Survey of school nurses underscores dire need to develop more feasible food allergy policies

Nearly all school nurses participating in a national survey (96 percent) reported that staff at their school received training on handling severe allergic reactions to food. Over 80 percent asserted that their school had an emergency epinephrine auto-injector on hand to stop a potentially life-threatening allergic reaction. The study findings, published in the Annals of Allergy, Asthma and Immunology, also underscore the dire need for these policies, with over one-third of the school nurses reporting at least one severe allergic reaction to food at their school in the last academic year.

"We were encouraged to see high rates of epinephrine availability in schools," says senior author Ruchi Gupta, MD, MPH, from Ann & Robert H. Lurie Children's Hospital of Chicago, who also is an Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine. "This is significant improvement over the last decade. We also saw that epinephrine was available more often when schools had full-time nurses. Greater nurse presence appears to be an important factor in implementing food allergy policies in schools."

Food allergy occurs in up to 8 percent of children in the U.S., and up to two students in every classroom may be affected.

Currently, no standardized food allergy protocols exist for schools. However there are evidence-based resources such as the Centers for Disease Control and Prevention (CDC) Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs and the online toolkit from the National Association of School Nurses.

The survey revealed that among the least implemented policies were labeling of school lunch items with allergen information (31 percent), specific food policies for after-school activities (29 percent) and having emergency epinephrine that travels with groups during activities outside of school (28 percent).

"Listing allergen information on foods sold during lunch at school is critical to protect kids with food allergy from accidental ingestion. The top eight allergens, including peanut, tree nuts, milk, eggs, shellfish, finfish, soy and wheat, must be listed clearly on all food products," says Dr. Gupta. "We also know from previous studies that up to 19 percent of life-threatening allergic reactions to food during the school day may occur outside of the school building or on field trips. Given this high risk, we need to promote the availability of emergency epinephrine to keep children with food allergies safe during these situations."

The survey included 242 respondents, representing schools from all regions of the U.S. The majority were nurses who worked at a public school (88 percent), primarily at an elementary or middle school (90 percent).

"Future research needs to examine the effectiveness of specific policies in improving the safety of children with food allergies during the school day," says Dr. Gupta. "With one in three nurses reporting an allergic reaction in the past year, we need to continue working together with families and schools to develop feasible policies that protect children with food allergies."​