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Tips for coping with allergies in the school environment

Contemporary PEDS Journal, August 2022,

Multidisciplinary, proactive plans, and student self-sufficiency are vital.

Parents can control the home environment for their child with food allergies, but it is more difficult outside the house, especially at school. Pediatricians are often asked for guidance by parents on how to teach their kids about their food allergies, and how to manage those allergies when their children are on their own.

There’s no single perfect piece of advice, but experts say that a multidisciplinary effort, proactive measures, and self-sufficiency on the part of the child are all important components of an allergy management plan.

“Once a child goes to school and the parents cannot monitor them or control what the child eats, the concern is that they will have an accidental exposure to one of their allergens, particularly in young children who may pick up another child’s snack and eat it,” says Vivian P. Hernandez-Trujillo, MD, director of the Division of Allergy and Immunology at Nicklaus Children’s Hospital in Miami, Florida.

An estimated 8% of school-aged children in the United States have potentially life-threatening food allergies,1 but study results show that many teachers and schools aren’t knowledgeable enough about conditions such asthma and allergy treatment to address them properly.2 Better team- and school-wide plans can help,3 especially considering that many children with food allergies report high levels of anxiety.4

Most schools have policies to assist students with food allergies, but there is no national blueprint. Policies vary by school district, are loosely defined, and often are poorly implemented. Prevention policies are generally followed the closest at the lower grade levels, where it might be less practical to expect younger children to assume responsibility for monitoring their allergies.

For some parents and school districts, the answer has been to remove children with allergies from certain sections of the classroom or lunchroom.

“Families get very worried about how their kids are going to react,” said Jonathan Spergel, MD, PhD, chief of the allergy program and the Stuart E. Starr Chair of Pediatrics at Children’s Hospital of Philadelphia in Pennsylvania. “They want an allergy-free table, and the most common reaction is, ‘Nope, there’s no such thing as a milk-free table or a milk-free school.’”

Peanut allergies have received a lot of attention, and some schools have created policies to separate children with peanut allergies, but Spergel disagrees with this school of thought. He notes that milk allergies are more common than peanut allergies and that separating children with allergies from their nonallergic peers may cause more harm.

“We tell families that as long as they eat their own food they are fine,” Spergel said. This puts a large amount of responsibility on the child, but parents and pediatricians have to educate them about their allergy, how to manage it, and how to avoid their allergens. Just being at a table with children consuming the allergen, or even touching it, won’t cause a reaction. As long as children know to be careful not to ingest certain foods, there is no harm in them sitting with friends during meals.

“We want kids to be as normal as possible and not be ostracized because of their food allergies,” Spergel said. “If you’re ostracized, you’re going to get bullied. If you’re sitting with friends, you’re less likely to be bullied.”

Birthday parties or class holiday parties are usually the biggest worry, he said, because food is often a central part of these celebrations. Schools can take steps to limit common allergens or find ways to celebrate without food instead. For example, the student could bring a favorite book to share instead of a favorite treat.

“This can help support education as well as [work] against food allergies and obesity,” Spergel said.

Who should be notified of a child’s food allergy varies from school to school, Spergel said. A school nurse is a good place to start, followed by the principal. It also can be helpful for parents to discuss the allergy with their child’s direct teachers. All children with allergies should have an allergy management plan and an anaphylaxis plan, he said, and most schools require children with allergies to have emergency medications available at school.

Each school has its own rules, but Spergel said the important thing for parents to remember is that their child probably is not the only child in the school—and perhaps not the only one in their classroom—with food allergies. In fact, on average there are 2 children with food allergies in every classroom, according to Spergel.

Parents should be encouraged to ask about existing policies, when and where children will eat, where emergency medications are kept, and who is able to administer them, Hernandez-Trujillo said. If parents run into trouble having an allergy and anaphylaxis plan created or enforced at school, Spergel said they can ask their allergist or pediatrician for help. A 504 document—a formal plan for children with disabilities—can be drafted to solidify steps the school must take to increase accountability, but Spergel said he usually doesn’t recommend such a drastic step. It’s totally acceptable, however, for clinicians to speak to school on behalf of the student and the parents.

Parents should be encouraged to reach out to resources such as the Allergy & Asthma Network or Kids With Food Allergies to get an idea of what types of policies schools should have in place to address food allergies.

Rachael Zimlich is a freelance medical writer in Cleveland, Ohio. She has nothing to disclose.

References:

1. Dupuis R, Kinsey EW, Spergel JM, et al. Food allergy management at school. J Sch Health. 2020;90(5):395-406. Accessed June 6, 2022. doi:10.1111/josh.12885

2. Urrutia-Pereira M, Mocellin LP, de Oliveria RB, Simon L, Lessa L, Solé D. Knowledge on asthma, food allergies, and anaphylaxis: assessment of elementary school teachers, parents/caregivers of asthmatic children, and university students in Uruguaiana, in the state of Rio Grande do Sul, Brazil. Allergol Immunopathol (Madr). 2018;46(5):421-430. Accessed June 21, 2022. doi:10.1016/j.aller.2017.09.018

3. Vollmer RL, Girsch V, Foster JS. A qualitative investigation of parent and child perceptions of school food allergy policies in the United States. J Sch Health. 2022;92(2):185-193. Accessed June 23, 2022. doi:10.1111/josh.13121

4. Kanter AB, Yasik AE, Zaccario ML, Saviano JC. Self-reported anxiety ratings in children with and without food allergies and teacher knowledge of food allergies. J Sch Health. 2022;92(6):541-549. Accessed June 23, 2022. doi:10.1111/josh.13181