• Posted March 7, 2024

Food Allergies in College 101: Tips to Cope

Food allergies are difficult to manage at any age, but college students face complex challenges when it comes to navigating the dangers posed by the possibility of life-threatening anaphylaxis.

A recent review published in the Annals of Allergy, Asthma and Immunology, the journal of the American College of Allergy, Asthma and Immunology, examines recent evidence and addresses hurdles facing college students with food allergies, along with possible strategies to overcome those challenges.

Senior study author Dr. Edward Iglesia, an instructor of medicine in the Division of Allergy, Pulmonary and Critical Care Medicine at Vanderbilt University Medical Center in Nashville, Tenn., said the first priority is to confirm that your college student still suffers from a food allergy.

"Sometimes we miss the opportunity to reassess if someone's food allergies have resolved," he explained. "The transition to adulthood is a great time to do this, and the high school years can be a 'signpost' to take the time to re-confirm a food allergy."

If your prospective college student hasn't been evaluated for his or her food allergy in the past few years, it's worth talking to your allergist about getting re-evaluated. Meeting with your child's allergy team provides an opportunity to review practical strategies to safely navigate their condition, as well as helping cultivate the confidence and resilience to do so.

Advance planning can help with unsettled feelings about managing a food allergy. Knowing exactly how to use your epinephrine auto injector during a severe reaction is a vital skill to master.

A college student with a food allergy should be able to communicate their needs to others, whether it is to peers or strangers, keeping in mind that the phenomenon of "disclosure fatigue"is real. Young people get tired of constantly having to explain their food allergy needs to others, so they sometimes skip it because it feels like a heavy burden.

The review points out that college students are generally thought to be at increased risk for severe food reactions. Possible reasons include poor perception of their risk and vulnerability, and increased risk-taking behavior. A recent study cited in the review found a significant number of college students ate an allergenic food for reasons including: their previous symptoms weren't consistent; they believed the item didn't contain enough allergen to trigger a reaction; they believed they had the ability to treat any reaction; or they thought they could eat around the allergen.

According to the review authors, "Adolescents' understanding of 'anaphylaxis' and when to use epinephrine may also be inconsistent, with only half of participants in this same study able to identify severe reactions as 'anaphylaxis.'"

The review contains a "College Readiness Checklist"that includes suggestions such as:

• Work with your allergist to clarify your food allergy status before leaving for college

• Prepare an anaphylaxis emergency kit to always be carried at college, containing an epinephrine auto injector and emergency care plan

• Meet with student health services before or at the start of the semester

• Meet with dining services before or at the start of the semester

• Discuss food allergy and emergency plans with college contacts such as roommates and resident assistants

In February, the asthma medication omalizumab (Xolair) received FDA approval for the reduction of allergic reactions to one or more foods. The approval is a milestone for those with food allergies who hope to reduce the risk of severe allergic reactions. It is not a cure, and the FDA noted that people who take omalizumab must continue to avoid foods they are allergic to.

Your college student may want to discuss omalizumab with their allergist. They might also want to look into oral immunotherapy that gradually introduces you to allergenic foods, to build up immunity. Here's a primer on how to treat and manage food allergies.

"Everyone's personal circumstances are just that -- highly personal. We wanted to provide some high-level, common tips that could be useful, but we understand that each person's range of needs will be a little bit different," Iglesia said. "Part of life is inviting some risks. We may not be able to eliminate all of them, we can simply mitigate the risks that are within our control and be prepared when the risks show up -- carry your epinephrine auto injector and know when and how to use it!"