Ensuring kids with food allergy are safe at school and daycare is a goal of every parent, educator, and allergist no matter where they live.
Last week, suggested global recommendations were released to help local communities develop guidelines on how to manage food allergy in schools and childcare centres. Among them, a focus on education, individualized student plans, and having stock epinephrine available (i.e., epinephrine auto-injectors that are not prescribed to anyone and can be used in an emergency). The intent of the practice guidelines was to review the scientific literature on food allergy management in schools and childcare settings. As noted by the authors: “due to the lack of high-quality evidence available in the literature, the recommendations are rated “conditional” and policymakers are encouraged to adapt the guidance to fit their local circumstances.” Additionally, the authors call for more research to determine with greater certainty which interventions would be the most beneficial.
In some parts of the world, these recommendations are welcome concepts. In Canada – where food allergy affects more than a half million children – some of them are already in practice, backed by legislation in certain provinces including Ontario and Alberta.
Of the 8 recommendations in the publication, it is the language around removal of food “bans” that has generated the most discussion. Food restrictions may be merited in certain situations. Food Allergy Canada’s position on this issue has not changed. The organization continues to support this risk minimization measure as one possible element of a comprehensive policy. The most important factor to consider when contemplating food restrictions is the developmental readiness of children, and if the risk of exposure can be safely managed when food is part of the environment. The suggested global recommendations also support food restrictions in these circumstances despite what current conversations might suggest. Alternatively, when food restrictions are poorly implemented or unnecessary it can create isolation and stigma, impacting quality of life for affected students. The goal is to create inclusion and not division.
The foundation to managing food allergy in schools and childcare centres is based in education and access to epinephrine. Education means recognizing that food allergy is a serious medical condition that can be managed, knowing how to prevent anaphylactic reactions, and treating them appropriately with epinephrine if they happen. Access to epinephrine is crucial to ensuring there is treatment readily available when required.
The release of the publication should serve as a prompt for meaningful discussions. Schools and childcare centres can evaluate current practices and policies and how they could be enhanced. A comprehensive approach includes education and training to ensure staff and the community understand the basics of food allergy and anaphylaxis; an allergy plan for all impacted staff and students; a risk management strategy that looks at mitigating the risk of exposure; and access to epinephrine so reactions can be treated swiftly. These settings could also consider keeping current health and safety measures being used to limit the spread of COVID-19, like handwashing before and after eating, not sharing food/drinks, and the cleaning of surfaces. While these measures are intended to curb infection, they help reduce the risk of allergic reactions and should be considered part of an overall risk management strategy.
The food allergy community deserves the highest quality research to inform evidence-based guidelines for this area, similar to any other medical problem. There is also an opportunity to go beyond policy discussions on safety and look to educating future generations on food allergy as a mechanism to improve quality of life and inclusion. While parents of children with food allergy are responsible for safely managing their child’s allergy, with the responsibility shifting as their child matures, they rely on the knowledge and support of the broader community to manage confidently.
Schools have a significant role to play in educating on food allergy. Through our education system, food allergy can be a part of the healthy eating conversations in classrooms, equipping the next generation of children to develop broad-based knowledge on food allergy and how to support its management. This will ensure everyone has a seat at the table.
Jennifer Gerdts is Executive Director of Food Allergy Canada and Dr. Susan Waserman is a lead author of Prevention and management of allergic reactions to food and in child care centers and schools: Practice guidelinesTags: School, School policies