Q&A: Doctors can help prepare a safe school environment for food-allergic kids

As children with food allergies return to class this fall, families and their doctors need to work with teachers and school nurses to ensure safe learning environments, according to a presentation during the Global Food Allergy Summit.

Sally Schoessler, MSEd, BSN, RN, AE-C, director of education with Allergy & Asthma Network, discussed this collaboration during the virtual meeting. We spoke with her to find out more about what doctors need to know to improve this partnership and prevent dangerous allergic reactions.

Healio: During your presentation, you said that one in 12 students has a food allergy. Could you break down these numbers by specific types of allergies that students may be experiencing?

Sally Schoessler

Schoessler: The most common food allergies are peanut (2.2%), milk (1.9%), shellfish (1.3%), tree nut (1.2%), eggs (0.9%) and fish (0.6%). Of children with food allergies, 39.9% are allergic to multiple foods.

Healio: You also said that there are between 150 and 200 fatalities a year due to food allergies. What are the most prevalent drivers behind the fatalities in these cases?

Schoessler: It’s my understanding that most deaths occur when there is a delay in the administration of epinephrine – a lifesaving emergency medication.

Healio: What is the difference between allergen-free and allergen-safe environments, and why are allergen-safe environments preferable?

Schoessler: When you say “allergen-free,” you say that there will be no allergens present. In the school environment, with so many people and so many things present, that’s virtually impossible to promise. “Allergen-safe” means that staff is aware of allergens and is working to create a safe environment for the student with an allergy.

There’s been evidence that exposures to allergens actually go up when people are attempting to make an environment “allergen-free,” because people assume there are no allergens present. In an “allergen-safe” environment, everyone remains vigilant in looking at ingredients and allergens.

Healio: You have cited the importance of the partnership between families, schools and doctors in creating these allergen-safe environments. Could you discuss the doctor’s specific role and responsibilities in this relationship?

Schoessler: A strong partnership between the family, the medical provider and the school creates a circle of care with the student’s needs at the center. The school nurse is in an ideal position to coordinate care between home, the medical home and the school.

When looking specifically at the doctor’s role, there are several important components. The doctor should provide a statement identifying the student’s food allergens so food substitutions can be offered through the school’s food service department.

Also, medical orders for any medications and treatments should be provided as well as an anaphylaxis emergency care plan to guide any necessary emergency response. The American Academy of Pediatrics has a template for that emergency plan to help guide the physician.

Healio: What other kinds of resources should doctors provide to families and schools to prevent adverse events and minimize risks?

Schoessler: Doctors and school nurses can provide information to school staff related to the signs and symptoms of an allergic reaction and the importance of prevention.

Prevention strategies include the avoidance of food allergens and education for both the student with the food allergy as well as other students and staff to reduce the risk of an allergen exposure. Allergy & Asthma Network has free posters with signs and symptoms as well as common food allergens to help schools care for students with food allergies.

Healio: What is an individualized healthcare plan, and what role do doctors play in drafting it?

Schoessler: An individualized healthcare plan, or IHP, is a nursing document that is written in nursing language to guide nursing care. The registered professional school nurse develops the IHP based on assessment information as well as on the doctor’s medical orders.

Healio: What is an emergency action or emergency care plan, and what role do doctors play in drafting it?

Schoessler: The emergency action or emergency care plan should come from the doctor. It outlines an appropriate emergency response to guide school staff in the event that the child experiences anaphylaxis, which is a life-threatening allergic reaction. The American Academy of Pediatrics has an excellent template for doctors to help them develop a quality, comprehensive plan.

Healio: What kinds of additional education should doctors provide to families and schools?

Schoessler: The doctor and the school nurse can work together to assess educational needs for families in schools. The doctor can provide one-on-one education for families at medical appointments as well as provide an in-service educational presentation for school staff or school nurses. If a school does not have a school nurse, the doctor can help to advocate to provide that level of care on a daily basis and can teach school staff how to administer an epinephrine autoinjector as needed.

Healio: When an emergency does occur at school, what should doctors do during the emergency, and how best should doctors follow up with care?

Schoessler: With an emergency care plan in place, the doctor has outlined the appropriate response for the emergency at school. If epinephrine is administered, the student should be transported to the emergency room for further evaluation and care. The hospital and family should follow up with the doctor as soon as possible to evaluate the student’s condition and ongoing health needs.

Healio: Do you have any other advice for how doctors can best initiate or continue this partnership with families and schools?

Schoessler: I think it's really important for the doctor, family and school to work together and build bridges between them to provide the best care possible for a student with a food allergy.

One really important aspect of care is to be sure that a school has access to stock epinephrine for emergency use. Almost every state has a law that allows for stock epinephrine, but it is not always implemented. One of the big stumbling blocks is that a prescriber’s prescription is needed to have a stock of epinephrine in the school. The physician can advocate for the implementation of stock epinephrine and can provide that prescription to obtain this lifesaving medication.

Healio: Where can doctors go for more information?

Schoessler: Allergy Asthma Network has great resources for both physicians and schools at allergyasthmanetwork.org including:

• Signs and Symptoms of an Allergic Reaction
• Anaphylaxis at a Glance
• Understanding Anaphylaxis
• Epinephrine Treatments Poster

The American Academy of Pediatrics has a really useful template for an emergency plan for school.

The CDC provides voluntary guidelines for schools and early education care providers on food allergy management.

St. Louis Children's Hospital also provides a wonderful resource called FAME, which stands for Food Allergy Management and Education.

Finally, allergyhome.org has a staff education program as part of its resources that provides a certificate of completion for school staff.

For more information:

Sally Schoessler, MSEd, BSN, RN, AE-C, can be reached at sschoessler@allergyasthmanetwork.org.