Dealing with food allergies is a daily stress for many kids and their families; increasingly, it comes as no surprise that this same stress is shared by schools across the country.  The burden of food allergy is now estimated to affect 4%-6% of US children.  Somehow, this potentially life threatening issue – for still mysterious and unclear reasons – has managed to increase prevalence and disrupt many lives.

Checking labels, carrying emergency medicine and worrying that an inadvertent ingestion may lead to serious reaction poses constant challenges for many people – patients, parents, caregivers, friends, friends’ parents, school staff, school nurses, principals, school volunteers, bus drivers, restaurant workers, flight attendants, and on and on…

Schools obviously play a particularly large role in maintaining a safe environment.  It is a responsibility best managed with team work.  Partnerships between schools, students, families and medical providers must be solid and well communicated; however, even with the best of intentions the task is gigantic. Congress recognized the importance of managing food allergies in 2011 when it passed the FDA Food Safety Modernization Act to improve food safety; in Section 112, the act required development of guidelines for helping schools to better manage food allergy risk and reaction.

While these voluntary guidelines provide schools an excellent outline for managing this burden, they are just the beginning.  Confusingly, though with good intentions, there are now multiple food allergy guidelines; for example, to name a few, consider that there are:  the CDC Voluntary Guidelines for Managing Food Allergies in Schools in 2013 (developed as a result of the US Congress FDA Food Safety Modernization Act); the State of Illinois Food Allergy Guidelines in 2010; guidelines developed and published by groups of associations like the National Association of Secondary School Principals, the National Association of School Nurses and the National School Boards Association; and there are specific practice parameters for the treatment of anaphylaxis developed and updated periodically by a Joint Task Force comprised of members from the American Academy of Allergy, Asthma & Immunology, the American College of Allergy, Asthma and Immunology and the Joint Council on Allergy, Asthma and Immunology.

These guidelines are necessary and are of great help; however, distilling all of this information into an effective policy for a specific school or school district can be overwhelming, particularly when a school is also tasked with addressing and dealing with other serious issues in their students like diabetes mellitus, obesity, asthma, disaster preparation, violence in schools, vision and eye health (to name but a few).

It is not surprising perhaps to find that academic studies have previously documented deficiencies in school preparedness when dealing with food allergy (1).  Specifically, studies find teachers and principals are not well informed about food allergy and anaphylaxis and that much work needs to be done to effectively and adequately implement food allergy education and policy (2,3).

Guidelines are necessary and helpful when dealing with a prevalent and dangerous issue like food allergy in our schools, but simply having a policy is not enough.   The critical next step is to ensure that these well-conceived parameters are effectively implemented and integrated into day-to-day school life.  I would argue (and studies seem to support) that this next step falls short for many schools.  It is an issue well worth working to improve.

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• Portnoy et al. Managing School Allergies in Schools. Curr Allergy Asthma Rep. 2014 Oct;14(10):467
• Ercan et al. Primary school teachers’ knowledge about and attitudes toward anaphylaxis. Pediatr Allergy Immunol. 2012: 23: 428–432
• Polloni et al. What do school personnel know, think and feel about food allergies? Clin Transl Allergy. 2013 Nov 25;3(1):39