Helping Families Manage Food Allergy in Schools

Tips and Tools for the Allergist and Nonallergist

Matthew J. Greenhawt, MD, MBA

Disclosures

July 25, 2011

In This Article

School Policies and Strategies

What Are Some Examples of Effective Strategies and Policies for the Classroom of Child Care Center?

Very often, the healthcare provider caring for the food-allergic child is placed in a position to make recommendations to the school or child care center that have potential policy implications that affect not only the patient but also the other children in the classroom. Unfortunately, there is a lack of established evidence to support many of the recommendations. Instead, “expert opinion” of the allergist or treating clinician is relied on, and this is highly problematic because many providers are not familiar with the evidence or properly trained to make such recommendations (this applies to both allergists and nonallergists).

Specific examples of commonly recommended policies include the following:

  • Make a classroom or facility allergen-free (eg, “nut-free” or peanut-free);

  • Require handwashing after food contact;

  • Use special tables with certain food restrictions (eg, “nut” or peanut-free tables);

  • Place restrictions on sharing of food;

  • Restrict use of food items for school projects and celebrations; and

  • Establish policies that isolate the food-allergic child to a separate area of the facility at mealtime.

Despite widespread use of such policies, there is little if any established evidence to support their efficacy.[4] This is particularly the case for making a classroom or facility allergen-free (which is typically done for peanuts and/or tree nuts). Although schools sometimes have policies on peanuts or tree nuts, 1 study found that, despite such measures, more than 19% reported that a reaction still occurred at the facility.[6] This highlights single-allergen exclusion strategies as both potentially ineffective due to lack of enforcement and a contributor to a false sense of security. Furthermore, this strategy can be a point of contention between parents of food-allergic and non-food-allergic children.

Although evidence for the effectiveness of such strategies as handwashing, cleaning common surfaces, not sharing food, not using food for class projects or celebrations, and making separate seating available in the eating area is debatable or lacking, they are generally viewed as less contentious and have little effect on the lives of unaffected students.[4]

In general, when asked to intervene and make school or child care recommendations, it is highly advisable to place the least amount of restriction as possible on other children while offering adequate protection for the allergic child. Requests are often parent-specific and based on the parents' perception of need and familiarity with the facility. Some parents do not know what to ask for and thus it is incumbent on the professional to be familiar with the evidence.

Parents should be encouraged to meet with the school or facility and, if necessary, school district officials to explore their particular situation. A “1-size- fits-all” strategy, such as a state guideline, may not be available or appropriate. For example, restrictions for small children may be unnecessary for older children. Parents should also be encouraged to attempt to reach out to other parents in the classroom to help facilitate cooperation.

At present, 13 states (Arizona, Connecticut, Illinois, Maryland, Massachusetts, Mississippi, Missouri, New Jersey, New York, Tennessee, Vermont, Washington, and West Virginia) have centralized guidelines for managing food-allergic students, making the process easier for everyone involved. (Texas and Pennsylvania also recently approved measures, but a bill for these measures was rejected in Florida).[14] Guidelines serve to unify the approach to management and provide the legal basis of a mandate for particular accommodations.

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