current scientific evidence. Also, they recommended medical school programs, the food service industry and emergency organizations include food allergy and anaphylaxis management in their training. 4. Take note in your community. Find out about current food allergy plans and procedures. Do they provide a framework for a safe environment for those with food allergies? Then, raise awareness around the issue when necessary. NASM recommendation: To prevent severe reactions, improve practices and policies, such as food labels. They suggested that federal agencies should collaborate to replace current food allergy labels with clearer, more accurate information. Plus, they recommended federal agencies work on implementing emergency epinephrine policies for public venues, including schools, restaurants and airplanes, as well as staff trainings. Finally, the committee closed their report by recommending more research -- in areas like diagnosis, risk and management of food allergies. To Sum it Up All in all, the committee’s point in creating key steps and urging public health leaders to take action is to improve the health and quality of life for people with food allergies. Plus, other goals are to decrease food allergy reactions, and to raise awareness and dispel common myths to clear up the confusion. And eventually, the hope is that there will be consistent and effective procedures for those at risk for food allergies and those already suffering.


We probably all know someone who says they are allergic to certain foods or even food groups. To prevent a reaction from

occurring, they steer clear of potentially harmful allergens. Certainly, food allergies are very real and should not be taken lightly because they can dramatically affect quality of life and can be life- threatening. However, foodallergies,alongwiththeirsymptoms, are commonly misinterpreted, sometimes misdiagnosed, and confused for other issues like lactose intolerance or gluten sensitivity, according to a new report compiled by a committee of 15 doctors appointed by the National Academies of Sciences, Engineering and Medicine (NASM). The National Peanut Board helped sponsor the major consensus study, which broadly assesses food allergy causes, prevention, management and public policy. Evidence Tells the Truth You may have heard different behaviors are associated with preventing food allergies. But the report committee explained there is simply not enough evidence to link things like breastfeeding and vitamin D supplementation to food allergy prevention. Plus, the committee said there is not enough evidence to link these behaviors with food allergy prevention: • Vaginal delivery • Allergen-avoidance diets in pregnancy • Allergen avoidance in infancy So what are the recommendations from scientists? Positive Change in Action The report highlights steps to improve the food allergy environment for those with and without food allergies alike.

NASM recommendation: To improve education and training for everyone from healthcare providers to the food

First of all, the committee suggested the Centers

Peanut Allergy Community Education Guide 8

Common Questions About Peanut Allergies Answered.


Peanuts Returning to Lee County 22 min It’s been 18 years since the School District of Lee County became peanut free kitchens. On this episode, find out what drove the decision to bring peanut butter back into the school nutrition program.

By The National Peanut Board

What’s with peanut allergies? Though it’s increasingly in the news, the fact is less than 1% of Americans have a peanut allergy, 1 and food allergies only affect about 5% of children and 4% of teens and adults. 2 Peanut allergies are not the most common, but they are among top nine food allergens, and reactions to food allergens can be serious and sometimes life-threatening. What causes food allergies? Researches believe that food allergies are on the rise, but no one knows what causes food allergies in some people and not in others. While several hypotheses are being investigated, certain conditions in infants, including severe eczema and egg allergy, are known to be risk factor for developing a peanut allergy. 1 Vaccines are not considered a cause of peanut allergy,

and the Centers for Disease Control and Prevention clearly states that peanut oil is not used in vaccines. 3 Can peanut allergy be prevented? Yes. Research shows that introducing peanut foods to infants reduces their likelihood of developing peanut allergies by up to 86%. 4 Guidelines from the National Institute of Allergy and Infectious Diseases and the Dietary Guidelines for Americans recommend that parents introduce infant-appropriate peanut foods starting as early as 4-6 months, depending on their risk for developing peanut allergy. 5 Discuss questions about food allergies and introducing peanut foods with your healthcare provider. 5,6

Brought to you by:

FEATURING: Sherry Coleman Collins, MS, RD, LD Consultant Registered Dietitian Nutritionist | National Peanut Board

FEATURING: Wally Colon Assistant Director Health Services Lee County

FEATURING Amy Carroll, RD Coordinator, Food and Nutrition Services Lee County

HOST: Marlon Gordon NxtGen Network, CEO

Read On

Peanut Allergy Community Education Guide 10

Common Questions About Peanut Allergies - Answered.

Common Questions About Peanut Allergies - Answered.

