Leaving the Nest: Navigating College with Food Allergies and Restrictions

By Lisa Carlson, MS, RDN, LDN, registered dietitian nutritionist at Northwestern University

Off to College

The start of college is supposed to be an exciting time for students. It's a chance to exercise independence, make new friends and connect over meals and late-night pizza. However, for students with severe food allergies or dietary restrictions, eating can be one of the riskiest parts about leaving home for school.

Pranav B, a sophomore from Racine, Wisc., who has multiple food allergies, recently reflected on his first year at Northwestern.

"Soon after I arrived on campus, I realized

I needed to share my food allergies with lots of people . . . people I could trust and who cared about my well being: a core group of friends, my RA, club leaders, NU Dining chefs and the campus dietitian," he said. "While I didn't want my food allergies to define me as a person, I needed to build a network that would help me stay safe."

Pranav isn't alone. He is one of more than 32 million Americans with serious and potentially life-threatening food allergies and the number appears to be growing. That number becomes 85 million if you count the people who avoid certain foods or ingredients because they shop, cook and live with someone with food allergies or dietary restrictions such as avoiding gluten because of celiac disease.

Food Allergy Awareness Week

May 9-15, 2021 is the week designated to food allergy awareness and advocacy by Food Allergy & Research (FARE), the world's leading non-governmental organization engaged in food-allergy education, research and advocacy. FARE provides many resources to help raise awareness on food allergies and education: https: //www.foodallergy.org/our-initiatives/awareness-campaigns/food-allergy-awareness-week

Food-allergy prevalence in adults

Nearly 11 percent of adults have at least one food allergy, and 19 percent of adults, or nearly one in five adults, believe they may be allergic to a food according to a recent research survey of adults by Ruchi Gupta, MD, MPH, director of the Center for Food Allergy & Asthma Research (CFAAR) and professor of pediatrics and medicine at Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern Feinberg School of Medicine.

A confluence of factors for rise in food allergies

Dr. Gupta is a leading researcher on food allergies at Northwestern and she acknowledges they are on the rise. She says it may be due to a combination of factors such as early and better diagnostics, environmental influences and hereditary disposition. Her research suggests that there are currently at least 13 million food-allergic adults who have experienced at least one severe food-allergic reaction, at least 10 million adults who have received food allergy treatment in the emergency room, and at least 12 million adults with adult-onset food allergies.

Dr. Gupta is also the author of the upcoming book, Food Without Fear, from Hachette Book Group, which aims to help people identify, prevent, and treat food allergies, intolerances, and other sensitivities.

"Food allergies are not a minor problem," said Dr. Gupta. "They impact more than 1 in 10 adults and as students head off to college, they can interfere with many aspects of the college experience: social events, dining out, dorm life, sports teams, and more.”

A food allergy can develop at any time and can affect a person's breathing, gut, heart and skin. The outcomes can be serious and life-threatening and every three minutes, a food allergic reaction sends someone to the emergency room.

Allergy education and advocacy program at college

Dr. Gupta is on a mission to help college students with food allergies, especially first-year students, ease into young adulthood safely and without incident: meaning no life-threatening allergic reactions with the help of strong support networks at college.

She recently recruited 20 interns for the summer, mostly Northwestern undergraduates, to lead a comprehensive college food allergy education project that includes a video and orientation materials targeted to launch this fall during Wildcat Welcome. The program will help college students with food allergies manage their condition, educate others and advocate for themselves.

Pranav just happens to be one of Dr. Gupta's interns. He is returning for a second summer and he said this experience has been invaluable.

"In high school, I didn't get involved in promoting food allergy awareness. For me, it was about managing them on my own, and not calling attention to myself," said Pranav. "Now I see the value in this research and education and how it can help others, and I'm honored to be a part of it."

If successful at Northwestern, this food allergy education program will be shared with other universities with the goal of having more and more incoming students aware of food allergies -- how to prevent an incident and create support networks.

Celiac disease and avoiding gluten

Emma E., a senior from Rockville, Md., has celiac disease and needs to avoid any food containing gluten. While not a food allergy, celiac disease is a serious autoimmune disease that can that damage the small intestine and lead to medical complications if gluten is consumed. It affects about one in 100 people worldwide, and about 2.5 million Americans are undiagnosed and at-risk for long-term health complications. The only treatment for celiac disease is a gluten-free diet.

Emma said her first year at Northwestern was difficult and that eventually things became easier when she found her dining commons home: the Pure Eats station at Foster Walker Plex East. NU Dining has Pure Eats stations in all residential dining commons, and they avoid gluten and the top nine food allergens.

Like Pranav, Emma has built a network of supportive friends who know what she needs and will help look out for her.

"It means the world to me when a friend has me over for dinner and says she has double-checked all the ingredients in the meal so there's no gluten," said Emma.

