FOOD ALLERGIC PATIENTS IN THE SCHOOL SETTING
by Richard D Bloom MD, Sandwich School District Physician Consultant
Food allergy in the school setting is a controversial subject and delineating what is best for all involved is an ongoing learning process. As the Sandwich School district physician, I have been asked for my recommendation regarding allergen guidelines. I am pleased with the current Food Allergy Awareness Statement and Epinephrine Administration Guidelines. The Sandwich healthcare team currently outlines the history of individual students and their food allergies as well as the measures to take in the event of an allergic emergency.
Many guidelines are clear and have already been instituted. The main controversy involves food bans and allergy free tables and cafeterias. Of note, food bans are difficult to institute and often non allergic students/parents do not comply. Additionally, the vast variety of food allergens that can result in severe allergic reactions makes instituting multiple food bans untenable, i.e. restriction of all tree nuts, mushrooms, tomatoes, strawberries, eggs and milk, etc. It is unrealistic to view any school setting as allergen free, hence most protocols are aimed at minimizing exposures. Despite marked advances in science (skin and blood tests can now accurately test for IgE mediated immune responses to food antigens), there is still a lack of consensus when creating school policy. In fact, school policy/protocol may vary widely from district to district.
So what is clear in terms of guidelines?
- students who have a food allergy should be identified and documented by the school
- a written emergency action plan should be in place for managing food reactions during the school day
- epinephrine must be readily available – and staff must have knowledge of proper indications and techniques for administration, if they are agreeable and trained – and in the vast majority of cases, epinephrine will be administered by the school nurse
- schools should be prepared to handle allergic reactions involving any student (recent studies have indicated that 22% of anaphylactic reactions occur in non-diagnosed children)
- all school staff should be educated on identifying early signs and symptoms of anaphylaxis
- a written individualized student healthcare plan should be in place outlining prevention and proactive management for students in all school settings – this is done by the school nurse
- an emergency action plan should be formulated by the student’s physician with parental input to take into account the child’s history – and made available for staff during after school activities and or class trips
In most cases compromise solutions can be reached, i.e. food allergy free tables for very young students; ensuring good ventilation in cooking areas to prevent exposures to any fumes; good hand washing practices; and education stressing the dangers of sharing foods and snacks. It is unrealistic to police student lunch bags and to expect total compliance with food bans. The fact that there are multiple potential food allergens complicates the issue of banning foods. It is important to educate students, families and school staff about the dangers of food allergies and the importance of avoidance measures as well as rapid treatment with accidental exposures. School nurses are able to administer epinephrine but it is still important to educate teachers and coaches as well because time is of the essence for treatment of anaphylaxis. It is also essential for any student requiring an EpiPen injection to proceed to the nearest emergency room due to the risk of protracted anaphylaxis. With further advances in science, additional guidelines should evolve to help best keep our children safe.
You can view and download Dr. Bloom’s explanation here: Dr. Bloom article, final draft