Advocacy
Healthy Settings for People with Asthma and Allergies
In the U.S., about 90 percent of a person’s time is spent indoors, whether at school, home or in the office.1 Environmental triggers, such as dust, pests and mold, can cause asthma and allergy attacks that could possibly be life threatening. Minimizing the exposure to environmental triggers and creating a healthy environment is important for people living with asthma and allergies.
The Asthma and Allergy Foundation of America (AAFA) promotes public policies to assure improved safety for people with asthma and allergies in various settings, including schools, day care centers, work, housing, homes, while traveling on airlines, and in restaurants and other food service locations.
Healthy Schools and Child Care Centers
According to the Environmental Protection Agency (EPA), approximately 53 million children and 6 million adults in the United States spend a large portion of their days in schools.2 Many school buildings are in poor condition and contain triggers which can result in an unsafe and unhealthy environment for children and teachers. Poor indoor air quality (IAQ) can be a severe health concern for those with asthma and allergies. Poor indoor air quality increases the risks of severe asthma attacks and allergic reactions. 3 Studies by the EPA have shown that indoor air pollution levels may be 2 to 5 times higher than outdoor air pollution.1
Food allergies are a growing concern for parents as they send their children off to school. The Centers for Disease Control and Prevention (CDC) reports that between 4 to 6 percent of children in the United States have one or more food allergies and that approximately 90 percent of schools have one or more students with a food allergy.4 The CDC developed voluntary guidelines to help staff, teachers and students create a healthy school environment for children with food allergies.
The CDC encourages parents and caregivers to work with teachers and school staff to address student food-allergy-related needs. Parents can also give the school or child care center their doctor’s diagnosis of the food allergy, as well as any information on previous allergic reactions and the risk of anaphylaxis. It is encouraged that school and child care center staff and teachers create a coordinated and consistent plan of action, Food Allergy Management and Prevention Plan 
, for responding to food allergies.
In 2013, President Obama passed the School Access to Emergency Epinephrine Act which encourages states to require schools to stock epinephrine auto-injectors for emergencies. AAFA supports school policies that promote access to epinephrine to treat students and staff that have a severe allergic reaction. States are encouraged to implement policies to promote access and training.
In addition to improving air quality in schools, AAFA supports the development and use of comprehensive asthma management plans, and advocates for legislation to allow schools to stock medications such as epinephrine and albuterol.
Several organizations provide tools and resources that can be used by school officials, school staff, teachers, health care professionals, parents and students to promote a healthy school environment.
- CDC Tool Kit for Managing Food Allergies in Schools
This CDC tool kit contains tip sheets, training presentations and podcasts to help school staff implement guidelines for managing food allergies in order to prevent and manage severe food allergic reactions in schools. - EPA IAQ Tools for Schools
The Indoor Air Quality in Schools Mobile App provides the user with access to the EPA’s IAQ for Schools Action Kit, which provides strategies to develop or sustain an IAQ management program. - EPA Improve Indoor Air Quality in Schools
This webpage provides information on indoor air quality and explains the importance of addressing how indoor air quality has become an issue for children in schools. This page also provides tools that show how to address indoor air quality problems. - EPA Managing Asthma in the School Environment
This document provides tools to establish and evaluate an indoor air quality management program, develop an asthma management plan, and reduce environmental triggers. - KFA Keep Kids with Food Allergies Safe at School
Kids With Food Allergies (KFA) provides free resources to parents, schools, teachers and staff to prepare to for the school year and keep children with food allergies safe. These resources include tips and articles, free guides and handouts, webinar videos, and guidelines and laws. - National Heart Lung and Blood Institute Managing Asthma: A Guide for Schools
This guide is intended to assist schools in planning or maintaining an asthma management program for students with asthma. This guide is designed to offer follow-up steps for schools that currently have identified students with asthma and provide information to school staff.
