May 25, 2021
Children with food allergies often require diligent monitoring and a restricted diet to reduce allergic attacks, but there is little evidence available to support so-called "food bans" at schools and childcare centers.
Instead, a new practice guideline published earlier this month in the Journal of Allergy and Clinical Immunology calls for better allergy management training for staff as well as increased epinephrine availability in educational environments. The guidelines were developed by an international panel of clinicians, school personnel, and parents.
The Guidance at a Glance
Rather than creating site-wide food prohibitions on nuts, dairy, and other allergenic foods, the practice guidance recommends centers and schools use "common-sense approaches" to reduce allergic reaction risk among school-aged children. According to the guideline authors, these strategies could include promoting handwashing, providing adult supervision during snacks and meals, and cleaning surfaces where food is either eaten or prepared.
Additionally, the new evidence-based guidance calls for schools and childcare centers to teach school personnel to recognize, prevent, and respond appropriately to food-related allergic reactions when they do occur.The guidance also recommends that educational institutions require from parents an up-to-date allergy 'action plan' designed for their children with allergies. These action plans can be integrated into the training of teachers and nurses to help manage potential allergic reactions.
Moreover, the guidance suggests schools should keep unassigned epinephrine autoinjectors in stock, both on site and even when traveling, where laws permit, rather than requiring students with allergies to bring in their own autoinjectors. Ultimately, this represents a more proactive approach to treating anaphylaxis, particularly in settings where treatment is urgently needed, such as when students are away from campus and participating in a school-designated trip or event.
Jennifer A. Dantzer, MD, MHS, allergist-immunologist and assistant professor of pediatrics at Johns Hopkins School of Medicine, Baltimore, Maryland, told Medscape Medical News via email that the practice guidelines offer an important starting point for ensuring quality of life of students, parents, and other school personnel.
While the Centers for Disease Control and Prevention published voluntary guidance for managing food allergies in schools back in 2013, there has since "been a lack of universal policies and procedures to manage the risk of allergic reactions in schools," explained Dantzer. "The new guidelines are a good first step of using available evidence and all the key stakeholders, clinicians, school personnel, and families, to figure out the best way to keep children with food allergies safe at school."
Dantzer wasn't involved in the creation of the new practice guidelines, but she shared how her clinical experience reinforces the need for the evidence-based recommendations. "Every single week we talk with families, both in clinic and in our research studies, about living with food allergies, and we recognize that every child is different," she said. "We constantly work to advocate for each individual child with food allergies."
Pediatric allergist Malika Gupta, MBBS, MD, told Medscape via email that the guidelines could assist in the creation of new nationwide policies for food allergy management at schools. "Also, the guidelines are labeled 'conditional,' which gives policymakers the ability to adapt to their specific circumstances and individuals as well as make modifications according to regional trends," she added.
Gupta, a clinical assistant professor in the Division of Allergy and Clinical Immunology at the University of Michigan in Ann Arbor, echoed the guideline panel's sentiments regarding food bans, explaining that prohibiting certain foods could lend a "false sense of security" and could also "promote bullying and a sense of isolation for the food-allergic child." In spite of the lack of evidence supporting food bans, Gupta noted that these bans can give families a sense of control and security. Ideally, more research should be performed to determine whether food bans actually work, she added.
In addition to promoting the new guidelines, allergists and pediatricians can also implement proactive allergy reaction mitigation strategies that work with school systems, according to Gupta. "In clinic, we ensure all families have food allergy action plans for school and current epinephrine auto-injectors," she said. "We also often have our food allergy nurses educate schools when food allergy awareness is a concern."
Many of the 25 authors of the food allergy guidelines disclosed relevant financial relationships. The full list is with the original article. According to a footnote within the guidelines, "Panel members who were deemed to have a real, perceived, or potential conflict of interest were asked to abstain from voting on recommendations related to that interest."