MDining decided to implement an emergency-use epinepherine program for fall of 2019 after a change in Michigan Legislation in 2015 allowing pharmacists to dispense auto-injectable epinephrine to an authorized entity.
The epinephrine auto-injectors will be available as an emergency resource in all residential dining halls, according to a press release from the University of Michigan. MDining will partner with Housing security, a subunit of U-M Division of Public Safety & Security, which will have security officers patrolling residential areas, equipped with epinephrine auto-injectors.
According to the press release, a 2017 FDA report said there has been a 25 percent increase in allergy sensitive adults from 2007-2017. The Journal of the American Medical Association found nearly 26 million adults have food allergies, and that number is growing.
MDining Dietitian Anne Smiarowski explained the implications of this research in the University press release.
“All research points to this number increasing for many reasons, including new additives and food processing that our bodies are not used to, as well as the possibility that we’ve become too clean,” Smiarowski said “The focus has been on making sure we use hand sanitizers, disinfectants, etc., everywhere in our life. Some studies suggest this has altered our immune system's response to potential allergens.”
Kathryn Whiteside, Director of Systems Management for MDining, said the epinephrine program is not necessarily a response to a rise in allergy sensitive adults but to the recent legislation passed under the Public Act 221 of 2015 that allows for authorized personnel on campus, including dining staff and housing security officers, to possess epinephrine.
“In the past, our position on epinephrine and having it available in the unit was we did not have a way of procuring epinephrine because prior to some recent legislation, we couldn’t purchase it,” Whiteside said. “Recently the legislation changed in the state of Michigan and it became possible for us to get a prescription that is associated with the organization, not with an individual, and that would allow us to get epipens and get them in our first aid kits…We’ve had students asking for us to be able to do this for years and we weren’t legally able to.”
Whiteside said personnel authorized to administer the epipen have undergone appropriate training.
“The professional dining staff, the management teams in the dining hall, have taken the red cross training for how to administer an epipen,” Whiteside said.
Whiteside said she hopes access to the program will eventually expand to more of the student body. There will potentially be epinephrine available at student recreation centers and other locations in the event that a student experiences a delayed food allergy reaction.
Whiteside said college students are more likely to take risks while trying foods despite known allergies, one of the reasons the University sought to implement the new epinephrine program. Food Allergy Research & Education stated teenagers and young adults are a population at the highest risk of experiencing fatal food-induced anaphylaxis.
“The percent of the population we see, they are adults,” Whiteside said. “As adults they are responsible for themselves, but also the age group that we see are the population of individuals that take the most risks when managing their own food allergies.”
Whiteside said the emergency epinephrine program is important to maintain the safety of students because many people do not know they have a food allergy and can experience a severe reaction. According to FARE, approximately 20-25 percent of epinephrine administrations in schools involve individuals who were unaware of their allergy at the time of the reaction.
“There’s a large percentage of the population that doesn't know they have a food allergy and could have an anaphylactic reaction and not even know it at that point, not even know that they have an allergy,” Whiteside said. “And the percentage of that population is high enough that we felt like it was a win win for us to have epipens available.”
Whiteside explained the immediate procedure to deal with an anaphylactic reaction to a food allergy prior to the auto-injection program was to call 911.
“Up until we had the epipens available, that would be our standard safety procedure,” Whiteside said. “You call for assistance immediately.”
In addition to the new epinephrine auto-injectors, the University has worked to accommodate students with food allergies in the past using online databases to present nutritional and allergen facts. Ingredient information can be found on digital menus throughout dining halls, physical signage, websites and mobile apps which include allergen information for all food served in residential dining halls and catered campus events.
The MDining website “MyNutrition” allows students to filter menus for the some of the most most common allergens such as eggs, fish, milk and peanuts, as well as gluten-free, halal, spicy, vegan and vegetarian options. According to the press release, MyNutrition displays all ingredients for every single item found in the dining hall.
“On MyNutrition you can actually read the ingredients like you would on a label in a grocery store,” Whiteside said.
A disclaimer is provided on the MyNutrition site states accuracy of nutrition information is not guaranteed.
“The University of Michigan does not guarantee the accuracy of nutrition information; ingredient and nutrition content of foods may vary due to changes in product formulation, recipe substitutions, portion size and other factors,” the disclaimer reads. “The nutrition analyses provided here are approximations only. Guests with food allergies or other food intolerances should consult a Chef or Dining Manager for specific ingredient questions.”
MDining dieticians also offer one-on-one counseling for individual students. According to the press release, U-M was one of the first schools to pilot Food Allergy Research & Education (FARE)’s College Food Allergy Program in 2016 to implement food allergy management policies. These policies include providing ingredient information for all self serve and made to order items, pre-order meals, allergy friendly stations and procedures in place in the kitchen to avoid cross contact of certain foods.
While MDining works to provide students with ingredient information, LSA sophomore Rachel Stockman spoke about her experience with MDining to work around her allergy to eugenol, a compound which is found in plants and can be extracted from a variety of spices.
“So basically in the dining hall, what they do for allergies, is they have a thing online where you can look at the ingredients but it looks like what you would see on the back of a packet of food, and so my allergies, unless it is a main part of the meal…it is either listed as ‘spices’ or ‘natural flavoring’ and so that didn’t help me and so their allergy chart didn’t work,” Stockman said.
Stockman said when she asked the cooks about certain spices in dishes, they would rarely know the specifics.
“Whenever I asked the cooks, I think most of the spices came in a pre-mix, so they wouldn’t really know what was in it,” Stockman said. “And whenever I asked about it they would always refer me back to the online thing.”
Stockman acknowledged the dining hall may use premade spices and ingredients for cost efficiency, but suggested a more comprehensive review of ingredients be displayed to help students with rare allergies better understand what’s in their food.
“I know that it’s cheaper to get things that are pre-made but for someone like me that has such a weird allergy it’s impossible for me to know what’s actually in it that I can’t have,” Stockman said. “So if they were to actually list all of the ingredients instead of just saying like spices or ‘natural flavoring’ I think that would be very helpful.”
Whiteside explained the difficulty in presenting specific information regarding ingredients present in spices.
“Some of the products that we purchase from vendors are components of products and we can't control those ingredients,” Whiteside said. “Until laws change about that there’s not much more we can do than publish the information that’s shared with us.”
Whiteside said it is sometimes difficult to provide extensive information regarding spice ingredients when food is imported out of the country.
“Spices are tricky,” Whiteside said. “Because a lot of them come from countries outside of the U.S. and the U.S. does a really good job of managing the safety of the food in our country. I think we lose sight of that when we try to purchase foods we want to try to use different spices and different seasonings to make our food taste better and have more authenticity, but when we purchase from other countries who may not have the same rules and regulations there’s a level of risk there because we don't really know how the foods were handled before we receive them.
Stockman said MDining offered for her to speak one-on-one with an allergen professional, but Stockman ultimately declined because of personal past experiences with dieticians.
“They did offer to have me create a special meal plan but at the same time those have never really ended well for me in places where other people make my food,” Stockman said.
Stockman said the epinephrine program is a good idea to combat emergency allergic reactions due to potential misunderstandings regarding ingredients in meals.
“Sometimes there can be miscommunications, so you eat something where you think it doesn’t have anything and then it does,” Stockman said. “I think it’s a really good idea just because I think there can be a lack of communication with the amount of people they have and the amount of people they’re serving.”