Emma admits having celiac disease can be tricky because gluten is often hiding is unsuspected foods such as regular soy sauce, marinades, dressings, beer, mock crab in sushi, some oatmeal and more. Like all students with food restrictions, Emma is a devoted label reader. Currently, she lives off campus with a roommate who does not have celiac disease. "We both have our own set of pots and pans, and separate sponges, and we use mine when we make gluten-free dishes. It works well. I feel blessed," she said.

How to Help Yourself and Create a Support Network

The following tips were offered by several NU students with food allergies or celiac disease to help students navigate college with food restrictions -- and how friends can help, too.

Tips and strategies for students with food allergies and celiac

• Speak up: make sure you tell all the people in your circle (your roommate, RA, club leaders, athletic instructors) about your food allergies and how they can help.

• Self identify and notify Northwestern Dining: Get to know the chefs, managers and dietitian at the residential dining commons, especially the ones you frequent. Schedule a meeting with the team starting with the campus dietitian and chefs. Then when you go to eat, the team will know you and your food allergies and how to help. They can show you labels from the kitchen and answer your questions.

• Download the Dine on Campus app or go online (www.dining.northwestern.edu) and review daily menus and ingredient lists ahead of time.

• Always read station signage and ingredient label information in residential dining commons to check whether an allergen is on the ingredient list. If you have questions, ask a chef or manager. When grocery shopping, double check the ingredient list, allergen listings and “may contain” statement to ensure the food is safe to eat.

• Visit Pure Eats stations located in all of our residential dining commons. These stations avoid gluten and the top nine food allergen (peanuts, tree nuts, shellfish, fin fish, wheat, soy, eggs, dairy and sesame). Also peanuts and tree nuts are not brought into our residential kitchens, so we do not use these ingredients in dishes in our residential dining commons. We offer sunflower butter instead of peanut butter.

• Have your own cooking supplies. If you cook in residential housing, be especially careful about cross-contact. Cross-contact is when one food touches another food, creating the potential for a reaction.

• Carry your meds at all times (epinephrine auto-injector, Benadryl, etc.) and have a back-up supply in your room.

• Make sure your friends know the signs of an allergic reaction. It's great if your friends can pick up the signs and say, "Hey, are you alright...are you having a reaction?" It is also good to speak up if you think you are having a reaction.

• Know how to administer an epipen (in the thigh, through clothing). Know how to use your meds, and teach close friends how to use if you can't. Many food-allergy experts suggest that you practice on an orange with a trainer EpiPen.

• Call ahead if you eat out or take out. Make sure your friends know your allergies and what to avoid. Call a restaurant a few days ahead to see if they can accommodate you, then call again the day of dining just to confirm. Always ask for the chef when you arrive. It is always important to speak with the person who is going to make your food.

• Plan to bring your own food or snack. Before an event, consider eating ahead and bringing some of your own food. Eating is a part of college life, and you don't want to take a chance on unsafe food if you are starving.

• At sporting events, also consider bringing your own food. Come prepared, if necessary, with a doctor's pass/note for these social or sporting events that typically don't allow you to bring in outside food.

Tips for friends: what to know and how to help

• If a friend has a serious food allergy or celiac, take your friend seriously. Food allergies can be life-threatening. Listen and show empathy. Students with food allergies get bullied much more often than students without diet restrictions. If your roommate has a food allergy or celiac, be considerate and clean up after yourself and try not to bring the offending food into your room.

• Any food can potentially cause a food allergic reaction. Just because you've never heard of an allergy to red meat (Alpha Gal Syndrome) or a sensitivity to fruits with pits (Oral Fruit Allergies), doesn't mean they don't exist. More than 170 foods have been documented as responsible for an allergic reaction, however any food item can potentially be an allergen, a substance that causes an allergic reaction.

• Remember, cross-contact can happen. Be careful at salad bars and buffets and use one spoon per food or ingredient to avoid cross-contact.

• Be respectful of an Avoiding Gluten zone. If a red toaster is marked "avoiding gluten" don't use it to toast gluten-containing bread. The same goes for the waffle iron. If a crumb drops in the red toaster it won't be safe for someone avoiding gluten.

• Dining out: your role. Make sure your friend with food restrictions feels safe eating at a restaurant. Your friend may need to call ahead and ask a lot of questions to stay safe. Be an advocate. Make sure you know what to do if a friend has a reaction.

If you have questions about food allergies -- how to navigate your own or help someone else, please reach out to us at NU Dining. We are happy to help. Thanks. Lisa Carlson dietitian@northwestern.edu or lisa.carlson@compass-usa.com

References:

Leaving the Nest: Improving food allergy management on college campuses: https://www.sciencedirect.com/science/article/pii/S1081120618302953?via%3Dihub

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2720064

https://design.northwestern.edu/news-events/articles/2017/edi-spotlight-final-presentations-winter-2017.html