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Introduction
Around the globe, food allergies are a growing concern. Parents of children with food
allergies have a higher responsibility of keeping their children safe. The threat of those suffering
from food allergies becomes intensely more severe outside of the home, especially in larger
bodies of people. There are many reasons why parents are concerned about sending their
children with food allergies to school; is the staff trained and are the facilities safe, will it be an
issue socially for them, and will their child be mindful about their eating habits?
Parental Concerns
“The relationship of parental confidence in managing food allergy to the severity of food
allergy and to the foods involved has been found to be different to previous research
Each parent has the obligation to create the best and secure atmosphere for their children.
Some parents face more trying difficulties in establishing a place for the children to roam free or
participate in activities or events with others. It can hinder the life that they were hoping for their
child. Some of the concerns for mothers of children facing an allergy and transitioning to school
in the study by Sanagavarapu, Said, and Katelaris concluded that, “Overall, there was a
heightened sense of vulnerability, lack of trust, unfamiliarity, anxiety, fear of the unknown and
loss of control for mothers during their child’s transition to school, presumably associated with
their perceptions of increased risks of food allergies and diminished adult supervision in schools.
Furthermore, mothers had a myriad of concerns, not only relating to their child’s safety, but also
Running Head: CONCERNS FOR STUDENTS WITH FOOD ALLERGIES IN SCHOOL 3
in relation to other parents’ negative attitudes towards food allergies and normalizing their
Exposure to food allergies in school can be very dangerous for some children. Sadly,
there isn’t a cure for food allergies. To begin the process of alleviating parents’ concerns, parents
must have an accurate diagnosis from a medical professional before placing their child in school.
Along with that diagnosis, parents should have a note outlining the specific details/symptoms of
the particular allergy and pre and post safety precautions. (Portnoy & Jodi Shroba, 2014)
Despite a school’s effort to create a safe environment, parents can still feel a sense of
anxiety. Schools may ban nuts or try to create a nut-free environment, however, 85 percent of
fatalities caused by major food allergy reaction happen outside of the home. (Sanagavarapu,
Said, Katelaris, & Wainstein, 2016). The hazards to children safety grow substantially when
Sanitization
Proper sanitization is crucial in all of the areas that the children work, play and is
especially vital in developing areas to promote a nontoxic atmosphere for children. Any allergen
removal is necessary, especially when working with food. Students prefer to eat with their peers
and the food provided by the school. Food handlers need to follow the important protocol when
it comes to food preparation. If an allergy is made known, either the food needs to be omitted
completely or food handlers need to wash their hands, place new gloves on and sanitize the area
that might be affected by the allergen. By both sanitizing the food preparation areas and safe
For some students, exposure to their allergy from the eating area can be problematic.
Their peers might bring food from home and residue might be left on the table. Children might
also share their food with their peers and unknowingly cause another child to become very ill.
Over time, school has been able to able to operate their communal eating habits with their
students. Children bring their lunch to school or they purchase their lunch. Social eating habits
are a part of life and sharing is an element of those eating habits that has been fostered since
youth. The challenge can be monitoring the children and not prohibiting their interaction.
“Childhood, it should be noted, is the most intensively governed period of human life (Rose,
Depending on the child with the allergic reaction, exposure reactions can vary. There is a
study that 30 children with confirmed peanut-allergies had peanut butter applied directly to their
skin in a double-blind, placebo-controlled method. Out of all of the children, not a single
participant had a universal response. Three of the participants experienced erythema on the
located spot. The conclusions were verified in another established study. This study found that
children who were skin-reactive and had a confirmed oral issue to peanuts, had application of
peanut butter to their skin for 15 minutes and had not experienced any cutaneous reaction.
Nurse’s responsibility
The American of Pediatrics worked with Food Allergy and Anaphylaxis Network of
2010, approving that children with food allergies should have a personalized health plan. The
plan should include a written emergency plan for students when their allergy has been
compromised. The school nurse is responsible for being aware and maintaining for these plans
Running Head: CONCERNS FOR STUDENTS WITH FOOD ALLERGIES IN SCHOOL 5
for the students. “[This is action is supported] by the National Association of School Nurses
(2001) Emergency Care Plan (ECP) Position Statement released in 2004, addressing children
with special health care needs, whereas it is the responsibility of the health care provider to
prescribe the specific treatment supported by the American College of Allergy, Asthma, and
Asthma and Immunology’s (AAAAI, 2002) Position Statement addressed the use of epinephrine
in the treatment of anaphylaxis.” (Robinson and Ficca, 2012) With the individualized health plan,
there are special considerations that outreach the use of epinephrine, and the school or district
severe threat to attending school. Confirmation from Radioallergosorbet testing (RAST) proved
that she was allergic to wheat, dairy, eggs, blueberries, cranberries, shellfish, beef, peanuts, and
shellfish. Prior to Alison’s attendance at school, a meeting was held to ensure her safety and to
initiate the IHP (Individualized Health Plan). Included in the personalized plan, her parents will
be included in any school trips in addition to the invited chaperone. If the parents are not able to
attend, another person will be educated on the necessary plans to protect Alison.
