The Food Allergy team at MassGeneral Hospital for Children answers common concerns about food allergies and school.
Food Allergies and School: Frequently Asked Questions
Q: Where do most school reactions occur?
A: Reactions during the school day most often occur in the classroom when food is brought in outside of structured meals, but they may occur anywhere, including off campus or before/ after regular school hours.
Q: What should I expect the school to do?
A: Create a team of people (e.g. school nurse, principal, teacher, food service) to work with you and your student to establish a prevention plan that is in accordance with federal and local laws and does not exclude the student from school activities because of their food allergy.
Ensure that the school staff understands and knows how to respond to suspected reactions (including the use of and indications for epinephrine) and support/reinforce prevention strategies.
Review policies and procedures with staff and families if reactions occur with the goal to prevent recurrences.
Q: What should I do?
A: In addition to the familyʼs responsibility along with the medical provider to maintain current medications and an action plan, parents can teach their children some very important safety lessons.
Parents of children with food allergies should:
Children with food allergies should be taught from an early age to:
Q: Should my school have a "nut-free" policy? Should my child sit at a "nut-free" table?
A: The responsibility of your childʼs school is to create a safe environment by establishing thoughtful measures aimed at both prevention of and response to accidental reactions. These measures need to be individually suited to the affected students and appropriate for the resources of the school. They should also aim toward equal participation in the classroom for everyone.
Allergen-free facilities, classrooms or tables are often implemented, but they are not sufficient, not individualized and may be stigmatizing. They can also be unnecessarily divisive. Schools and families should ideally work together, along with the familyʼs medical providers.
Policies should be primarily focused on:
Q: Is my child in danger if she gets an offending food on her skin or smells the food?
A: The greatest risk by far for a dangerous accidental reaction is from accidental ingestion. Skin contact will likely cause local reactions, and airborne particles (not simply the odor) may induce significant reactions, but the primary risk is from ingestion. Allergen on intact skin, unless that leads to contamination of something that is ingested, is not likely to cause any systemic symptoms.
Thoroughly cleaning hands, eating surfaces and food preparation materials is an important part of effective prevention.
Q: Should my child carry an epinephrine autoinjector with them to all of their classes?
A: Readily available treatment is fundamental to an effective action plan and it may be appropriate for a child to carry their emergency medications depending on their developmental level.
Q: Is it ok if the epinephrine is locked up in the nurseʼs office? Does the epinephrine need to be in the classroom? Should the teacher know how to administer?
A: No, it is very important the emergency medication be readily available. It may be appropriate for medication to be centrally located, but care should be taken to minimize potential barriers to timely treatment. Storage in locked cabinets should not be used.