Healthy Housing
Quality of housing is a major factor that contributes to asthma disparities around the country and keeping a healthy home is vitally important to helping manage asthma. An unclean home can be extremely harmful for someone with asthma. If someone in your family is living with asthma, it is important to take steps to get rid of the asthma triggers that may be present inside your home to help prevent future severe asthma attacks.
Common indoor allergens found in the home are dust mites, cockroaches, animals (pets), mold, and secondhand smoke. These allergens may be airborne as well as present in carpeting or on furniture.
The Department of Housing and Urban Development (HUD) announced a plan to create smoke-free public housing. It has been proven that eliminating exposure to secondhand smoke can greatly improve the health of people living with asthma.5
Families living in substandard, low income housing are more likely to be exposed to harmful asthma triggers and are at a greater risk of suffering from severe asthma. These families often lack the resources to address health issues in the home. It is important that people with asthma know how to avoid asthma triggers.6 AAFA supports reimbursement for preventative services and home assessments that provide asthma education for people with severe asthma.
- ACAAI HOME Allergy Management
This online tool by the American College of Allergy, Asthma, and Immunology (ACAAI) educates allergy sufferers on managing indoor allergens. With HOME, a person can learn about the different types of indoor air allergens and receive tips on managing allergies. - EPA 10 Steps to Making Your Home Asthma Friendly
The EPA provides 10 steps to help get rid of allergens in the home and create a more asthma-friendly home. - EPA Help Your Child Gain Control Over Asthma
This booklet helps parents learn more about how to prevent their child’s asthma attacks. It describes how to create a plan to take control of asthma and ways to find and keep things that could trigger an asthma attack away from a child. - EPA Implementing an Asthma Home Visit Program
This guide is provided to be used by health plans that have established asthma management programs. This guide offers a step-by-steps instructions on how to implement an asthma home visit program with an emphasis on environmental risk factor management. - HUD Asthma Awareness
This fact sheet from the HUD provides information about asthma and the steps to take to keep a clean, health home. - HUD Smoke-Free Multifamily Housing
This webpage describes the HUD’s action plan to create smoke-free multifamily housing. - National Center for Healthy Housing Healthcare Financing of Healthy Homes
This document provides recommendations for increasing the number of states with Medicaid coverage of lead follow-up and home-based asthma services. - National Center for Healthy Housing Healthcare Financing of Healthy Homes
This document provides the findings from a 2014 nationwide survey of state reimbursement policies.
Healthy Workplaces
Occupational asthma is caused when substances found in the workplace cause the airways of the lungs to construct leading to wheezing, shortness of breath, chest tightness and coughing. You may develop asthma symptoms from your workplace or you may already suffer from asthma and notice that your condition has worsened at work. People who already suffer from allergies are more likely to develop occupational asthma. Jobs that require individuals to be exposed to certain chemicals, such as spray painting, insulation installation, manufacturing plastic or rubber can cause asthma. Common triggers for occupational asthma are chemicals, dust, mold, animals and/or plants. It is important to understand whether or not you are suffering from work-related asthma because constant exposure may result to long-term lung damage, loss of productivity and disability. AAFA supports policies which promote a healthy workplace for all employees.
- OSHA Do You Have Work-Related Asthma?
This Occupational Safety and Health Administration (OSHA) fact sheet provides a guide for a person and their doctor to determine if they are suffering from work-related asthma. - National Heart Lung and Blood Institute Employees, Employers, and Worksites
This webpage details who is a risk for developing occupational asthma and what role employees and employers can take to create safe and supportive worksites.
Other Settings: Airplanes and Restaurants
Other settings can also provide environmental challenges for people suffering from asthma and allergies, such as airplanes and restaurants. AAFA supports policies which allow people with asthma and allergies to live complete and healthy lives in every setting.
Airplanes
Airline travel can be particularly challenging for those with asthma and allergies for a variety of reasons. Passengers must rely on the cooperation of crew members and fellow passengers to prevent accidental exposure to asthma or allergy triggers. There is no access to emergency medical care, and airline accommodations for passengers with chronic conditions can vary from one airline carrier to another. Additionally, these accommodations are not consistently or uniformly implemented.