The nurse is the coordinator of the classroom management of safety and wellbeing. The
nurse is also in contact with the students’ physicians. The physician is the approving head of the
individualized health plan for the student that the nurse will be in charge of. Additionally, the
nurse will be the facilitator of information for faculty and staff, and any other person who will be
Teacher training
Despite all of the effort made by the assigned nurse and the attention to detail given in the
classroom management of securing a nut-free or allergy free environment, the allergy cannot be
interesting to note what other countries are doing to keep their students safe.
“It is now mandatory for all school teachers in Victoria and Western Australia who have
and emergency treatment of food allergy and anaphylaxis. The training is available in
both face-to-face and online modes, although the former is preferred by the Australasian
Society of Clinical Immunology and Allergy (ASCIA) and Anaphylaxis Australia Inc.
settings in Australia and New Zealand, at no cost. It is Volume 37 Number 2 June 2012
developed by the ASCIA, in liaison with the Western Australian and New South Wales
(NSW) health departments, and will be of help to educators before completing face-to-
Parents should have some of their worries resolved knowing that there is the proper
EpiPen
There have been a lot of advances in the world of food allergies. Governments and school
administrations have taken great lengths in the protection of students. In addition to teacher
training for adverse reactions to a food allergy, students who are old enough can be educated on
the proper procedure and care of carrying their own EpiPen. Self-administration should be the
first action when a student is having an allergic reaction. After the EpiPen has been administered,
Running Head: CONCERNS FOR STUDENTS WITH FOOD ALLERGIES IN SCHOOL 7
medical attention should be made known after the incident. It can be problematic if no adherence
“A survey of 109 school districts in Massachusetts from September 2001 to August 2003
found that epinephrine had been administered 115 times and that 24 % of the time, it was
school bus, or during field trips. The average time from onset of symptoms to treatment
Fortunately, this and other studies provided for the School Access to Emergency
Epinephrine Act. Due to the President signing this Act, the schools individual states should
accommodate and have some sort of “stock,” of epinephrine. However, despite the progress,
only 43% have reported that they have the injectors on hand, and it seems to be less with the
Even with the all of the physical maintenance of keeping schools safe, there is a worry
about the social and emotional ramifications that are associated with a food allergy. This life
altering existence can prove difficult in social scenes in every age. Several teens have found that
having a food allergy is difficult socially, and are bullied for their unfortunate circumstance.
Another study found that among 251 families with children ages 8 to 17 being treated at
Mount Sinai’s Food Allergy Institute, “31.5% of the children and 24.7% of the parents reported
bullying specifically due to [food allergies], frequently including threats with foods, primarily by
Schools can create a ban of certain foods; most commonly is a peanut and tree-nut free
space. However, there are some pros and cons to this ban. In an adapted table from Young MC
looks at the pros and cons of banning peanuts and tree nuts. On the con side, it notes that it gives
a false sense of security and that the schools should be preparing students for the real world. It
lists some of the pros of a peanut and tree-nut ban being that young children cannot hold the
responsibility of proper care for their allergy and that this could be a community approach to
safety.
Lastly, it mentions that on the pro side that with a ban, it is difficult to control school
bullying; assuming that banning certain foods will eliminate the possibility of bullying. The
challenge for the educator would have to be keeping the issue of the food allergy confidential.
However, there might be issues of not informing classmates and parents of the allergy if they
From preschool to high school, bullying is a major concern and can be quite a
predicament for parents, educators and administrators. Acceptance is the hope in the classroom,
but there are always various causes for students to feel isolated or excluded from activities.
“Bullying behaviors include ‘direct bullying’ such as verbal abuse or physical aggression,
scapegoat. ‘Cyber bullying’ is a relatively new phenomenon that includes threatening behaviors
and behaviors that are meant to embarrass or socially exclude someone through e-mail, cell
phone or text messages, Twitter, Facebook, and Internet sites. The actual number of kids who are
bullied is uncertain, but it is clear that children with food allergies are not immune to bullying
Running Head: CONCERNS FOR STUDENTS WITH FOOD ALLERGIES IN SCHOOL 9
behavior. Bullying behaviors in the school setting should be addressed directly with school
officials, as many schools have anti-bullying policies. In addition, parents need to be aware of
There are several methods and practices of prevention for all types of bullying that
teachers can establish in the classroom. Michael E. Bratsis mentions that an educator can assess
bullying situations or behavior with an anonymous survey. Students can give the details of when
and where these unfortunate situations are occurring or what maltreatment students are facing,
without fear by anonymously sharing. Bullying is a real threat to students and can sometimes
“A Duke University Medical Center study reveals that the effects of bullying can linger
into adulthood (Copeland et al.2013). Bullied kids and teens were more likely to have anxiety
problems, panic disorder, and suicidal thoughts as adults, the study said.” (Bratsis, M. E. 2013)
In the teenage mind, being accepted and a part of their peer group is a huge factor. For
some teens who deal with food allergies, being accepted is more important than the adverse
reaction to their allergy. This of course is preposterous when facing a life or death situation, but
most teenagers try to include their inner circles in their more serious allergy.
