Schools everywhere are lining up for peanuts

• Banning peanuts from schools does not reduce the risk of food allergy reactions. In a study of 567 food allergy reactions in a Canadian pediatric cohort, 4.9% of reactions occurred in “peanut-free” schools compared to 3% in schools that allow peanut foods. Authors warned about a false sense of security when foods are banned.¹
• Banning peanuts does not reduce the use of epinephrine in schools. According to a study of schools in Massachusetts, schools with policies that restricted peanut foods from being brought from home, served in the school cafeteria or in the classroom did not reduce the use of epinephrine to treat food allergy reactions compared to schools that did not have peanut-free policies.²
• Experts do not recommend bans to manage food allergies. According to guidance on the role of the allergist in school food allergy management, there is no evidence that supports bans as a way to reduce the risk of reactions. They also can increase the burden on schools and students, while creating a false sense of security. Finally, they are impractical when multiple allergenic foods are banned.³

References
[1] Cherkaoui S., B. M. (2015). Accidental exposures to peanut in a large cohort of Canadian children with peanut allergy. Clinical and Translational Allergy.
[2] Bartnikas L., H. M. (2017). Impact of school peanut-free policies on epinephrine administration. J Allergy Clin Immunol, 467-473.
[3] Wang J., B. T. (2018). The Allergist’s Role in Anaphylaxis and Food Allergy Management in the School and Childcare Setting. JACI-In Practice, 427-435.

• A study of 30 peanut allergic children who smelled peanut butter for 10 minutes resulted in zero reactions. Skin contact in this study also resulted in zero life-threatening reactions; redness and irritation occurred for some where the peanut butter touched the skin.¹
• Further research found washing hands with soap and water, and using common household cleaners on surfaces, can remove peanut proteins to mitigate cross contact.²
• More recently, allergists documented their practices of placing peanut butter in close proximity to peanut allergic patients to show them just being near peanut foods does not cause anaphylaxis. Similarly, they applied peanut butter to the skin of allergic patients. In the article, the clinicians reported none of their patients has experienced a systemic reaction and only one had a hive at the site of application.³

References
[1] Simonte S, M. S. (2003). Relevance of casual contact with peanut butter in children with peanut allergy. J Allergy Clin Immunology, 180-182.
[2] Perry T, e. a. (2004). Distribution of peanut allergen in the environment. J of Clin Immunology, 973-976.
[3] Dinakar C., S. J. (2016). The transforming power of proximity food challenges. Annals of Allergy, Asthma & Immunol, 135-137.

1. Start with the experts — refer to the CDC’s Voluntary Guidelines for Managing Food Allergies in Schools and Early Child Education.¹
2. Focus on training — everyone who provides oversight, care and services for a food-allergic student should be trained on identifying symptoms of a reaction and how to respond. That means foodservice, teachers, bus drivers and after-school staff, plus any others with direct student supervision.
3. Be prepared for reactions — as the evidence proves, nothing completely prevents reactions from happening. Be sure every food-allergic student has an emergency anaphylaxis plan, access to emergency medication and that everyone knows what to do in case of an allergic reaction.
4. Create a supportive community — communicate your food allergy management plans early and often with parents and stakeholders. Let them know you take allergies seriously and that you are “allergy aware.”
5. Consider allergen-safe tables in cafeterias since they did reduce the risk of epinephrine use in one study.²

References
[1] https://www.cdc.gov/healthyschools/foodallergies/ pdf/20_316712-A_FA_guide_508tag.pdf
[2] Bartnikas L., H. M. (2017). Impact of school peanut-free policies on epinephrine administration. J Allergy Clin Immunol, 467-473.

Only about 15% of K-12 schools ban any specific food. The most-used practice to manage food allergies is providing allergen-safe zones on campus, such as food-free classrooms or a nut-free table in the cafeteria.¹

Reference
[1] Management of Food Allergies in Schools

• Banning peanuts from schools does not reduce the risk of food allergy reactions.
• Food bans take the focus off education and on enforcement. Being “allergen-free” gives a false sense of security. Allergic children and school officials can become lax about the precautions needed, potentially increasing the risk for allergic reactions.
  In a study of 567 food allergy reactions in a Canadian pediatric cohort, 4.9% of reactions occurred in “peanut-free” schools compared to 3% in schools that allow peanut foods. The study authors warned about a false sense of security when foods are banned.¹
• Banning peanuts does not reduce the use of epinephrine in schools. According to a study of schools in Massachusetts, schools with policies that restricted peanut foods from being brought from home, served in the school cafeteria or consumed in the classroom did not reduce the use of epinephrine to treat food allergy reactions compared to schools that did not have peanut-free policies.²

References
[1] Cherkaoui S., B. M. (2015). Accidental exposures to peanut in a large cohort of Canadian children with peanut allergy. Clinical and Translational Allergy.
[2] Bartnikas L., H. M. (2017). Impact of school peanut-free policies on epinephrine administration. J Allergy Clin Immunol, 467-473.

