Helping Families Manage Food Allergy in Schools

Tips and Tools for the Allergist and Nonallergist

Matthew J. Greenhawt, MD, MBA


July 25, 2011

In This Article


This discussion has reviewed some of the considerations that clinicians (allergist or nonallergist) should remember when advising the food-allergic family about attending school or child care.

Following are some important summary points to consider in counseling food-allergic patients in your practice.

Kids with food allergy, even severe food allergy, can and do safely attend school every day. This is the goal that we all must work to achieve through effective school policies as well as community and school education.

Food allergic students of every age must be provided with a current emergency action plan that is updated each year, and keep epinephrine at school. Providers must strongly encourage parents to make sure that the school or child care center has both the plan and the emergency medication in its possession and knows how to use the drug in the event of an emergency. Parents should take the initiative to ensure that the center or school can execute the steps of the action plan. If necessary, parents must also take the responsibility to train staff in recognizing a reaction and using self-injectable epinephrine. Clinicians must ensure that parents of food-allergic children have been trained to do this and must be available to help schools and centers in need of training.

Restrictive policies that are not backed with evidence of need and efficacy (eg, allergen-detecting animals, forced washing of the face and rinsing the mouth before entering the classroom) should not be encouraged. However, strategies like handwashing after food contact, not sharing food, and being aware of children's dietary restrictions when planning craft projects or class celebrations are effective and minimally disruptive to both the food-allergic child and unaffected children.

The frustration that may be expressed by parents of unaffected children should not be dismissed by those who are affected by food allergy, just as the fear and anxiety that may be experienced by the family of those with food allergies also need to be taken into account by those who are unaffected. This is not a “zero-sum” game, and both sides have the right to express their feelings as long as the dialogue fosters a productive debate that leads to a mutually satisfactory solution.

Efforts should be focused on common-sense approaches stressing empathy, understanding, and a sense of a communal effort to protect students both with and without food allergy. It is important for school communities to work aggressively to reach a compromise that allows children just to be children and to attend school normally. Both allergists and nonallergists need to be strong community advocates for their food-allergic patients and help to facilitate this process.

I thank Dr. Todd Green (Children's Hospital of Pittsburgh), Dr. Michael Pistiner (Children's Hospital of Boston), and Ms. Lynda Mitchell (President, Kids with Food Allergies Foundation) for their assistance and contributions to this article.


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