“In one study of food-allergic adolescents and young adults, more than half of the
adolescents reported trying a food that they knew contained a known allergen. In another study, a
majority of teens reported checking food labels only on “new” foods and routinely trying foods
that likely contain food allergens. Teens and college-aged students report trying food allergens
It can be a struggle for teenagers to feel a part of their classmates when facing an allergy.
Students often struggle to carry an EpiPen even knowing the dangers. Attending school, dances,
Running Head: CONCERNS FOR STUDENTS WITH FOOD ALLERGIES IN SCHOOL 10
sport competitions, and clothing can be reasons for teenagers to believe that carrying their
emergency medication is a hassle. However, in most situations, teenagers will report to most of
the people in their circles of their restrictions. Typically, a teenager will inform their teachers,
There are several intervention programs that are implemented in the school system, but
reduce bullying and victimization found that in general, school-based programs are effective as
duration and increased intensity being most effective.” (Egan, & Sicherer, 2016)
Although there are instances of bullies attacking children with food allergies, there isn’t
much factual evidence to show how many are being affected and at what lengths. Intervention
programs maybe the best route for educators, but there is still more that needs to be done.
In an evaluation with a group of patients to assess the patterns of bullying for food
At 1-year follow up, 69% of children with food allergies continued to be bullied. Actions
were taken by 65% of parents who were aware of the bullying. Actions included
contacting the child’s principal (49%), teacher (47%), offender and their parents (14%),
and addressing bullying with school personnel and their own children (19%). Parental
action to address bullying was associated with a 2.10 increased odds of bullying cessation
(P < 0.01), while mere parental knowledge was not associated with resolution. (Egan, et
al., 2016)
Parents might not always be cognizant of their child’s bullying in connection to their food
allergy, "…as evidenced by only 50% of surveyed parents being aware of bullying that was
Running Head: CONCERNS FOR STUDENTS WITH FOOD ALLERGIES IN SCHOOL 11
occurring by child report. This highlights the need for physicians to discuss bullying with both
the child and parent at medical visits; indeed, parental knowledge and action to address bullying
are associated with resolution and an improvement in quality of life.” (Egan et alt., 2016)
Summary
Parents are the warriors of their children’s success and overall wellbeing. When it comes
to food allergies, there are many concerns that parents face. Parents want to ensure that there is
an outlined Individualized Health Plan for the school nurse. The school nurse should be
educating faculty and staff on the safety and well-being of the students who have an
individualized health plan. Teachers should be educated and not isolating the students who suffer
from food allergies. It is questionable to fully know if banning all types of food is better for the
children in school and giving their parents a piece of mind, or is does it create a false sense of
safety in that the children will not be experiencing in the real world? In other attempts to
promote food safety with food allergies, some schools report to keep an EpiPen. Older students
might carry an EpiPen and might properly know how to administer it. Some students might feel
pressured to try foods that they are allergic to and not willing to carry the EpiPen. Students with
food allergies can also become the victims of bullying. There is not much evidence that
demonstrates how many students are affected by bullies or what types of management programs
are specifically linked to aid such instances. Parents need to be mindful that bullying can become
an issue and that they need to have an open discussion about it with their children.
Running Head: CONCERNS FOR STUDENTS WITH FOOD ALLERGIES IN SCHOOL 12
References
Bratsis, M. E. (2013). Preventing Bullying at Your School. Science Teacher, 80(6), 80.
Dean, Jennifer. Fenton, Nancy E. Shannon, Sara. Elliot, Susuan J. Clarke, Ann (2015) Disclosing
food allergy status in schools: health-related stigma among school children in Ontario,34-52.
doi: 10.1111/hsc.12244
Egan, M., & Sicherer, S. (2016). Doctor, my child is bullied: food allergy management in
doi:10.1097/ACI.0000000000000269
Knibbl, R.C., Barnes, C., Stalker, C., (2015) Parental confidence in managing food allergy:
development and validation of the food allergy self-efficacy scale for parents (FASE-P).1681-
Mudd, Kim. Wood, Robert A. (2011) Managing Food Allergies in Schools and Camps, 471–480
doi: 10.1016/j.pcl.2011.02.009
Portnoy, Jay M., Shroba, Jodi (2014) Managing Food Allergies in Schools. 1-7. doi:
10.1007/s11882-014-0467-z
Robinson, Joanne M. Ficca, Michelle. (2012) Managing the Student With Severe Food Allergies.
Rousa, Trevor, Hunt. (2004).Governing peanuts: the regulation of the social bodies of children
Sanagavarapu, P. (2012). Don't forget to pack my EpiPen® please: What issues does food
allergy present for children's starting school?. Australasian Journal Of Early Childhood, 37(2),
56-61.
Running Head: CONCERNS FOR STUDENTS WITH FOOD ALLERGIES IN SCHOOL 13
Sanagavarapu, P., Said, M., Katelaris, C., & Wainstein, B. (2016). Transition to school anxiety
for mothers of children with food allergy: Implications for educators. Australasian Journal Of