Food allergy in college or university students
- Scott H Sicherer, MD, FAAAAI
Scott H Sicherer, MD, FAAAAI
- Section Editor — Food Allergy
- Professor of Pediatrics
- Icahn School of Medicine at Mount Sinai
Food allergy may affect up to 8 percent of teenagers  and can involve life-threatening or fatal reactions [2,3]. Teenagers and young adults appear to be at higher risk for fatal allergic reactions, possibly because of risk-taking behavior and reluctance to use epinephrine [2-6]. College years may be the first time that young adults are away from parental supervision and fully responsible for self-management of their allergy. Risks of allergic reactions may be increased due to social pressures against proper allergen avoidance and prompt treatment, as well as factors associated with obtaining meals that are prepared by others.
This topic presents an overview of the prevalence of food allergy in teenagers, reviews data on fatal food-allergic reactions, describes food allergy attitudes and behaviors among teenagers and college students, focuses on risk-taking behaviors identified in this age group and possible approaches to reducing these behaviors, and discusses general strategies for managing food allergy in this age group.
This review also discusses the components of effective management of food allergy in colleges and the approach that students with food allergies and their families may take in preparing for college. Publications are available that provide further resources, such as college training instructions, as well as examples of materials provided by colleges. (See 'Resources' below.)
Other aspects of food allergy are presented separately. (See "Management of food allergy: Avoidance" and "Clinical manifestations of food allergy: An overview" and "Food allergy in schools and camps".)
Prevalence — Although studies are lacking to adequately document a potential rise in food allergy among college-age students, several studies suggest high rates of allergy in this age group, underscoring the need for management in colleges. The following observations about food allergy prevalence are especially relevant:
- Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics 2011; 128:e9.
- Bock SA, Muñoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol 2001; 107:191.
- Bock SA, Muñoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001-2006. J Allergy Clin Immunol 2007; 119:1016.
- Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med 1992; 327:380.
- Sampson MA, Muñoz-Furlong A, Sicherer SH. Risk-taking and coping strategies of adolescents and young adults with food allergy. J Allergy Clin Immunol 2006; 117:1440.
- Monks H, Gowland MH, MacKenzie H, et al. How do teenagers manage their food allergies? Clin Exp Allergy 2010; 40:1533.
- Sicherer SH, Muñoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol 2010; 125:1322.
- Gupta RS, et al. Diagnosis of childhood food allergy in the United States. J Allergy Clin Immunol 2012. 129:AB230.
- Skripak JM, Matsui EC, Mudd K, Wood RA. The natural history of IgE-mediated cow's milk allergy. J Allergy Clin Immunol 2007; 120:1172.
- Savage JH, Matsui EC, Skripak JM, Wood RA. The natural history of egg allergy. J Allergy Clin Immunol 2007; 120:1413.
- Macadam C, Barnett J, Roberts G, et al. What factors affect the carriage of epinephrine auto-injectors by teenagers? Clin Transl Allergy 2012; 2:3.
- Greenhawt MJ, Singer AM, Baptist AP. Food allergy and food allergy attitudes among college students. J Allergy Clin Immunol 2009; 124:323.
- Jones CJ, Llewellyn CD, Frew AJ, et al. Factors associated with good adherence to self-care behaviours amongst adolescents with food allergy. Pediatr Allergy Immunol 2015; 26:111.
- Annunziato RA, Rubes M, Ambrose M, et al. Allocation of food allergy responsibilities and its correlates for children and adolescents. J Health Psychol 2015; 20:693.
- Wüthrich B, Däscher M, Borelli S. Kiss-induced allergy to peanut. Allergy 2001; 56:913.
- Hallett R, Haapanen LA, Teuber SS. Food allergies and kissing. N Engl J Med 2002; 346:1833.
- Eriksson NE, Möller C, Werner S, et al. The hazards of kissing when you are food allergic. A survey on the occurrence of kiss-induced allergic reactions among 1139 patients with self-reported food hypersensitivity. J Investig Allergol Clin Immunol 2003; 13:149.
- www.foodallergy.org/file/college-pilot-guidelines.pdf (Accessed on February 03, 2016).
- The Rehabilitation Act of 1973, Section 504. Public Law 93-112; Rehabilitation Act. 1973. Volume 29 U.S.C. Section 794.
- Public Law 101-336, Americans with Disabilities Act of 1990 [ADA]. Title 42, U.S.C. 12101 et seq. , 327-378. 7-26-1990. U.S. Statutes at Large.
- American Academy of Pediatrics. Committee on School Health.. American Academy of Pediatrics: Guidelines for emergency medical care in school. Pediatrics 2001; 107:435.
- American Medical Association House of Delegates. Resolution 415 (A-04): Allergic Reactions in Schools and Airplanes, 2004.
- American Academy of Allergy, Asthma & Immunology. Position Statement: Anaphylaxis in Schools and Other Child-Care Settings, 1998.
- Centers for Disease Control and Prevention. Voluntary guidelines for managing food allergies in schools and early care and education programs. US Department of Health and Human Services, Washington, DC, 2013.
- National Association of School Nurses. Position Statement: Epinephrine Use in Life-Threatening Emergencies. https://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStatementsFullView/tabid/462/ArticleId/9/Allergy-Anaphylaxis-Management-in-the-School-Setting-Revised-June-2012.
- Marrs T, Lack G. Why do few food-allergic adolescents treat anaphylaxis with adrenaline?--Reviewing a pressing issue. Pediatr Allergy Immunol 2013; 24:222.
- Fatal food reactions
- Risk-taking behaviors in adolescents and young adults
- Food allergy attitudes and behaviors among college students
- Insights on adherence to food allergy management in adolescents and potential interventions
- MANAGING FOOD ALLERGY IN COLLEGE
- Student responsibilities and preparation
- Institutional food allergy management plan
- Personalized food allergy action plan
- OTHER CONSIDERATIONS
- Roommates and campus housing
- Legal issues
- Strategies to reduce morbidity and mortality
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS