For students with food allergies, college campuses can be hazardous

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The number of young people with food allergies has been surging in the past few decades. This fall, many of them are heading to college.

Living with a food allergy at home is challenging under the best of circumstances. But college students say navigating food allergies on campus is particularly fraught.

Nearly a dozen current and recent college students with food allergies shared stories of encountering allergens in campus dining halls, during dorm-life shenanigans and at off-campus events.

Alyssa Bauder, 25, a doctoral candidate in Chicago with a severe nut allergy, recalls waking up one day in her sophomore year at Ohio State University to find peanut butter splattered across her dorm hallway, including on the carpet and the doors to her bedroom and the communal bathroom. No one living on her floor knew at the time that she and her roommate were severely allergic to peanuts, so they chalked up the incident to “drunk students coming home from the bar.”

Bauder said dorm workers “put minimal effort” into finding out who had vandalized the hallway and in cleaning up the mess, residues of which lingered in carpet fibers before a proper cleaning was finally done.

“Even after the physical allergens were removed from the hallway, the traumatic experience lived on with me,” said Bauder, who launched a blog, All Things Allergies, about food allergy-related mental health struggles. She said the incident reignited feelings of post-traumatic stress related to food allergies that she’s had since childhood.

“I never felt comfortable in that space again,” she said. “I was constantly worried my shoes were tracking the peanut butter into the safety of my room.”

The university offered Bauder and her roommate a vacant dorm to live in during the cleaning, but she chose to stay at a family home nearby instead.

An Ohio State spokesman said that he could not discuss specific students but that the health and safety of students, faculty and staff “is a top priority.”

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A new landscape for food allergies

The prevalence and severity of food allergies among children increased 50 percent between 1997 and 2011, according to the nonprofit organization Food Allergy Research & Education. Now, at least 1 in 10 adults in the United States have food allergies, according to data published in JAMA Network in 2019. Some researchers have described the surge as a “food allergy epidemic.”

“They’re all growing up and taking their food allergies into college,” said Ruchi Gupta, a physician and the founding director of the Center for Food Allergy and Asthma Research (CFAAR) at Northwestern Medicine. “We’re talking about 10 percent of a college population learning how to be independent for the first time, making food choices on their own, and that coinciding with wanting to be accepted, make friends, eat out and go to parties.”

The true scope of the problem is unknown, Gupta said, partly because college students are not required to declare their food allergies on applications. It is even harder to quantify how many of them experience anaphylaxis – a life-threatening allergic reaction – while on campus.

A 2016 study described a nearly threefold increase in emergency department visits related to food-induced anaphylaxis among 5- to 17-year-olds from 2005 to 2014.

“What we do know is that about one in five kids and one in 10 adults end up in the emergency room every year for a food allergic reaction,” Gupta said. “And we definitely think it’s higher for college students and young adults at that age.”

Many aspects of the college experience involve food, including welcome buffets during orientation week and dorm gatherings. Parties are among the riskiest environments, Gupta said.

“It’s like kindergarten all over again,” said Caroline Moassessi, the vice president for community relations with the Food Allergy & Anaphylaxis Connection Team (FAACT), and a mother of two college students. “You have to let go and pass the food allergy baton as you hold your breath because you hope they make good decisions.”

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Campus dining halls are food-allergy minefields

Some college dining halls have dedicated stations that are free of nine common allergenic foods: peanuts, tree nuts, milk, egg, wheat, soy, fish, shellfish and sesame. (These foods are responsible for 90 percent of all food allergy reactions, according to FAACT.)

But despite precautions, mistakes do occur, a number of anecdotal reports indicate. In one study, students told researchers that they had eaten food that was mislabeled or that they had received the wrong meals in dining rooms.

Some say that campus dining room workers are inadequately trained to understand food allergies.

At the beginning of her freshman year at the University of Toronto in 2016, Jenna Tso struggled to find safe meal options at her dining hall.

One day, Tso, who is severely allergic to milk, eggs, beef and pork, picked a bowl of vegan lentil dal, only to have the dining hall employee top it off with a piece of bread that contained dairy.

“I had to give my meal away to someone else,” said Tso, 24, now a social worker in Los Angeles. “I didn’t feel comfortable going back and ordering the supposedly vegan meal again without the bread, because of the worker’s lack of awareness.”

Cate Weiser, a 19-year-old sophomore at the University of Chicago who is allergic to eggs, peanuts, tree nuts and fish, said she was fortunate to have access to an allergen-free dining station.

A University of Chicago spokesman said “menus follow a 5-week cycle where different meals are introduced each day.” But Weiser said the hardest part about her first year on campus, she said, was the repetitive and limited meal options.

“It’s hard to eat the same thing every day,” Weiser said. “Plus, it’s dining hall food, so it’s not good in the first place.”

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The challenges of socializing with food allergies

For those with food allergies, social events and other outings introduce myriad other risks.

Alcohol is one factor. The labels on many alcoholic beverages do not disclose ingredients or potential allergens, setting up exposure risks for those who are allergic to rye, wheat, barley and even peanuts. Not only can alcohol increase the severity of an allergic reaction, but its intoxicating effect also can reduce a person’s ability to notice what is happening, leading to delayed treatment.

But many people with allergies say the biggest challenge is a general lack of support and understanding among peers.

Tso said she avoided talking about her allergies out of fear of “being labeled as difficult or annoying.” She recalled a sorority event at an Italian restaurant during her freshman year when she began having an allergic reaction after taking a bite of a spaghetti dish that she thought was safe.

Tso felt a tingling in her throat and began to have trouble breathing. She said she was too embarrassed to use her EpiPen in front of her companions and instead excused herself to call an Uber to go to a hospital.

She administered her EpiPen in the car but was too late to prevent a severe reaction. She began to vomit. When she arrived at the hospital her airways were nearly closed and her hands and fingers were turning blue because of a lack of oxygen.

“I really downplayed my allergies, which I regret,” said Tso, who now offers food allergy and mental health consulting for students and parents. “I went most of my childhood without having an allergic reaction, but then I went to college and had three in the span of three years because I didn’t have the skills to advocate for myself.”

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Finding support on campus

Katelyn Chu, an 18-year-old freshman at the University of Virginia, developed an allergy to soy at 10 years old. As a Korean American, she grew up having to avoid traditional foods like tofu, soybeans and miso.

She joined an Asian students group on campus, but traditional Asian foods are often served at the group’s events. “For some events, they’ll serve sushi or other traditional Asian foods that I can’t eat,” she said. “It’s stressful.”

Two juniors at Northwestern University, Kethan Bajaj and Julia Auerbach, organized College Advocates for Food Allergy Awareness & Education (CAFAE), to support students who have food allergies and other food-related conditions.

Bajaj said he started advocating for students with food allergies after watching his older brother cope with his own during his time as a college student. Auerbach said she has had celiac disease since she was 12 and wanted to help others navigate the transition from high school to college.

CAFAE holds EpiPen training sessions on campus and provides opportunities for students to discuss their food-allergy experiences. The group also plans to extend its work to nearby high schools.

Students at Tulane University in Louisiana are starting their own CAFAE chapter this upcoming school year, and Bajaj and Auerbach are chatting with several universities about new chapters.

Bajaj and Auerbach said they were motivated to start the club after they used an online survey to gain insights into campus allergy experiences. They found that students who did not have allergies were interested in EpiPen training and in learning how to help someone who is having an allergic reaction.

Food Allergy Research & Education (FARE) and FAACT have launched programs to raise allergy awareness among university staffers and in resource centers. They also provide college students with checklists, legal help and other food allergy information.

An app called Spokin recently released a “Top 100” allergy-friendly college ranking based on over 300 student reviews so far. Next month, the app will offer more detailed information about the food allergy policies and practices at various colleges. Participating schools will pay a fee to be included.

“The goal is to make the already daunting school research process far easier,” said Spokin founder and chief executive Susie Hultquist, who also is the mother of a college student with food allergies.

Michael and Rebecca Suhy started the Allison Rose Foundation after their daughter, Allison Rose, a freshman at Ohio University, died in 2017 of complications of an anaphylactic reaction while spending time off-campus with friends.

The foundation offers food allergy awareness and education to more than 60 high schools, colleges, restaurants and other organizations. It also provides schools with epinephrine stock at no cost. Ohio University recently installed yellow allergy emergency kits in every dining hall in Allison’s honor.

“We feel like we have to be pioneers for those parents that are coming behind us so they never experience what we had to,” Rebecca Suhy said.

Sami Sanders, a 17-year-old high school senior in Georgia with multiple severe food allergies, has already started her college application journey.

Sanders’s mother has taught her to call restaurants and companies and send them emails to request information about certain foods, and to talk to friends and family members about her allergies.

“The older I got, I realized my mom isn’t going to be able to talk and do the research for me. I need to do it myself,” Sanders said. “I’m definitely nervous for college, but I’m staying positive. I know I’m going to end up where I am supposed to be.”