Managing Food Allergies at School
Transitioning to a school setting can be difficult and bewildering for the food allergic student and his or her family
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As food allergies become more and more common – now affecting three million U.S. children – parents, caregivers and school personnel are among those impacted most. Transferring from the safe confines of one's home to a daycare or school setting can be a difficult and bewildering experience for the food-allergic student and his or her family.
As part of our ongoing efforts to provide members with helpful information for preparing for back-to-school, Kids With Food Allergies is pleased to share an excerpt from the food-allergy handbook "On the Nature of Food Allergy".
Food Reactions at School
In 2000, a joint study from the Jaffe Food Allergy Institute in New York City and the Food Allergy and Anaphylaxis Network (FAAN) described the clinical features of allergic reactions to peanuts and tree nuts in school and day-care settings. Of the 124 reactions reported in the study, ninety percent required treatment. Antihistamines were given in 84% of the incidents and epinephrine was administered in 28%. A school nurse was available for only 23% of the reactions. Cooked or baked products served at birthday or holiday celebrations triggered many reactions. Other sources of accidental exposure included arts, crafts, and science projects and poorly supervised field trips and bus rides.
Most schools in this survey were not prepared to deal with the reactions. Only one in every three students had a food allergy action plan or treatment plan in place. Treatment delays were a result of delayed recognition of a reaction, attempting to call parents first, not following emergency plans, and in one case, an inability to administer auto-injectable epinephrine. The study concluded that peanut and tree nut reactions were common in school and day-care settings and that school personnel needed more education on how to recognize and treat allergic reactions.
Managing Life Threatening Food Allergies in Schools
At this time, there are no federal food allergy management guidelines for schools. The amount of awareness in schools and school districts about keeping food allergic children safe at school varies greatly. Some schools may offer resistance to putting protocols and policies in place to keep the allergic child safe. In these situations, sometimes the allergist can intervene to meet or speak with the school to address the need for putting programs in place to ensure the safety of food allergic children in school.
Some states and school districts have taken matters into their own hands and have published proactive guidelines for managing life-threatening reactions at school which can be used as models for developing similar guidelines in other school districts or schools. These guidelines outline the roles and responsibilities of specific individuals – from the school administrator to the school custodian and bus drivers – in a detailed checklist format. Also included are templates for composing letters to classmates, families and parents, detailing how to respond to a student with life-threatening food allergies, and much more.
Examples are:
Managing Life Threatening Food Allergies in Schools by the Massachusetts Department of Education
Guidelines and Practices: Managing Food Allergies in Elementary School Children by the Ann Arbor, Michigan Public Schools
(require Adobe Reader 
)The Role of Parents or Guardians
Prevention starts at home. The parent's first job is to develop an Individualized Health Care Plan (IHCP) that should include reports from primary health-care providers or allergy specialists that details the student's allergy and medication program. The best plan is the
Food Allergy Action Plan (FAAP) developed by FAAN that describes the signs, symptoms and appropriate treatments for allergic reactions. The FAAP provides informed consent and contact numbers for parents, guardians and health care providers. Responsible parents should review the IHCP and FAAP with the school nurse and classroom teacher each year prior to the opening of school.
Parents must provide schools with a minimum of two up-to-date EpiPens® or Twinject® devices and be sure that these devices are stored in an unlocked cabinet and accessible to all school personnel during and after school hours. Parents should provide safe snacks for classroom parties and whenever possible, accompany food-allergic children on field trips.
PARENTS MUST TEACH CHILDREN: - How to recognize the symptoms of an allergic reaction
- How to communicate clearly as soon as possible when a reaction begins
- How to read labels
- To avoid food-sharing at lunch time
- To stress the importance of handwashing before and after eating
- To report teasing, bullying and threats to an adult authority
- To not share their auto-injector devices with other students
- How to say "no thank you" when offered food not from home.
How to Handle an Acute Allergic Reaction
Once an emergency situation arises in a school, the first responding staff member must assess the situation. The signs and symptoms of an allergic reaction can range from mild to a severe life-threatening emergency. A delay in initiating treatment is the major reason for a near fatal or fatal reaction. In many cases, the early signs are deceiving, as warning signs like hives are not apparent. The first sign or symptom may be a "funny feeling in the mouth" or abdominal discomfort.
The biggest decision for the first responder will be whether or not to administer injectable epinephrine. In my opinion, all too often there is hesitancy and a delay in administering epinephrine. When in doubt about whether to give epinephrine, better to give it immediately and then seek additional medical attention as most fatal reactions occur when epinephrine is delayed. Remember, there are no medical contraindications to giving epinephrine in a life-threatening emergency. In my opinion, anyone who requires epinephrine in the school setting should be transported to an emergency room for additional evaluation and treatment. Remember a significant number of patients who experience an anaphylactic reaction may develop a delayed, biphasic reaction.
Final Words
The key to the safety and well-being of food allergic children in schools is developing a collaborative partnership among the school, families, and medical personnel to provide a safe and healthy learning environment that enables parents and their children with food allergies to make the transition from the safety of their homes into the expanding world of schools. The parents play a vital role in initiating the process and in making the child's needs known; in providing the school with a IHCP or FAAP, and a supply of epinephrine autoinjectors and/or other needed medication; and in teaching their food allergic children responsible behavior in school. The school plays a vital role in training personnel and setting up systems to keep food allergic children safe at school, and to promptly respond when a reaction occurs.
Reference:
Sicherer SH, Furlong TJ, DeSimone J, Sampson HA. "The U.S. Peanut and Tree Nut Registry: Characteristics of Reactions in Schools and Day Care," J Pediatrics 4(2001): 560 - 565.
The late Paul J. Hannaway, M.D., FAAAI, was a practicing allergist and Associate Clinical Professor at Tufts University School of Medicine. He is the author of "
On the Nature of Food Allergy", Lighthouse Press: 2007, a complete handbook about food allergy, from which this article is excerpted with permission.
Visit www.onthenatureoffoodallergy.com for more information. This book is featured in the
Kids With Food Allergies Book Shop.
Updated August 2008. This article first appeared in the Fall 2007 edition of Support Net™ and is available to
download (requires Adobe Reader
.)
Approved by KFA Medical Advisory Team August 2007.
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