Introduction:

Over the past two to three decades, the global prevalence of food allergies has surged, leading to an increase in food-induced anaphylaxis and subsequent emergency department visits. This phenomenon predominantly affects children, with 2% to 8% of children estimated to have confirmed or probable food allergies which equates to 1–2 children per average-sized classroom. This article aims to provide laypeople, including teachers and school staff, with insights into the current landscape of food allergies in schools and offers guidance to ensure the physical and psychological safety of children with food allergies.

Current Landscape of Food Allergy in Schools:

Food-allergy training for teachers varies globally, with some countries having national guidance while others lack consistent policies. Teachers often resort to self-directed learning due to inconsistent training, leading to varied levels of knowledge and confidence in handling food allergies. The article highlights a decrease in knowledge retention over time, emphasising the need for ongoing education and training for teachers.

Ensuring Physical and Psychological Safety:

An estimated 8% to 18% of all food-induced anaphylaxis occurs in school settings, making it crucial for schools to be well-prepared to handle allergic reactions. Adrenalin, the primary medication for anaphylaxis, is more commonly used in schools, but underutilisation remains a concern. To enhance physical safety, individual health plans are recommended, providing essential information about a child’s allergies, emergency contacts, and treatment procedures. Additionally, a shared decision-making model is encouraged between families and teachers to promote psychological safety and inclusivity.

Challenges and Risks:

Children with food allergies face not only physical risks but also experience poor health-related quality of life and food-allergy-related anxiety. Bullying is a significant concern, with 23–45% of these children reporting incidents, including serious threats. The article emphasizes the need for zero-tolerance policies against food-allergy bullying and the importance of open communication between families and teachers.

Guidance for Schools:

All children have the right to education. Some jurisdictions consider food allergy a disability requiring accommodation. The article stresses the importance of ongoing education for teachers, awareness of the location of adrenalin autoinjectors and the development of individual health plans for children with food allergies. Clear communication between healthcare providers, families and teachers is crucial for timely updates on a child’s allergy status. See our allergies in schools policy and action plans.

Physical Safety Measures:

Prevention and immediate treatment of allergic reactions are key components of physical safety. Ongoing evidence-based education for teachers, awareness of adrenalin autoinjector locations, and the availability of individual health plans contribute to minimising risks. The article also discusses the potential cost-effective use of stock adrenalin in schools.

Psychological Safety Measures:

A shared decision-making model between families and teachers is proposed to foster open communication about food-allergy management. The article addresses the common issue of food-allergy bullying in schools and advocates for zero-tolerance policies to ensure the safety and well-being of children with food allergies.

Conclusion

Managing food allergies in schools is a complex and inconsistent challenge influenced by external factors. However, there is critical need for safe food-allergy management and immediate access to adrenalin autoinjectors in the school environment. Adopting a shared decision-making approach prioritising physical and psychological safety is essential for creating an inclusive and secure school community for children with food allergies.

To all parents, teachers and school nurses, please participate in our survey so we can develop strategies to best assist you with allergy awareness, training and the implementation of good strategies for all schools. See survey here>>

Ref. Current Allergy & Clinical Immunology Journal of the Allergy Society of South Africa Vol 36, No 4 December 2023