Dr. David Stukus, pediatric asthma and allergy specialist at Nationwide Children’s Hospital and member of the Asthma and Allergy Foundation of America’s Medical Scientific Council, recently wrote an editorial on the findings of the study, Impact of school peanut-free policies on epinephrine administration. This is a summary of his article. Read his full editorial for more information.

About 4 to 8 percent of children in the United States have at least one food allergy. About 1 to 2 percent of these children are allergic to peanuts. A food allergy can sometimes cause a life-threatening reaction called anaphylaxis (anna-fih-LACK-sis). There is no cure for food allergies. Avoiding the food completely is the only way to manage an allergy.

Among food allergens, peanuts are one of the more common causes of anaphylaxis. Epinephrine (eh-pi-NEH-frin) is the medicine used to treat this severe reaction. This can cause a lot of stress for parents of children with a peanut allergy, especially when they send them school. A lot of schools create peanut-free tables in their cafeterias to better monitor students.

A recent study on peanut-free policies in schools found that schools with peanut-free policies actually had higher epinephrine use for the treatment of anaphylaxis caused by peanuts and tree nuts.¹ But, schools with peanut-free tables in the cafeteria had lower epinephrine use. Middle schools and high schools with peanut-free classrooms also had lower rates, which was not seen in elementary schools.

Why Do Peanut-Free Schools Have Higher Epinephrine Use?

More studies need to be done to find out why schools with peanut-free policies have higher epinephrine use. Here are some possible reasons why:

• Children accidently bring foods with peanuts in them to school. To be truly “peanut free,” school staff would have to look at every food item brought in to check for peanuts. This would need to occur every single day, for every child, and would be impossible for schools. Parents of children without food allergies may not know how to read labels. This means they might send in food with peanuts by mistake. In fact, one of the children in this study with a known walnut allergy had a reaction to a cookie he brought from his own home that contained walnuts.
• The school staff might have a false sense of security. Because they have peanut-free policies, school staff may not check food for peanuts as often. They may feel their policy lowers risk. They may also let down their guard and have lower suspicion for a food allergy reaction when a student starts to complain of symptoms.

How Can Schools Reduce the Risk of Severe Reactions?

Many schools currently focus on allergen-free policies. But it might be best for them to focus on awareness and training of their school staff. Better reporting might also help them track areas where they could better manage food allergies.

Allergists have a great chance to work with both parents and schools when it comes to food allergy management. If your child has a food allergy, be sure you work with your child’s allergist and school to create a food allergy treatment plan. Make sure your child’s school staff and teachers understand how to act if your child has a severe allergic reaction. And ask your child’s allergist for help when creating a 504 plan.

Schools will need to make policies based on their situations. They should think about building layout, schedules, number of students and more when deciding on policies. What might work for one school, might not work for another.

This study offers some helpful information. But until we know more, parents and schools should work together on awareness and education of food allergy management.

Visit our school planning page to learn ways to keep students with food allergies safe at school.

Medical Review September 2017.

References
1. Bartnikas, L., Huffaker, M., Sheehan, W., Kanchongkittiphon, W., Petty, C., & Leibowitz, R. et al. (2017). Impact of school peanut-free policies on epinephrine administration. Retrieved 20 September 2017