The management of food allergy in child care centers and schools is a sensitive and often controversial topic, for which evidence-based guidance is needed. Across jurisdictions, there is considerable variability in the policies and procedures used to manage the risk of allergic reactions.
Researchers from McMaster University recently developed a practice guideline for the prevention and management of allergic reactions to food at child care centres and schools. The guidelines were published in the Journal of Allergy and Clinical Immunology on May 01, 2021.
These guidelines provide evidence-informed recommendations to help policymakers determine optimal strategies for managing food allergy in child care cent/ers, primary/elementary schools, middle/junior high schools, and secondary/high schools. The guidelines are intended to be international in scope.
These guidelines were developed by an international panel of key stakeholders, including 22 health professionals, school personnel, and parents, with support from a methodology team. They conducted systematic literature reviews of the anticipated health effects of selected interventions for managing food allergy in child care centers and schools, considering their costs, feasibility, acceptability, and effects on health equity.
The international panel recommend,
1. "We suggest that child care centers and schools implement training for teachers and other personnel in the prevention, recognition, and treatment of allergic reactions to food.
2. We suggest that child care centers and schools require all parents of students with diagnosed food allergy to provide an up-to-date allergy action plan.
3. We suggest that child care centers and schools implement site-wide protocols for the management of suspected allergic reactions to food in individuals with no allergy action plans on file.
4. We suggest that child care and school personnel use epinephrine only when they suspect that someone is experiencing anaphylaxis, rather than use epinephrine as the first universal treatment for all suspected allergic reactions.
5. We suggest that child care and school personnel do not preemptively administer epinephrine in cases when no signs or symptoms of an allergic reaction have developed, even if a student has eaten a food to which they have a known allergy or history of anaphylaxis.
6. When laws permit, we suggest that child care centers and schools stock unassigned epinephrine autoinjectors on-site, instead of requiring students with an allergy to submit personal autoinjectors to be stored on-site for designated at-school use.
7. We suggest that child care centers and schools do not prohibit specific foods site-wide.
8. We suggest that child care centers and schools do not establish allergen-restricted zones, except in the special circumstances identified in the full guidelines."
These recommendations were graded as "conditional" due to a lack of high-quality evidence. However, in many cases, current policies and practices at schools and child care centers may not be supported by the best available evidence.
The authors concluded, "More research is needed to determine with greater certainty which interventions are likely to be the most beneficial. Policymakers might need to adapt the recommendations to fit local circumstances."
For additional recommendations and implementation on special circumstances, see the full guidelines.