Allergy Resources for Schools

Food Allergies in Schools

Parents of peanut allergic children need their children to be protected from a potentially serious – even fatal – reaction. Many other parents, and often school nutrition professionals as well, count on peanut butter as an affordable, shelf-stable, nutritious option that they know most children will eat.

Balancing those needs within a school nutrition program that addresses food allergies in schools requires a comprehensive, evidence-based plan that is communicated fully and with compassion.

About 2% of school-aged children is the U.S. may have a peanut allergy. Protecting students with a food allergy is a much broader issue than just peanuts though. According to the National Institute of Allergy and Infectious Diseases (NIAID), about 4 percent of American adults and about 5 percent of American children have a food allergy. Allergies can be caused by more than 170 foods, but nearly 90 percent of food allergies are caused by nine foods: milk, eggs, peanuts, tree nuts (almonds, walnuts, pecans, cashews, pistachios, etc.), fish, shellfish, wheat, soy, and sesame. Any food allergy could result in a serious reaction so any food allergy management plan should not be focused on one food alone.

Food Bans in Schools are NOT Medically Necessary

In fact, with the number of common foods which can cause a food allergy reaction, schools already serve common food allergens every day without incident. Food bans, especially the banning of one food only, takes the focus off of education and onto enforcement. Being ‘allergen-free’ can give a false sense of security and unfortunately may lead to an increased risk for allergic reactions or a delay in responding appropriately in the unfortunate event of an allergic reaction. One study actually showed a higher incidence (4.9% of reactions) in ‘peanut-free’ schools compared to schools which allowed peanut foods (3% of reactions). ⁽¹⁾ Another study of schools in Massachusetts found that restricting peanut foods from being brought from home or served in the cafeteria or classrooms did not reduce the use of epinephrine to treat food allergy reactions compared to schools that did not have peanut-free policies. ⁽²⁾

Best Practices to Manage Food Allergies in Schools

Start with the experts:

• CDC’s Voluntary Guidelines for how to Manage Food Allergies in Schools and Early Child Education [https://www.cdc.gov/healthyschools/foodallergies/pdf/20_316712-A_FA_guide_508tag.pdf]
• Managing Peanut Allergies: A Resource for Parents, Educators and Others Who Care for Children [https://peanutallergyfacts.org/for-schools/]
• School Nutrition Association – Food Allergies: Plan, Don’t Ban [https://schoolnutrition.org/resources/featured-resources/food-allergies/]
• Food Allergy & Anaphylaxis Connection Team: Food Allergies & Schools [https://www.foodallergyawareness.org/education/food-allergies-schools/]

General Guidelines to Consider:

• Utilize the 504 Plan. Focus on training – everyone who provides oversight, care, and services for a food-allergic student should know the student’s confirmed allergies, how to identify symptoms of an allergic reaction, and how to respond quickly and appropriately to an allergic reaction.
• All 50 states allow schools to stock undesignated epinephrine to use for an anaphylactic reaction. ⁽³⁾
• Casual contact presents an extremely low risk for anaphylaxis. A study of 30 peanut allergic children who smelled peanut butter for 10 minutes resulted in NO reactions. Skin contact in this same study resulted in NO life-threatening reactions although redness and irritation occurred for some where the peanut butter was on the skin. ⁽⁴⁾ More recently, allergists documented their practice of placing peanut butter in close proximity to peanut allergic patients to show them that being near peanuts does not cause anaphylaxis. They also applied peanut butter directly to the allergic patients’ skin which resulted in NO systemic reactions and only one patient with a hive at the application site. ⁽⁵⁾
• Hand washing with soap and water (not hand sanitizer) and cleaning surfaces with common cleaners effectively removes proteins which cause allergic reactions to avoid cross-contact. ⁽⁶⁾
• Prevent cross contact in the cafeteria by:
  • Thoroughly cleaning and sanitizing all utensils, equipment and preparation surfaces before and between uses.
  • Consider using separate utensils for allergenic foods.
  • Consider preparing allergen-containing foods – like a PB&J – last.
  • Use visible labels on all bulk and packaged foods to identify common food allergens.
  • Clean dining tables with common cleaners before and between each usage.
  • Consider allergen-free tables in the cafeteria for younger children.
• Communication is key! Remember, parents of food-allergic children just want peace of mind that there is an effective and evidence-based plan for food allergies in schools to keep their child safe.