Q:

2/5/2013
Our facility is an out-patient surgery center, with all patient care areas (Pre-op, OR, and Post-op) on the first floor, and offices, lockers, and a lunch room on the lower level. We have a "Nutrition Room" on the first floor, where beverages and snacks for post-op patients are stored and accessed. What are the recommendations regarding safety precautions we should observe as far as having any foods with peanuts in this room? Patients and families do NOT have access to this room. On occasion, staff members will bring in treats FOR STAFF ONLY and place them in this room since it is easy access for all staff. Is it acceptable to have foods with peanuts in this room? Thank you for your help!

A:

Thank you for your inquiry.

Although there has always been some controversy as to the degree of precautions one should take in facilities that might be used by peanut-allergic patients, I believe that the consensus of opinion would be that you would not need to institute any peanut-free policy for your “staff only” room. Although there is no consensus of which I am aware that deals with facilities such as yours, we can draw conclusions from policies that have been instituted in schools. For example, I have copied for you below a quote taken from the Farmington Public School Board policy indicating that when children reach middle school, there is much less need for precautions. This is because they are more aware of the danger than younger children, and less likely to mistakenly ingest food brought in by another child. I assume that the individuals having access to your staff room are all adults and therefore this statement would apply to them.

Another statement copied for you below was taken from the Journal of Allergy and Clinical Immunology article entitled “Management of food allergies in schools.” As you can see, anaphylaxis is almost always due to ingestion and therefore casual contact with peanuts is unlikely to produce such a reaction.

Thus, I think most allergists would feel that you need no special precautions in the room that you described.

Thank you again for your inquiry and we hope this response is helpful to you.

Farmington Public Schools Board policy
"Generally, why aren’t middle schools or high schools Nut Restricted?
Pediatric allergists generally suggest that as students with severe allergies enter middle school, they are much more independent and therefore become more capable of self-monitoring their allergy. Therefore, middle and high schools, often times, can have less restriction and support more of a Nut Awareness Level"

Management of food allergies in schools: A perspective for allergists
J Allergy Clin Immunol 2009;124:175
"Recommendations should be based on the scientific literature, including evidence that anaphylaxis results almost exclusively from ingestion of a food and not from inhalation or skin contact and that routine hand washing and cleaning are highly effective in the removal of food allergens."

Sincerely,
Phil Lieberman, M.D.


AAAAI - American Academy of Allergy Asthma & Immunology