Managing food allergy in school and camp environments involves creating an individualized plan that addresses safety, and supports growth and development of the food-allergic child. The result is a dynamic strategy that meets the needs of a food-allergic child and promotes the development of a food-allergic adolescent.
Managing food allergies in schools and camps involves a community approach. The goal is to create a safe environment that still allows for maximal growth and development of the food-allergic child. The process involves building a supportive structure based on education and planning and then dismantling the more restrictive components through constant revision. The product is an individualized strategy that not only meets the needs of a food-allergic child but also supports the development of a food-allergic adolescent.
The preschool-aged food-allergic child
By the time the child reaches preschool age, most families and caregivers have a constructed a significant protective structure around their food-allergic child to prevent food exposures at home, and to a lesser extent at the homes of family and friends. The thought of sending a food-allergic child to preschool or day camp without their carefully orchestrated plans is daunting to most parents. Families are very anxious about the child’s safety although the level of anxiety is not necessarily related to the severity of previous reactions, the need to treat with epinephrine, or a food allergy–related hospital admission. Despite the fact that many families of food-allergic children would prefer a food-free (or at least, allergen-free) preschool situation, a realistic goal is to create a safe environment. The key is to implement the necessary structure and restrictions to balance safety with a situation that allows for growth and development. The structure should include both preventive strategies and food allergy emergency treatment plans. The preventive plans may include more restrictive techniques such as peanut-free policies and/or allergen-free tables. The level of restriction should reflect the personality and the developmental stage of the food-allergic child.
Preschool-aged children are prone developmentally to food sharing and messy eating behaviors. Many exhibit hand-to-mouth activities, all of which put them at risk for inadvertent ingestion exposures. Creating a safe environment for preschool-aged food-allergic children starts with prevention techniques, such as appropriate avoidance measures, proper cleaning techniques, and a “No Food Sharing” policy. Most of the avoidance effort should focus on preventing allergen ingestion because the largest “risk” to any food-allergic individual is actually consuming an allergenic food. Details of avoidance measures including label reading and prevention of cross-contamination are discussed in detail elsewhere in this issue in the article by Kim and Sicherer. In general, any food consumed by a food-allergic child needs to be pre-approved or provided by the family of the food-allergic child, or checked by a caregiver well versed in food label reading and preparation. A shared cookie can circumvent all of the layers of pre-approval and planning, necessitating a “No Food Sharing” policy. This policy ideally should include all children, not only the food-allergic child. Planning also should include a contingency plan for impromptu “special treats” that may appear in a classroom at birthdays as well as the potential consumption of “nonfood items.” For example, there is wheat in molding clay and egg in certain finger paints, and preschool-aged children may ingest these “nonfood items” during an art project.
Proper cleaning is another important part of the prevention strategy. Cleaning policies should reflect the evidence-based research on allergen removal. Food allergens can be effectively removed from eating surfaces with household cleaners such as soap and water, sanitizing wipes, and spray cleaners, using usual cleaning techniques. Allergens can also be removed from hands using soap and water or wipes. Therefore, foods can be prepared and served in a safe manner using proper cleaning and hand-washing procedures. It is noteworthy that hand sanitizers such as antibacterial gels are not effective at removing allergens, which means that for the purpose of “allergy cleaning,” use of hand sanitizer is not an acceptable alternative to hand washing. Areas where children eat or play with must be properly cleaned before and after eating, and proper hand washing needs to be enforced.
Creating a safe environment also includes having people and plans to recognize a food-allergic reaction and initiate a treatment plan. In the event of a food allergy reaction, everyone responsible for the food-allergic child needs to be able to respond appropriately. Written food allergy emergency treatment plans include specific instructions on symptom recognition and treatment. Because it is not possible to predict the severity of a reaction based on a previous reaction, it is prudent to prepare for a severe event. As shown in Fig. 1 , a Food Allergy Action Plan lists potential symptoms matched with appropriate treatment including medications, doses, and monitoring plans.
Many preschool programs choose to implement “Peanut-Free” or “Peanut/Tree Nut-Free” policies. These food bans take several different forms, from allergen-safe tables in the cafeteria to school-wide, food-specific bans. There is evidence that school-wide “peanut-free guidelines” are successful in decreasing the amount of peanut present in lunches brought from home, but it is not clear that the allergen-free guidelines actually result in fewer allergen exposures. There is no agreement on the effectiveness or need for food bans ( Table 1 ). In general, food bans and allergen-free seating may be helpful in preschool and early elementary school children, but are generally not necessary in upper elementary school-aged children.
| PRO | CON |
|---|---|
| “Loaded Gun” argument: reduce the chance of exposure | “No peanut detectors” to enforce food bans |
| Young children cannot bear responsibility of avoiding allergens | Causes an undue burden on children without a peanut allergy |
| Food contamination of shared equipment resulting in contact exposures | “Slippery Slope” argument: if you ban peanuts, why not ban other allergy foods |
| Food sharing is a common behavior in children | “False Sense of Security” argument |
| School bullying difficult to control | Schools should prepare students for the “real world” |
| “Community responsibility” approach to safety | Feelings of divisiveness |
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