According to Misrad Hachinuch (Ministry of Education), Israel currently has several thousand children with serious food allergies studying in the elementary school system. The most common food allergies are milk, eggs, peanuts, soy, sesame, tree nuts, wheat, fish, shellfish and kiwi.
There seem to be fewer cases of food allergies in Israel than in the U.S., Canada & the UK, and, accordingly, public awareness of life-threatening allergies seems to be much lower here. In speaking to many Israeli adults about the risks of an allergic reaction, it is frequently necessary to start from the beginning and introduce the concept of what it means to have a life-threatening allergy. As with many things, however, once people understand the risks — they are usually happy to help.
Creating a safe school environment for any allergic child in Israel is a process that involves informing administrators and meeting with the principal and teachers well ahead of time, and working together in making decisions about how the school is going to handle your child’s allergy in a safe and responsible manner. The decisions that are made will differ, of course, based on each child’s needs. If you would like to speak with a parent who has experience with this process, please email Nefesh B’Nefesh at [email protected].
Unlike many schools in the U.S., most Israeli schools are not peanut-free by default and implementation of allergy-safety policies may vary widely from district to district depending on many factors. However, Misrad Hachinuch has recently (Nov. 30, 2016) published new country-wide guidelines for handling food allergies in public schools. This updated protocol is available online (in Hebrew) at: http://cms.education.gov.il/EducationCMS/Applications/Mankal/EtsMedorim/2/2-2/HoraotKeva/K-2016-4-1-2-2-92.htm
Israeli schools do not have an in-house nurse and teachers are not necessarily qualified or required by law to administer emergency medical assistance, including life-saving medications such as Fenistil or EpiPens. This is a policy that is presently being reviewed by the Supreme Court, but in the meantime needs to be verified in writing on an individual basis. In cases of potential life-threatening food allergies, it may be possible to request the presence of a Saya’at Refu’it, a personal shadow aide for the child, who is hired and paid through the public school system. Receiving a Saya’at Refu’it is dependent on meeting the specific guidelines of Misrad Hachinuch, and may also be affected by external factors such as availability of governmental funding or availability of personnel, and the policy itself is presently under review. For more information, contact Irit Livneh, who is responsible for health issues for Misrad Hachinuch, at 02-560-3451.
The allergy epidemic made Aliyah a bit late – and so policies surrounding allergies in daycare, kindergartens and schools are currently in a state of flux as the Knesset and courts assess the best ways to protect the rapidly growing number of allergic kids. In the meantime, implementation can vary greatly from town to town and from school to school. School safety should be taken into consideration when you choose where to settle. You can prepare yourself well in advance by speaking with parents of allergic children, schools who have had allergic children, and even a lawyer and/or MK who is knowledgeable in the matter of allergies.
* Does the school have any experience with food allergies? Ask them to describe.
* What is their policy for storing and administering EpiPens/antihistamine?
* Who is authorized to give medications and do they have an emergency plan in place? What is it? This should be confirmed in writing and well rehearsed.
* How can they ensure that there are no delays in getting treatment?
* If there is a suspected reaction do they call an ambulance immediately? Have they ever done so? You may be required to give written pre-approval of payment or even a deposit check for ambulance costs.
* How does one apply for a Sayaat Refuit? (Ask about for forms, deadlines, and policies)
* Will allergens be banned, at what level, and how can they enforce this?
* Where do the kids eat and where is their food stored?
* Are allergic kids segregated in any way from the other kids? What happens at mealtimes?
* Do external contractors (such as “Tzaharonim” or caterers) bring allergens to the school?
* What happens when the teacher or Sayaat Refuit is sick or called out of class for an emergency?
Childcare for children aged 0-3 falls under the auspices of the Ministry of the Economy, which supervises subsidized daycare centers through organizations such as Naamat, WIZO, or Emunah, and private initiatives, which are not subject to ministry regulations, although many do have the oversight of private regulatory organizations.
Daycare staff and nannies are not trained by default in allergy care so you will need to take the initiative to ensure that they are trained properly. You should also ask them for a written agreement stating that they are responsible for administering medication and calling an ambulance. You, in turn, will be required to give written permission to do so and commit to paying for ambulance costs.
Allergic children in government-regulated daycares may be eligible for two hours daily of private supervision by a personal Sayaat. This is provided by the Ministry of Social Welfare (Misrad HaAvoda, HaRevaha VeHashirutim HaSotzialim) even for families who would not ordinarily qualify to register with the Welfare Ministry. The Sayaot provided by the Welfare Ministry have a strictly supervisory role and are not authorized to administer EpiPens or other emergency medication. Thus, it is upon the parent to find out who will do so, and to train them accordingly.
