A new set of guidelines from an international team of allergy experts says that in general, schools shouldn’t ban foods like nuts and other allergens as a way to prevent serious allergic reactions in children.
“We don’t have good evidence that these bans do anything to decrease food allergic reactions within the school context,” said Dr. Susan Waserman, an allergist, clinical immunologist and professor of medicine at McMaster University, who was lead author on the guidelines published Wednesday in the Journal of Allergy and Clinical Immunology.
Such bans are never enforced perfectly, and there have been documented cases of children encountering and reacting to the banned substance at school, the guideline document notes. Such bans can also single out the child with allergies, making them vulnerable to bullying by classmates.
Instead, these guidelines emphasize things like maintaining a stock of epinephrine injectors (eg. EpiPens) available for any student who needs one, creating personalized allergy management plans for children, and providing training to staff on how to manage serious allergic reactions – including making sure they quickly deliver epinephrine in all suspected cases of anaphylaxis.
The non-binding guidelines are endorsed by organizations like the U.S. Allergy and Asthma Network, the Canadian Society of Allergy and Clinical Immunology, and the World Allergy Organization.
Canada’s current guidelines, published on the Food Allergy Canada website, also emphasize training staff and making sure that children with allergies have emergency plans.
The new guidelines represent the best available evidence on how to manage food allergies at schools and child-care settings, Waserman said, adding she hopes that they will be used as a starting point for discussions about food allergies in schools — and for further research on the issue.
Allergists have been advocating for these sorts of measures for years, said Dr. Anne Ellis, professor and chair of the Division of Allergy at Queen’s University.
She says it’s important to make sure schools have some training and allergy action plans – and that staff are not afraid to actually use the EpiPen.
Around 500,000 Canadian children have food allergies, according to Food Allergy Canada. These kids’ parents can be nervous about sending their kids to school, where they might come into contact with foods that trigger severe allergic reactions, said Lisa Galloway, a Grade 5 and 6 teacher in Kamloops, B.C. who is also a co-author of the guidelines.
She said she tries hard to make sure both the parents and students are comfortable with the situation.
“I think the biggest thing for me is because I teach grades 5 and 6, it’s getting those children used to being around those allergens and making them aware of what they can and cannot put in their mouth, what they should and shouldn’t touch, surfaces-wise,” Galloway said.
“And then also making the other students aware that there is a potential life-threatening allergy in our classroom and to be sensitive to that.”
Schools can also take practical measures to minimize allergic exposure, such as watching the children during mealtimes, wiping down surfaces as needed, and even stocking up on allergy-free snacks so kids don’t feel left out of bake sales, she said.
And in situations where kids are too little to understand what they should and shouldn’t eat, or are otherwise unable to keep themselves safe, some kind of blanket ban might still be appropriate, according to the guidelines.
When it comes to school food restrictions, Ellis hopes that parents take some comfort in these guidelines.
“A lot of schools implement that, ‘We’re a peanut-free school,’ because it’s the easiest thing to do,” she said.
“I think it’s helpful, particularly for patients and family members of children with a food allergy to know that you don’t have to feel like you’re hard-done-by because your school doesn’t have these things. There’s actually not a lot of evidence to support that a milk-free table, for example, is going to give you one hundred per cent reassurance about accidental exposure at schools.”
Galloway also thinks that children with food allergies have to be taught to manage them safely.
“We need to start preparing them for a world where they’re in a high school and things are not being monitored the same way they are in an elementary setting, where they could be exposed to the allergen and they have to know how to deal with it and how to manage it,” she said.