Managing food allergies in schools: What pediatricians should know

Pediatricians play a central role in helping schools safely manage students with food allergies, from establishing accurate diagnoses and emergency action plans to supporting age-appropriate self-management, according to Michael Pistiner, MD, MMSc, FAAP.

Pistiner, a pediatric allergist at Mass General Hospital for Children and director of food allergy advocacy, education, and prevention, discussed strategies for improving food allergy management in schools at the American Academy of Pediatrics (AAP) 2026 National Conference & Exhibition.

He highlighted the AAP clinical report on food allergy management in schools, emphasizing communication among pediatricians, families, and school personnel to support prevention and emergency preparedness.

Why is accurate food allergy diagnosis essential?

Pistiner emphasized that establishing an accurate diagnosis of immunoglobulin E (IgE)-mediated food allergy is one of the pediatrician's most important responsibilities.

IgE-mediated reactions can develop within minutes to a few hours after food exposure and may involve multiple organ systems. Symptoms can include coughing, wheezing, vomiting, sneezing, and hives. These reactions can progress to anaphylaxis, for which epinephrine is the first-line treatment.

Pediatricians may collaborate with allergists to confirm diagnoses and establish appropriate management strategies.

"Being able to make an accurate diagnosis is one of the most essential roles of the pediatrician," Pistiner said.

A confirmed diagnosis provides the foundation for communicating a child's needs to school personnel and preparing appropriate documentation.

How should pediatricians prepare schools for allergic emergencies?

Following diagnosis, Pistiner recommended developing an allergy and anaphylaxis emergency plan that can be shared with families and schools.

The AAP provides an example incorporating available epinephrine treatment options. When signed by the child's primary care clinician, the document can serve as medication orders and support individualized health plans or Section 504 accommodations.

School nurses play an important role in implementing these plans, coordinating staff training, establishing protocols, and facilitating communication.

However, access to full-time school nursing remains a significant challenge.

"One of the biggest challenges when it comes to food allergy management in the school is the lack of a full-time school nurse," Pistiner said.

Without dedicated nursing support, schools may struggle to implement prevention strategies and maintain emergency preparedness. Pediatricians can help by providing documentation and directing school personnel toward established resources.

What is the FAMS toolkit, and how can schools use it?

Pistiner highlighted the Food Allergy Management in Schools (FAMS) K–12 recommendations as a resource supporting schools with different staffing levels and resources.

The toolkit provides a framework for food allergy prevention and emergency preparedness that pediatricians can share with families, teachers, administrators, and school nurses.

Designed for use across schools and states, the recommendations establish consistent expectations while allowing flexibility for different student populations and available resources.

Pistiner explained that this approach helps families understand what effective school food allergy policies should include, even when implementation varies between schools.

How should food allergy self-management change with age?

Pistiner emphasized that food allergy education should reflect each child's developmental abilities.

Younger children may learn basic avoidance strategies and when to seek adult assistance. Older students can gradually assume responsibilities such as reading ingredient labels, preventing cross-contact, recognizing allergic reactions, carrying epinephrine, and administering it when appropriate.

"High school kids will be able to self-manage, and ultimately, pediatricians can reinforce to the student, to the child, to the family food allergy management strategies that need to be implemented at all times in all circumstances, including school," Pistiner said.

He encouraged pediatricians to reinforce these skills progressively rather than expecting younger children to manage responsibilities beyond their developmental abilities.

For pediatricians, Pistiner's recommendations underscore the importance of accurate diagnosis, coordinated emergency planning, and consistent education. Collaboration with families and school personnel can help students with food allergies receive appropriate support throughout their school years.

Reference

Pistiner M. Food Allergy Management in Schools (FAMS): Expert Recommendations for K-12. Presented at: American Academy of Pediatrics 2026 National Conference & Exhibition; October 54 2026; San Diego, CA.