• It is estimated about 4% of teens and adults and 5% of children have food allergies, with less than 1% of Americans allergic to peanuts. Estimating the number of people with food allergies in the United States is a challenge, which means current estimates are just that — the best approximations of the numbers of people with food allergies.
• According to the National Academies of Sciences, Engineering and Medicine’s Committee on Food Allergies report Finding a Pathway to Safety’s Key Messages, “there is no estimate of true prevalence of food allergy in the U.S.”¹

References
[1] National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee on Food Allergies. (2017). National Academies Press. Retrieved from National Academies Press; https://www.nap.edu/resource/23658/Food-Allergies-message.pdf

There are many expert resources available to help you manage food allergies in schools:

• CDC’s Voluntary Guidelines for Managing Food Allergies in Schools and Early Child Education 
• School Nutrition Association’s Food Allergy Resource Center
• Food Allergy Management & Education (FAME) Toolkit from St. Louis Children’s Hospital

1. Start with the experts — refer to the CDC’s Voluntary Guidelines for Managing Food Allergies in Schools and Early Child Education.¹
2. Focus on training — everyone who provides oversight, care and services for a food-allergic student should be trained in identifying symptoms of a reaction and how to respond. That means foodservice, teachers, bus drivers and after-school staff, plus any others with direct student supervision.
3. Be prepared for reactions — as the evidence proves, nothing completely prevents reactions from happening. Be sure every food-allergic student has an emergency anaphylaxis plan, access to emergency medication and everyone knows what to do in case of an allergic reaction.
4. Create a supportive community — communicate your food allergy management plans early and often with parents and stakeholders. Let them know you take allergies seriously and that you are “allergy aware.”
5. Consider allergen-safe tables in cafeterias — as they did reduce the risk of epinephrine use in one study.²

References
[1] https://www.cdc.gov/healthyschools/foodallergies/pdf/20_316712-A_FA_guide_508tag.pdf
[2] Bartnikas L., H. M. (2017). Impact of school peanut-free policies on epinephrine administration. J Allergy Clin Immunol, 467-473.

The United States Department of Agriculture (USDA) requires a student whose allergies are determined, as a result of an evaluation by a qualified healthcare provider, to have a physical or mental impairment that substantially limits one or more major life activity, such as breathing, will qualify for coverage under Section 504 of the Rehabilitation Act. Section 504 is the primary law governing accommodations for those with disabilities in the educational setting. Since food allergy reactions have the potential to substantially limit the major life activity of breathing, even if a student has never had an anaphylactic reaction, these students still can qualify under Section 504. Schools still can be required to provide reasonable accommodations for food allergic students who are evaluated as being eligible for Section 504.

Section 504 accommodations are meant to ensure equal access for students. Examples of accommodations that can help ensure equal access to education for students with food allergies include:

• Ensuring access to non-allergenic foods during times when foods are being provided to all students.
• Designating “allergen-aware” tables in the cafeteria where the top eight allergens are not allowed.
• Creating “food-free” classrooms and shared spaces, such as computer rooms and libraries, where food is not allowed, thus reducing the risk of accidental ingestion.

The USDA provides guidance for accommodating children with special dietary needs in the school nutrition program.

• Research shows casual contact presents an extremely low risk for anaphylaxis. A study of 30 peanut allergic children who smelled peanut butter for 10 minutes resulted in zero reactions. Skin contact in this study also resulted in zero life-threatening reactions; redness and irritation occurred for some where peanut butter touched the skin. ¹
• Further research found washing hands with soap and water, and using common household cleaners on surfaces, can remove peanut proteins to mitigate cross contact.²
• More recently, allergists documented their practices of placing peanut butter near peanut allergic patients to show them just being near peanut foods does not cause anaphylaxis. Similarly, they applied peanut butter to the skin of allergic patients. In the article, the clinicians reported none of their patients experienced a systemic reaction and only one had a hive at the site of application.³

References
[1] Simonte S, M. S. (2003). Relevance of casual contact with peanut butter in children with peanut allergy. J Allergy Clin Immunology, 180-182.
[2] Perry T, e. a. (2004). Distribution of peanut allergen in the environment. J of Clin Immunology, 973-976.
[3] Dinakar C., S. J. (2016). The transforming power of proximity food challenges. Annals of Allergy, Asthma & Immunol, 135-137.

• The 2013 School Access to Emergency Epinephrine Law incentivizes schools to have epinephrine injectors available in the school in case of a severe allergy attack. Some states are moving in this direction. For more information on managing food allergies in your child’s school, contact the school district to find out more about the status in your state.
• Everyone on the education/care team should be trained to administer epinephrine, the only medication approved for treating anaphylaxis, a potentially life-threatening allergic reaction, in an emergency situation. 

• Some parents, nurses, school boards, administrators or others may advocate for banning a particular food from school menus; however, the Section 504 Committee need not do that if other accommodations can be made to allow students with food allergies equal access to educational opportunities. Furthermore, this approach is not medically necessary.
• Food bans take the focus off education and onto enforcement when all resources are needed to provide education. Claiming to be “allergen-free” gives food-allergic students a false sense of security. Allergic children and school officials can become lax about the precautions needed, potentially increasing the risk for allergic reactions.
• Instead, it is recommended schools model their food allergy management programs after the CDC Voluntary Guidelines for Managing Food Allergies in Schools and Early Child Education.