Dealing with Inmate Food Allergies

Food allergies can be a real challenge for correctional nurses. It is important to document these allergies during intake screenings and put safeguards in place to avoid allergic reactions behind bars. However, inmates can report food allergies that are really preferences (I’m allergic to bologna sandwiches) or food intolerances (I’m allergic to onions). How can true allergies be sorted out from among the many reported?

I recently interviewed Dr. Jeff Keller, correctional physician from Idaho Falls, ID, about the issue on the Correctional Nursing Today Radio Show. This episode is full of interesting and important information for correctional nurses. I highly recommend you download or livestream the 30 minute program. Here are some important points from my notes of the session.

  • There are IgE mediated and non-IgE mediated allergic reactions. The medical concern is with IgE mediated allergies, which involve immune system mast cells that respond violently to contact with the allergen. Check out this animation to remind you of the IgE allergic reaction process.
  • Peanuts make up 85% of food allergies. The remaining 15% are from tree nuts and shellfish. Other food allergies such as fin fish or strawberries are rare.
  • Almost all food allergy deaths happen to teenagers and those in their early 20’s.
  • Allergic reactions include hives, angioedema and asthma/wheezing.
  • Ways to test for true allergy include a food confrontation test and skin prick testing. There is also a fairly inexpensive blood test for IgE circulating levels.
  • Epinephrine is the main treatment for a life-threatening food allergic reaction.

Managing Food Allergies Behind Bars

If an inmate is determined to have a peanut allergy, a peanut-free diet is needed. However, precautions do not end here. Cellmate assignment and work detail must also be considered. This inmate may not be able to be housed with other inmates who have peanut products in their possession. For example, peanut butter and peanut butter products such as sandwich crackers may be available in the commissary. A peanut-allergic inmate may not be able to be assigned kitchen duty if peanut products are present. Shellfish and tree nuts are fairly easy to deal with as pecan-crusted shrimp are rarely on the menu. However, peanut butter is an inexpensive protein source in frequent use in corrections.

Preparing for an Allergic Reaction

A coordinated response to food allergies is needed in every facility. Dr. Keller recommended a protocol be developed addressing actions custody and medical staff will take to respond to true food allergies. Besides diet, housing and work detail issues, a coordinated emergency response to a reaction is needed. Epi pens are the standard mechanism for emergency treatment of an allergic reaction. Inmates are not able to carry needles on their person so the location and accountability for epi pens should be considered. Housing officers may need to have pens available and know how to use them. Correctional nurses may need to provide information and demonstration of epi-pen use. Officers are also likely to be the first responders in an allergy emergency. They need to know the signs of allergic reaction so that they can act quickly to summon assistance and administer epinephrine.

How has your facility dealt with food allergies? Tell us your experiences using the comments section.


Photo Credit: © Jaimie Duplass –


  1. Karen says

    This is a huge problem at the jail I am the medical team administrator of. We are requiring inmates who have an “allergy” to sign a records release for any medical records which can demonstrate they were treated for the alleged allergy. While I am sure it is risky to take that chance, my dietary people cannot keep up with the sheer volume of “allergies” that inmates report. I have asked the warden and kitchen staff to have a ready alternative to the diet being offered that particular meal, such as a peanut butter sandwich milk and fruit. It seems in this area the largest offender is tomatoes or as the inmates like to call it “red stuff”.

    Any suggestions will be appreciated.

    • Lorry Schoenly says

      I think tomato allergies are pretty rare. This is more likely a food intolerance that causes GI distress. I hope others comment on how they are dealing with food intolerances. A true allergy, such as can take place with peanuts, requires high vigilance and substitution.

  2. says

    Hi Karen,
    I would suggest taking a more aggressive approach to inmates complaining of food allergies. I personally would not order a special diet of someone who claimed an allergy to tomatoes but could provide no history to back up the claim (a visit to an ER, and allergist,etc). If you are not comfortable with that, then test them–draw a blood test that measures IgE to tomatoes. The test is less expensive than the hassle of ordering a special diet. You should have very few special diets due to allergies.

  3. JC says

    We have adopted an all or none response.
    If you have an allergy to any meat or eggs you are put on a vegetarian diet.
    If you have allergy to tomatoes, chocolate, peppers of any kind, onion, nuts, “spicy food” etc… you get a bland diet
    If you have allergies to any milk product, you go on a lactose free diet.
    Most often when people are questioned they will reveal that they don’t have allergies just don’t like the food but when they are explained what that entails the story changes dramatically. They are also required to sign a release of responsibility if they choose not to have the diet.

  4. Amy says

    As someone who has had food sensitivities and intolerances I can tell you that while these do not necessarily cause an anaphylaxis, they have been known to cause GI distress, other allergy symptoms, asthma symptoms, behavioral symptoms and can lead to health issues. Giving someone who can’t tolerate or is highly sensitive to certain foods those foods or foods exposed to those foods can be like beating them on the inside. Celiac can be developed. For those with gluten issues, some research shows that the gluten can damage the villi in the intestines and that this can lead to further GI problems. In other words IgE reactions are not the only ones that matter even if other kinds of reactions do not require an epipen. I am sharing this information, because people don’t always realize how serious other kinds of reactions can be.


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