As a growing number of adolescents with food allergy begin attending college, an important question of how the medical community can help create safe environments that encourage students with food allergies to fully participate in campus life has emerged. Previous research shows that fatal food-induced anaphylaxis is most common among adolescents and college-age students.  However, most colleges are not currently positioned to meaningfully accompany and support students with food allergies throughout their transition to school.

 

Challenges

Although food allergy has become a disease of public health importance, most college campuses are in the beginning stages of creating systems, structures, and policies that provide comprehensive support, safeguard against accidental ingestions, systematically train key stakeholders in emergency preparedness protocols, and make stock epinephrine widely accessible.

To better understand how to support students and build stronger college systems addressing food allergy, our team conducted a study— published in Annals of Allergy, Asthma & Immunology—to explore the systems, structures, and policies of food allergies, assess unmet needs, and develop pilot interventions through the use of patient-centered design processes. We conducted interviews with 26 stakeholders, including students and families, health services representatives, university police, administrative staff, and risk management. Interviews were analyzed to determine challenges currently faced by college students with food allergies. We also explored potential solutions through the development of five pilot interventions, collectively called Spotlight.

 

Potential Solutions

After analyzing our key informant interviews, the following themes were identified to better smooth the transition of college students with food allergies:

  • Improve college notification systems regarding how a student’s food allergy is communicated to his or her campus network.
  • Establish clearly-defined roles/responsibilities on those in the student’s college network can specifically help prevent accidental exposure to a food allergen and adequately respond to a food allergy emergency.
  • Increase public education on college campuses regarding how to recognize and respond to signs and symptoms of a food allergy emergency

We found that working on one intervention at one level of the problem cannot ensure the wellness of college students with food allergies. Therefore, the Spotlight interventions were developed to focus on multiple levels within a student’s lived experience to provide a more comprehensive support system. These interventions included the following components: 1) Spotlight Cares: Preparing for College; 2) Orientation; 3) Campus Clubs: Joining a Club Sports Team; 4) External Food Vendors: Increasing the Use of Best Practices on Campus and 5) Emergency Response: Addressing Emergencies Involving Anaphylaxis. Each area consisted of different support strategies and resources to aid students in their daily life on campus. Figure 1, for example, depicts the “Spotlight Cares: Preparing for College” Intervention that primarily aims to improve food allergy notification systems and help students communicate openly with their campus network. The other four interventions also provide tools and resources to ensure a smooth transition in different areas of campus life, and can be found in the full manuscript.

 

The Physician’s Role

The role of the physician remains integral to ensuring a seamless transition to college for patients with food allergies. For college students with chronic conditions, a smooth transition involves uninterrupted access to healthcare services, student empowerment, and skills to manage their condition. Physicians play a key role to ensuring student preparedness. Meeting with students before transitioning to college should focus on updating emergency action plans and prescriptions for epinephrine auto-injectors, as well as underscoring the importance of carrying an epinephrine auto-injector at all times. In addition, physicians should be equipped to provide targeted counseling on how to reduce risk-taking behaviors. Well-known risk-taking behaviors among this population include an increased likelihood of eating foods that may contain known food allergens and being less likely to carry epinephrine auto-injectors. In addition, students tend to not readily notify their peers, teachers, or extended social networks of their food allergies nor educate them on the appropriate emergency response should they experience an accidental ingestion.

Roles for physicians beyond the clinical domain include advocacy opportunities to better ensure access to stock epinephrine as well as interdisciplinary working groups on college campuses or with community organizations focused on food allergy and emergency preparedness.

Much work remains regarding how to best support students with food allergies transitioning to college. Future research efforts should focus on:

  • Implementing and rigorously testing the pilot interventions our study developed to better understand how to systematically support and welcome both incoming students and their caregivers.
  • Systematically assessing the barriers to making stock/undesignated epinephrine available throughout various locations within a college student’s environment.

References

Dyer A, O’Keefe A, Kanaley M, Kao L, Gupta R. Leaving the nest: Improving food allergy management on college campuses. Ann Allergy Asthma Immunol. 2018;121(1):82-89.e5. Available at www.annallergy.org/article/S1081-1206(18)30295-3/fulltext.