Tips for dealing with allergies in the school setting

Parents can control the home environment of their child with food allergies, but it’s more difficult outside the home, especially at school. Pediatricians are often asked by parents about how to tell their children about their food allergies and how to manage those allergies when their children are alone.

There is no perfect advice, but experts say multidisciplinary effort, proactive measures and self-sufficiency on the part of the child are all important parts of an allergy management plan.

“Once a child goes to school and the parents cannot supervise him or control what the child eats, there is concern that he may be accidentally exposed to one of his allergens, especially in young children who can 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-age children in the United States have life-threatening food allergies,1 But the study results show that many teachers and schools are not knowledgeable enough about conditions such as asthma and allergy treatment to treat them properly.2 Better team and school-wide plans can help,3 especially since many children with food allergies report high levels of anxiety.4

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

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

“Families are very concerned about how their children will react,” said Jonathan Spergel, MD, PhD, allergy program leader and 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, ‘No, there’s no table without milk or school without milk. “”

Peanut allergies have received a lot of attention and some schools have created policies to segregate 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 allergic children from their non-allergic peers can cause more harm.

“We tell families that as long as they’re eating their own food, they’re fine,” Spergel said. This places a great responsibility on the child, but parents and pediatricians need to educate them about their allergy, how to manage it, and how to avoid their allergens. Simply being at the table with children who consume the allergen, or even touching it, will not cause a reaction. As long as kids know how to be careful not to ingest certain foods, it’s okay for them to sit with friends during mealtimes.

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

Birthday parties or class parties are usually the biggest concern, 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 candy.

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

Who should be told about 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 may also 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 medication available at school.

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

Parents should be encouraged to ask questions about existing policies, when and where children will eat, where emergency medication is kept and who is able to administer it, Hernandez-Trujillo said. If parents are having trouble creating or enforcing a school allergy and anaphylaxis plan, 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 doesn’t usually recommend such a drastic step. It is perfectly acceptable, however, for clinicians to speak to the school on behalf of the student and the parents.

Parents should be encouraged to contact resources such as the Allergy & Asthma Network or Kids With Food Allergies to get an idea of ​​the 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. Management of food allergies 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 about asthma, food allergies and anaphylaxis: assessment of elementary school teachers, parents/caregivers asthmatics 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 survey of parents’ and children’s 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. Ratings of self-reported anxiety in children with and without food allergies and teachers’ knowledge of food allergies. J Sch Health. 2022;92(6):541-549. Accessed June 23, 2022. doi:10.1111/josh.13181

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