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Allergic Nation

February 16, 2010

College students take risks. They pull all-nighters ahead of early-morning presentations. They skip more classes than they attend. They eat peanut butter and jelly sandwiches, chocolate bars and pizza.

That last one doesn’t sound so risky – and isn’t, for most people. But it can be dangerous, even fatal, for the growing ranks of traditional-age undergraduates with food allergies. According to the Centers for Disease Control and Prevention, the number of Americans under the age of 18 with food allergies rose to 3 million, which is 4 percent of the age group, in 2007, up from 2.3 million, or 3.3 percent of the under-18 population, in 1997. As those kids grow up, some lose their allergies, but many others don't.

In greater numbers than ever before, they're arriving on college campuses with concerns that dining halls don't know how to handle.

The allergic student of even a few years ago might have had to take chances, pester cooks about ingredients or just skip eating anything made in a public kitchen altogether. But as allergies seem to have become more common – and as allergy sufferers and advocates have become more aggressive in lobbying for accommodations – dining services officials are beginning to act. Many college and university dining halls have adopted signs that point out common allergens, while others offer frozen meals and special items like gluten-free bread so students with allergies can have the social experience of eating with their friends.

A few others, including Brown University, College of the Holy Cross, and Franklin and Marshall College, have gone even further, opening allergy-free kitchens and offering made-to-order meals prepared by specially-trained cooks.

Matthew Greenhawt, an allergist and clinical lecturer at the University of Michigan, says he anticipates “an explosion of kids about to arrive on college campuses who have food allergies.” But their attitudes toward those allergies are often apathetic or risk favoring, he says, citing a survey he conducted of Michigan students, showing that many who knew they had allergies intentionally ate those foods, often because they had yet to experience a severe reaction like anaphylaxis. "Our data suggest that there are students out there taking risks."

Photo: College of the Holy Cross

Cortney Flanagan, a junior at Holy Cross, often eats meals she makes in the college's allergy-free kitchen.

In October, the Food Allergy and Anaphylaxis Network (FAAN) premiered its College Network, a Web site that includes a growing list of colleges and what they offer for students with food allergies, as a resource for potential applicants. Jennifer Love, media and marketing communications manager, says that as ranks of kids with food allergies have grown – and grown up – FAAN has seen increasing evidence that "there was a need to help at the college-age level, to figure out what colleges were and weren't doing for students with food allergies."

Chefs and dining administrators can sign up to be included as contacts at their institutions, and students with food allergies can register as "student ambassadors," who can share their personal experience with parents and potential applicants who send them e-mail messages. The goal, Love says, is "to open lines of communication" so that students feel comfortable asking colleges to accommodate their allergies.

FAAN's site lists 40 colleges in about two dozen states that have adopted some method of handling students' food allergies. No single method has emerged as the most effective or efficient way to accommodate students, Love says. "Each college is really taking a different approach at this point in time."

No colleges have taken the step of banning all nuts – often the most problematic and dangerous allergen – from campus, as many elementary and secondary schools have. Not only would it be impossible to enforce with dorms and students ordering delivery, but it wouldn't be fair to the vast majority of students not affected by the allergy, Greenhawt says. “I don’t think banning foods on campus is the answer.”

Instead, he thinks dining halls should make efforts to meet the needs of students. But students also need to watch out for themselves, by keeping close tabs on what they eat and carrying self-injectable epinephrine or other medications.

The dining halls at Franklin and Marshall College, in Lancaster, Pa., have been almost completely nut-free for the last three years or so. The college had signs denoting foods with nuts but confusion or lost labels led to "some pretty difficult situations," says Barry Bosley, associate vice president for administrative services. Several students experienced severe allergic reactions, including anaphylaxis.

The result was, over a summer, the elimination of all nuts and nut products from dining halls and recipes. After some student pushback, Bosley says, the college reintroduced granola but offers it only at clearly marked stations that allergic students know to avoid. Upon request, students can get single servings of peanut butter from dining hall staff. The college's retail dining and catering options do serve nuts.

Bosley concedes that "there were a couple of comments early on" from students who were irritated to see their food options limited by the needs of a small group of students. But those complaints have dissipated over time, he says.

The University of New Hampshire's three dining halls have refrigerators stocked with gluten-free foods and pans used only for gluten-free orders at omelet and stir fry stations. Students can use an online order form to request personalized fresh meals. Brown University has eliminated nuts from its dining hall recipes and offers meals free of nuts, gluten and dairy that students order in advance.

The University of Wisconsin at Madison has begun cataloging all its ingredients and the allergens in them, says Denise Bolduc, assistant food service director there. Students will be able to search a database to see if specific items or meals include allergens. By next fall, all line signs will denote peanuts and tree nuts.

Because students can opt not to buy a meal plan if they have allergies, Bolduc encounters only a few students a year with food allergies; she anticipates many more to come. An on-campus summer camp for middle and high schoolers had a few dozen students with food allergies last summer, far more than it had in the past. "It really seems like a lot more kids with food allergies are coming our way," she says.

At the College of the Holy Cross, in Worcester, Mass., the approach is to offer as many options as possible for the 100 or so students there who are known to have food allergies. Students can pre-order allergy-free meals via e-mail; the meals are made fresh by cooks in the college's Kimball Dining Hall. For dinner that means they can choose an appetizer, an entree, a vegetable, a starch and a dessert from a list that includes steak, salmon and stir fry.

The dining hall's head chef, Tim Trachimowicz, says that each new school year has brought a larger number of students asking for assistance in dealing with food allergies. When the college first began offering individual meals a few years ago, some of Trachimowicz's cooks were "resistant to making meals just for one person" when so much of their work focused on preparing large quantities of specific dishes. Getting positive feedback from students, he says, "has changed their minds and gotten them to think this is a really great thing for students with food allergies."

Christina Guittar, the dining hall's general manager, says Holy Cross has expanded its offerings as the demand from students has risen and in anticipation of even greater demand in the years to come. “This is a spot where we really thought we had a need larger than the one we knew existed," she says. "There were a lot of students with food allergies that we didn't even know had them, they just weren't eating in the dining hall" despite the fact that the college requires all students to buy a meal plan.

This fall, Holy Cross expanded its offerings by opening an allergy-free kitchen in the dining hall that's stocked with frozen meals, snacks and desserts. "It's a happier, safe zone because students don't have to be afraid of cross-contamination," Guittar says. All students with documented food allergies have access to the kitchen.

Cortney Flanagan, a junior at Holy Cross, learned of her allergies to wheat, peanuts, soy, egg whites and certain kinds of mold last summer, after spending the first two years of college in a near-constant state of illness. Adhering to a diet that avoids all her allergens has been "unbelievable" in improving how she feels.

But when she approached college officials to notify them of her diagnosis, she had "no idea what the college offered, or even that it offered anything," and worried that it would be difficult to get by. Learning "how much I had to choose from, getting brochures, hearing about the kitchen" reassured her. The accommodations, she adds, "have definitely made it a lot easier to get used to eating this way every day."

Though Flanagan worried about getting flak from her friends about her allergies, they've all been supportive. "Even though I have allergies, I can eat with my friends in the dining hall or go out to dinner with them." And some friends have decided to get tested for food allergies after seeing how much her health has improved since starting a restricted diet.

 

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