What is the treatment for someone who is suffering from an allergic reaction? Anaphylaxis is a life-threatening allergic reaction, and can occur when only a small amount of the allergenic protein is eaten. Epinephrine is the approved treatment for anaphylaxis and should be administered without delay. 8 Individuals should seek medical help when a reaction occurs, including calling 911 anytime epinephrine is administered. What are the signs and symptoms of an allergic reaction to food? Identifying and treating a reaction quickly is paramount for safety. Common signs and symptoms of food allergy reaction include: 8 • Hives • Itching and swelling of the mouth, throat and eyes • Vomiting and diarrhea • Difficulty breathing • Reduced blood pressure, weakness and fainting Will smelling or touching peanuts or peanut butter cause anaphylaxis? No. Research does not support skin contact or airborne peanut butter exposure as a source of anaphylaxis, though hay fever type reactions may occur. 9 Most instances of anaphylaxis are the result of accidental ingestion of peanut proteins or exposure through the eyes or mouth.

How can peanut proteins be cleaned from surfaces and skin? Common household cleaners have demonstrated to be effective in removing peanut proteins from surfaces and eating areas. Soap and water remove peanut proteins from skin, but sanitizer alone does not. 0 Do bans on peanut products reduce the risk of accidental exposure? No. To the contrary, research has shown that banning peanuts in schools may increase the risk for reactions and does not reduce the frequency of epinephrine use. Bans give a false sense of security, and are not recommended by healthcare professionals. Best practices for managing food allergies in foodservice include using basic food safety techniques, separating allergens, clearly labeling allergens and avoiding cross contact in kitchens and serving areas. Most importantly, allergic customers should use caution when dining out, be sure to notify staff of their allergy and be prepared in case of accidental ingestion. What if my friend at school or family member has a peanut allergy and I do not?

Should pregnant and breastfeeding women avoid peanut foods? No. The American Academy of Pediatrics and Dietary Guidelines for Americans explicitly state that research does not support avoiding any food as a means of preventing food allergies. 6,7 They also state that there’s no need for women to avoid peanuts while pregnant or breastfeeding, unless they are allergic. 6,7 How are peanut allergies diagnosed? Diagnosing a food allergy is complex, and should be conducted by a board-certified allergist. Blood and skin-prick tests are valuable tools for identifying an allergy, but are not conclusive in diagnosing food allergies on their own. Oral food challenges are the gold standard for food allergy diagnosis. How can peanut allergic individuals prevent a reaction? Avoiding a food allergen is the only way for allergic individuals to prevent a reaction. 8 Those who are food allergic should always check labels on packaged foods, ask about ingredients in meals at restaurants and have an emergency action plan in place in case of accidental exposure. Is there a cure for peanut allergies? Not yet. In 2020, FDA approved a treatment for peanut allergy called Palforzia, which reduces the risk of a life-threatening reaction if peanuts are accidentally eaten. It is not a cure.

If your friend or family has a peanut allergy, you can still enjoy the great taste of peanuts and peanut products! Just be mindful of who has an allergy, do not share food or utensils, clean up after yourself and always wash your hands. 9, 10 What are best practices for eating peanuts/peanut products in public? Be mindful that others may have an allergy to peanuts. Following good hygiene and using basic sanitation goes a long way in reducing the risk to those with food allergies. For instance, avoid sharing food, especially with people you do not know, throw out all food wrappers in designated disposals and always maintain good hand washing practices. 10 Where can I find more information about peanut allergies? With evidence-based resources from physicians, researches, healthcare organizations, the Centers for Disease Control and Prevention, and food allergy advocacy groups, PeanutAllergyFacts.org is a reliable source for information on peanut allergies.



1. NIAID Guidelines for the Diagnosis and Management of Food Allergies in the U.S. 2. WAO White Book on Allergy 3. CDC 4. NEJM Randomized trial of peanut consumption in infants at risk for peanut allergy.

5. NIAID 2017 Addendum Guidelines for the Prevention of Peanut Allergy in the United States. 6. USDA and HHS 2020-2025 Dietary Guidelines for Americans. 7. AAP 8. AAAAI

JACI 9. Simonte. S, et al. Relevance of casual contact with peanut butter in children with peanut allergy 10. Perry, Tamara T .. et al. - Distribution of peanut allergen in the environment 12. Impact of School Peanut-Free Policies on Epinephrine Administration. 11. AACI Accidental exposure (AE) to peanut in a large cohort of Canadian children with peanut allergy.

Peanuts are a nutritious superfood that 99% of Americans can safely enjoy. Knowing that even one individual has the potential to be harmed by eating peanuts has motivated peanut farmers to contribute more than $35 million for allergy research, education and outreach. The National Peanut Board offers resources and assistance to parents, schools, health professionals and foodservice professionals to safely manage food allergens while still serving peanut products. By continuing to invest in research and education, the hope is that one day peanut allergies will be a thing of the past.

America’s Peanut Farmers Care

Additional Resources: PeanutAllergyFacts.org, FoodAllergyAwareness.org, FoodAllergy.org, AAAAI.org

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