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The American Academy of Pediatrics has released a new clinical report for the management of food allergies in the school setting, noting that as many as 1 in 10 children have a food allergy that can cause sever allergic reactions.¹

The updated guidance outlines the role pediatricians play in supporting safe and effective allergy management across these environments.

The clinical report, Management of Food Allergy in Schools, published in Pediatrics, replaces the AAP’s 2010 version and incorporates the latest national guidelines, laws, and evidence.²

“Pediatricians diagnose allergies and prescribe medications like epinephrine, but they are also an important source of education for families and school staff on how to prevent allergic reactions and respond to them,” said Scott H. Sicherer, MD, FAAP, lead author of the report.¹

Diagnosis and documentation

Authors note that accurate diagnosis is the foundation of food allergy management. The report emphasized that although any food can trigger reactions, the majority of severe cases involve peanuts, tree nuts, milk, eggs, soy, wheat, fish, shellfish, and sesame. Establishing diagnosis requires a clinical history consistent with IgE-mediated allergy, supported by allergy testing. However, testing alone is not diagnostic and may not predict severity. Clinician-supervised oral food challenges may be necessary to confirm cases.

Once diagnosed, pediatricians should provide schools with written documentation. AAP recommended using a standardized allergy and anaphylaxis emergency plan, available in English and Spanish, which can be embedded in electronic health records and renewed annually. These plans authorize treatment, outline symptom recognition, and guide emergency responses, while serving as the basis for individualized health care plans (IHPs) or 504 Plans under federal civil rights law.

Emergency preparedness in schools

“Right now, 1 in 15 schools experience a case of anaphylaxis each year. That can be a scary and potentially devastating scenario without a predetermined plan in place on how to respond,” Sicherer said.¹

Pediatricians are encouraged to prescribe epinephrine auto-injectors for school and home use and to discuss with families the importance of ensuring access to these devices in educational settings.²

Stock epinephrine, or unassigned auto-injectors, have become an important tool in addressing emergencies for children without a prior diagnosis. Studies show that in up to 31% of cases, students treated with epinephrine had no known allergy. In schools where stock devices are available, 49% of all reactions were treated with an unassigned injector. Pediatricians may be asked to provide prescriptions for these devices, though laws vary by state. The report stresses that prescribers should be aware of their state’s regulations and liability protections.

In addition to prescribing, pediatricians can help ensure that schools are prepared through education. Training done by school personnel including teachers, cafeteria workers, bus drivers, and coaches, on recognizing and responding to anaphylaxis is recommended, regardless of who may administer epinephrine in an emergency.

Reducing risk of exposure

The AAP guidance highlighted several strategies that pediatricians can reinforce when advising schools and families:

• Encourage strict “no food sharing” policies.
• Recommend hand washing with soap and water, since water alone or hand sanitizer may leave residual allergen.
• Stress the importance of reading food labels and avoiding cross-contact during food preparation.
• Support policies limiting food on buses or during activities, unless necessary for medical reasons.

The report also notes that allergens may appear outside the cafeteria, in activities like cooking classes, art projects, or science labs. Pediatricians can help families and schools anticipate risks and provide safe alternatives when necessary. Food allergies also extend beyond medical risk, as children may experience anxiety, social isolation, or bullying.

“The AAP also discusses the social and emotional impact of allergies on children, who may experience anxiety, teasing or bullying. Students should be encouraged to report bullying, and anti-bullying programs can be implemented,” the academy stated in a press release.¹

Using a team-based approach to allergy care

“While awareness about allergies has increased over the years, a child’s safety really depends on a team approach – in which school staff are trained and emergency supplies are on hand in case of a severe allergic reaction,” Sicherer said. “There are a number of actions everyone can take to reduce risks of allergic reactions, as well. Your pediatrician can help provide that information."

To view the full clinical report, click here.

References:

1. American Academy of Pediatrics offers clinical recommendations on managing food allergies in school, childcare settings. American Academy of Pediatrics. Press release. September 25, 2025. Accessed September 25, 2025.
2. Sicherer SH, O’Leary S, Pistiner M, Wang J. Management of Food Allergy in Schools: Clinical Report. Section on Allergy and Immunology, Council on School Health. Pediatrics. 2025; doi:10.1542/peds.2025-073168