As most people know, airlines often serve nuts as snacks on airplanes, and this can be dangerous for people with food allergies. If you have a food allergy, it is important for you to contact the airline on which you will be traveling ahead of your journey to make sure you are familiar with the airline’s policy for food allergy accommodation. AAFA’s New England Chapter developed a resource listing the steps you can take to prevent having an allergic reaction while traveling on an airplane.
Legislation has recently been introduced to address safety concerns for allergic airline passengers. The Airline Access to Emergency Epinephrine Act (S. 1972) was introduced on August 6, 2015, by Senators Mark Kirk (R-IL) and Jeanne Shaheen (D-NH). This bill would require airlines to carry epinephrine auto-injectors for emergencies and to train crew members to recognize the signs of a severe allergic reaction (anaphylaxis) and to treat the reaction with the auto-injectors. Since epinephrine is the first-line treatment for anaphylaxis, it is important that airlines have this life-saving medication on hand in the event that a passenger experiences a severe reaction.
Policies of Large U.S. Airlines on the Serving of Nuts
Restaurants
People living with food allergies are likely to have trouble going to eat at restaurants because there are currently no consistent restaurant regulations regarding food allergies. A 2013 CDC study showed that between 1997 and 2011 the prevalence of food allergies increased by 50 percent.7 Massachusetts, Michigan, Rhode Island, and Virginia have current restaurant regulation laws for food allergies.8, 9, 10, 11 AAFA encourages other states to follow the example of these states and create restaurant regulations for food allergies.
It is important the restaurant industry be prepared for a possible food allergy reaction, anaphylaxis and know how to treat it. The states that have enacted policies for food allergies in restaurants have required that at least one manager be trained in food safety awareness and food allergy awareness training. It is also important for people with food allergies to inform their servers of their food allergy.
This is an online course which provides food allergy and gluten-free training for the food service industry. This program gives instructions for safely preparing and service allergen friendly items.
This is an online course which trains employers and employees are the best practices in food sanitation, food preparing and serving to accommodate guests with food allergies.
AAFA Projects and Activities
asthma & allergy friendly™Certification Program
Stocking Epinephrine in Schools
References
[1] Environmental Protection Agency. Questions about your Community: Indoor Air. http://www.epa.gov/region1/communities/indoorair.html
[2] Environmental Protection Agency. Indoor Air: Improve Indoor Air Quality in Schools. http://www.epa.gov/airquality/community/details/i-schools_addl_info.html
[3] Environmental Protection Agency. Sensible Steps to Health School Environments: Cost effective, affordable measures to protect the health of students and staff. 2013. http://www2.epa.gov/sites/production/files/2014-05/documents/sensible_steps.pdf
[4] Center for Disease Control. Food Allergies in Schools. http://www.cdc.gov/healthyyouth/foodallergies/
[5] World Health Organization. Smoke-free Inside. http://www.who.int/tobacco/wntd/2007/wntd_2007_brochure.pdf
[6] Center for Disease Control. Vital Signs. http://www.cdc.gov/vitalsigns/asthma/
[7] Center for Disease Control. NCHS Data Brief. http://www.cdc.gov/nchs/data/databriefs/db121.htm
[8] Department of Health and Human Services. Food Protection Program. http://www.mass.gov/eohhs/gov/departments/dph/programs/environmental-health/food-safety/
[9] Michigan Legislature. Senate Bill 0730. 2013. http://www.legislature.mi.gov/(S(o3m2mq4vye0my3c1spfo1dof))/mileg.aspx?page=getobject&objectname=2013-SB-0730&tr=y&auid=15117232
[10] JUSTIA US Law. Food Allergy Awareness in Food-Service Establishments. http://law.justia.com/codes/rhode-island/2014/title-23/chapter-23-20.12/section-23-20.12-2
[11] Virginia’s Legislative Information System. HB 2090 Restaurants. http://lis.virginia.gov/cgi-bin/legp604.exe?151+sum+HB2090