As many as 1 in 10 children have food allergies that can lead to severe allergic reactions, including anaphylaxis. That's a critical reason why schools and child care providers must be prepared to manage these types of medical emergencies.
"Right now, 1 in 15 schools experience a case of anaphylaxis each year. That can be a scary and potentially devastating scenario without a predetermined plan in place on how to respond," said
Scott H. Sicherer, MD, FAAP, lead author of a newly updated clinical report, written by the AAP Section on Allergy and Immunology and the AAP Council on School Health.
The report, "Management of Food Allergy in Schools," replaces a 2010 report and incorporates the latest relevant national guidelines and laws. It is published in September 2025,
Pediatrics.
Coordinated care for students with food allergies
The management of food allergies requires a coordination of care that includes the pediatrician, the school nurse, parents, and other caregivers in the child's life, according to the AAP.
"Getting an appropriate diagnosis of food allergy is the first step," said
Sonja O'Leary, MD, FAAP, co-author of the report. "But there are many cases where the child has never had an allergic reaction before. It is important for schools to be prepared for any emergency due to allergy."
The AAP provides instructions on prescribing epinephrine devices for anaphylaxis management and recommendations on stocking epinephrine in schools, which may vary according to state and federal laws.
Although any food may trigger an allergic reaction, the most serious reactions are attributable to peanut, tree nuts, milk, egg, soy, wheat, fish, shellfish, and sesame.
The report describes symptoms of anaphylaxis, including the onset of hives, itching or flushing skin within minutes or a few hours of exposure to an allergen; trouble breathing or wheezing; dizziness or fainting.
The emotional impact food allergies can have
The AAP also discusses the social and emotional impact of allergies on children, who may experience anxiety, teasing or bullying. Students should be encouraged to report bullying, and anti-bullying programs can be implemented. General education about food allergies for students and staff may promote peer support, according to AAP.
"While awareness about allergies has increased over the years, a child's safety really depends on a team approach—in which school staff are trained and emergency supplies are on hand in case of a severe allergic reaction," Dr. Sicherer said. "There are a number of actions everyone can take to reduce risks of allergic reactions, as well. Your pediatrician can help provide that information."
Clinical reports created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.
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