Matthew Greenhawt, MD, MBA, Andrew Singer, MD, Alan Baptist, MD, MPH
Food allergy is increasing worldwide, and on college campuses the risks for food allergies and associated fatal anaphylactic reactions may be growing as well. College-aged individuals have not been studied thoroughly with regard to food allergies, but recent research reported that almost one-fourth of food allergy-related fatalities occurred in college-aged subjects (18 to 22 years). Another study has shown that adolescents and teenagers are more likely to take risks pertaining to their food allergy, including eating foods known or likely to contain an allergen, not carrying self-injectable epinephrine (SIE), and failing to inform friends about their food allergy or how to treat it in an emergency.
In a study to be published in an upcoming issue of The Journal of Allergy and Clinical Immunology, Greenhawt and colleagues assess a college population at the University of Michigan, Ann Arbor, to determine current trends in food allergy and potential risk-taking behaviors pertaining to food allergy. A survey was randomly e-mailed to 14,990 undergraduate students, with 513 responding. Two hundred and ninety three of the respondents reported they had a known food allergy or had likely suffered an allergic reaction attributable to food. The survey revealed the most commonly reported food allergies to be to milk, fish, tree nut, peanut, and shellfish.
The authors found that only 47.7% of the food-allergic group reported maintaining any type of emergency medication; 21% maintained an SIE device, but only 6.6 % of those said they always carried their epinephrine device with them. Surprisingly, 27% of those with a known food allergy had not been prescribed an SIE device. Just 11.5% said that foods at dining halls were always labelled to identify allergen content, and only 36.6% reported that a main course alternative was available. Alarmingly, 60.3% reported they continue to willingly ingest a known food allergen.
College represents a unique time in a young adult’s life. For most students, it is their first time living without adult supervision. Responsibilities such as filling medication prescriptions, carrying the SIE at all times and remembering what is safe to eat are shifted to the student. With a rise in the incidence of food allergy likely, the ability to handle those responsibilities will be critical in keeping these students safe. A trend toward risky behaviour by the food allergic college students in this current study highlights a poor perception of health care needs, a general sense of invulnerability for this age group and a failure of patient education efforts.
Currently, colleges may not be equipped to handle the needs of food allergic students. Campus dining services would benefit from clearly labelling foods for ingredient content, modifying preparation areas to avoid cross-contamination and providing allergen-free foods. The authors suggest that colleges screen individuals for food allergies before the student arrives on campus, enabling the identification of such individuals for further education and periodic follow up. They also recommend that residence hall staff be trained to use self-injectable epinephrine and consider stocking on-campus first aid kits with SIE devices.