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, incarcerated individuals 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?

In a past episode of Correctional Nursing Today Radio Show, Dr. Schoenly discussed this with Dr. Jeffrey Keller. Interesting and important information for correctional nurses was shared, and I highly recommend you download or livestream the 30 minute program. Here are some important points from that 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.

Dealing with Patient Food Allergies

Managing Food Allergies Behind Bars

If an incarcerated individual 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 individual may not be able to be housed with others 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 individual 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 is rarely on the menu. However, peanut butter is an inexpensive protein source that is used frequently in corrections.

Preparing for an Allergic Reaction

A coordinated response to food allergies is needed in every facility. Your facility should have a protocol 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. Incarcerated individuals 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.