Many Israeli childcare providers are happy to adapt their menus to meet the needs of an allergic child, although this is more easily accomplished in private frameworks, and it is important to check if allergens will be totally banned and removed from the premises or if the child will simply be given a special meal. Welfare Ministry Sayaot are rarely authorized for private frameworks.
For children who have severe allergies to multiple foods or airborne allergies, it may be difficult to find a childcare center that is up to the challenge. This is also presently under review in the Knesset. In the meantime, for children under age 3, it may be easiest to bring a private babysitter into your home, rather than sending the child to group care.
A few initiatives have been taken to open allergy-friendly childcare centers in Israel. Some leads can be found at: https://web.archive.org/web/20110305031715/http://www.foodallergy.co.il/P3052.
Information and support for food allergies in Israel is available primarily through organizations for people with disabilities or special needs, such as Kol HaZchuyot as well as a variety of allergy-specific Facebook groups, some of which operate in English. Yahal and the Amuta HaYisraelit LeAlergiot LeMazon also operate websites. A non-official coalition of parents of kids with special needs also exists; their email is [email protected]gmail.com. However, because allergies are a relatively new phenomenon, it may be wise to find a lawyer who can help navigate the maze of laws as they become defined around allergy-related situations; free representation may be available through the coalition of Parents of Special Needs Kids, BiZchut, or the Israel Bar Association, although many landmark cases have been led by private lawyers.
Allergists are available through the major medical centers (such as Schneider, Ichilov and Hadassah), Kupot Holim, and the public healthcare system, as well as privately. Before choosing which healthcare provider your family will use, make sure that you research which Kupah has a good allergist who works in your new Israeli community.
Medical supplies, such as an Epipen (epinephrine auto-injector) and Fenistil (anti-histamine and anti-allergic) drops, are available at local pharmacies and can be purchased at discounted prices through the Kupah. You will need to make an initial appointment with an allergist in order to obtain a prescription, which can then be renewed through your GP or pediatrician.
Israel is a leader in food allergy research and a pioneering new desensitization treatment is available privately through Assaf HaRofeh hospital near Petah Tikva. The procedure can take several months or even years and has a waiting list of over a year.
If your child is joining a new Gan or school class, you can suggest that the teacher discuss your child’s allergies with the other children in the class. Here are three books which are sold in the bookstores that can be used for this purpose:
- For preschoolers: Ha’uga Ha’meyuchedet Shel Roni (Roni’s Special Cake), by Donna Aluf, published by Etzbaoni Publishers.
- For elementary school children: Hakrav Neged Ha’alergen Ha’akshan (Battling a Stubborn Allergen), by Galila Ron-Feder, #12 in a series called Sayeret Hamada
- Another popular book is HaAchbar SheLo Achal Gvina (The Mouse Who Didn’t Eat Cheese), available from the Yahal website
If your child wears a medical bracelet, you can order bracelets with Hebrew-language inscriptions online through a company called Medical-ID, which can be reached by phone or by phone at 050-541-1649.
Hi-tech Allerguarder bracelets can also be ordered online, and the app downloaded for free, at http://www.allerguarder.com
People with food allergies may be exempt from army service, and if they serve may need special dispensation to carry emergency medicine or special foods with them. This area is also undergoing changes and it is best to contact a lawyer familiar with army protocol to learn more about exemptions and EpiPens.
Some smaller Yishuvim have even gone so far as to ban certain allergens from the entire Yishuv. If you are considering moving to a smaller place, you can ask if they have such a policy.
The Knesset is presently reviewing a proposed new law which would require restaurants and schools to keep EpiPens on the premises at all times. Even if the law comes into effect, it will still be important to get written confirmation of who is responsible for injecting the EpiPen in a school and to rehearse various scenarios and alternative plans with your child and school staff, as there is presently some legal ambiguity regarding who is required to administer the first aid care.
Vaccinations are given at Tipat Halav, Kupot Holim, private clinics, at schools, and sometimes in the case of allergies – at hospitals. It is important to review with your doctor which vaccinations may contain or may be exposed to allergens and if alternative vaccinations are available. It is especially important to review vaccination policies with your school, your school’s teacher, and your child to ensure that allergenic vaccinations are not administered and that your child’s vaccinations are up to date.
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