Going Back to School with Food Allergies
For families or patients living with food allergies, going back to school can be a stressful time. Especially for those kids going to school for the first time, there can be a great deal of concern over preventing accidental ingestions and reactions. My goal as a physician and allergist is to help create an environment for my patients to live their lives in a healthy and prosperous manner. For children, that means helping them be kids without being defined as “the kid with food allergies”. Growing up is hard enough without feeling different than everyone else.
According to a 2021 review article, if an average school had 350 students, 1.3 allergic reactions of any severity would occur on average at each school per year; anaphylaxis would occur in approximately 1 in 15 schools per year; epinephrine would be administered in about 1 in 24 schools per year. On average, researchers report that roughly 1 in 10 allergic reactions and cases of anaphylaxis among children occur at child care centers or schools. Most reactions (90%) occur elsewhere.
The highest risk for any food-induced reaction stems from direct ingestion of the food. Severe reactions from contact or inhalation exposure to the allergen are extremely rare. In a study from Johns Hopkins, researchers failed to detect measurable quantities of peanut in air filters around the necks of volunteers who crushed peanut shells scattered on the floor of a poorly ventilated room. In the same study, they found that peanut allergen was easily cleaned from hands and tabletops with common cleaning agents and did not appear to be widely distributed in preschools and schools. Contact with the allergen may lead to localized hives that will not result in a full body reaction in the overwhelming majority of food allergic individuals. Wiping down the skin area where there was contact with allergen usually resolves the reaction.
The most important step that you can take is to make sure that the school has an up-to-date epinephrine auto-injector and Food Allergy Care Plan for your child. An example of such a plan can be found here. In order to prevent reactions, you should emphasize to your child that he/she cannot eat foods from other kids. Only foods that you provide or that you tell them are safe can be ingested.
In the aforementioned 2021 review article on this topic the authors suggest a few recommendations:
- Child care centers and schools implement training for teachers and other personnel in the prevention, recognition, and treatment of allergic reactions to food
- Child care centers and schools require all parents of students with diagnosed food allergy to provide an up-to-date allergy action plan
- Child care centers and schools implement site-wide protocols for the management of suspected allergic reactions to food in individuals with no allergy action plans on file
- Child care and school personnel use epinephrine only when they suspect that someone is experiencing anaphylaxis, rather than use epinephrine as the first universal treatment for all suspected allergic reactions
- Child care and school personnel do not preemptively administer epinephrine in cases when no signs or symptoms of an allergic reaction have developed, even if a student has eaten a food to which they have a known allergy or history of anaphylaxis
- When laws permit, child care centers and schools stock unassigned epinephrine autoinjectors on site, instead of requiring students with allergy to submit personal autoinjectors to be stored on site for designated at-school use
- Child care centers and schools do not prohibit specific foods site-wide
- Child care centers and schools do not establish allergen-restricted zones, except in the special circumstances identified in the full guidelines
The last 2 recommendations may create controversy but studies have not consistently found that these interventions lower the risk of allergic reactions or improve quality of life. It can be challenging to effectively monitor and promote community adherence to such prohibitions. Some students still bring prohibited foods to school, and there are documented cases of allergic reactions to a food occurring in schools where it is prohibited. Allergen-restricted zones may also negatively affect the socialization of students with food allergy if they are compelled against their wishes to eat separately from peers. These interventions might put students with food allergy at higher risk of bullying or isolation. They might also limit the development of self-management and social skills in students with food allergy, which in turn could reduce their preparedness for settings where their allergens are not prohibited.
In summary, the most important tenets of keeping food allergic children safe at school consist of emphasizing to the student to only eat foods that are designated as safe, making sure that emergency medications are available and communicating with the school about your child’s food allergies (including having a Food Allergy Care Plan). As always, please work with your trusted allergist to ensure that this upcoming school year is a safe one for your food allergic child!
Ananth Thyagarajan, MD
Allergy Partners of Springfield,
Dr. Thyagarajan (or “Dr. T.”) was born and raised in Cleveland, Ohio. He completed his allergy and immunology fellowship at Duke University. He practices in Burke, Virginia about 20 minutes outside of Washington, DC. He has earned the esteemed honor of being named a Washintonian Top Doc every year since 2017.
His interest in Allergy and Immunology stems from the science of the immune system and the ability to treat both adults and children. He has numerous publications and abstracts in the fields of allergy and immunology. He has received awards in research, including the American Academy of Pediatrics Section on Allergy and Immunology Outstanding Abstract Award. His research has been selected to be presented at annual meetings of the American Academy of Allergy, Asthma & Immunology. His philosophy is to work with patients and their families in creating an effective and practical treatment regimen. He strongly believes that open and robust communication between patients and providers leads to better health outcomes.