Management of food allergies in schools: a perspective for allergists

Epidemiologic studies indicate that food allergy has increased among school-aged children and now affects approximately 1 in 25. Food allergy and other triggers of anaphylaxis pose considerable challenges in the school setting. The cornerstones of management include methods to prevent relevant exposure to allergens and plans to recognize and treat allergic reactions and anaphylaxis. Numerous studies have identified gaps in the implementation of procedures to address these simple tenets. Guidelines and policies have been proposed from various stakeholders to improve the safety and management of schoolchildren with food allergy and anaphylaxis. However, there remain knowledge gaps that preclude suggesting definitive evidence-based guidelines to approach all aspects of management. The allergist plays a key role in guiding families, schools, administrators, and policymakers in developing meaningful plans to improve the safety of the school setting for children with food allergies and anaphylaxis. We review literature that is relevant to key elements that can assist the allergist in addressing patient- and school-specific issues. We additionally focus on areas of current controversy, provide information about available resources, and highlight areas in need of further study.