Running Head: CONCERNS FOR STUDENTS WITH FOOD ALLERGIES IN SCHOOL 1

Parents Concerns for Students with Food Allergies in School

Kristy J. Keaton
WSU
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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

In the discussion of a study by R. C. Knibb1, C. Barnes2 and C. Stalker2, in regard to

parental confidence in managing a food allergy, they state;

“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

focusing on quality of life. It is therefore important for self-efficacy to be measured in

order to direct appropriate healthcare advice.”

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
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in relation to other parents’ negative attitudes towards food allergies and normalizing their

affected child’s school life despite their food allergy.” (2016)

Schools Safety for Student with Food Allergies

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

placed in a larger population.

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

handwashing procedures, there is less cause for cross-contamination. (Mudd, Wood,2014)

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Exposure and Disaggregation

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,

1990, p. 121).” (Rousa & Huntb, 2004)

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.

(Portnoy & Shroba, 2014)

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
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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

Immunology (Powers, Bergren, & Finnegan, 2007)...The American Academy of Allergy,

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

nurse is responsible for facilitation and awareness of each plan.

In a case study about a 5-year-old kindergartner named Alison, allergies proposed a

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

on campus. (Robinson et at., 2012)

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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

totally eliminated. As mentioned before, staff and teacher education is mandatory. It is

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

a child at risk of anaphylaxis in their care to be trained in the prevention, management

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.

The Anaphylaxis e-training is available for educators in school and prior-to-school

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-

face training (ASCIA).” (Sanagavarapu, 2012)

Parents should have some of their worries resolved knowing that there is the proper

support and training of health care professionals in the school system.

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

to the allergy takes place.

“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

given to treat anaphylaxis in a student not previously known to be food-allergic. In

addition, 19 % of the reactions occurred outside of the building on the playground, on a

school bus, or during field trips. The average time from onset of symptoms to treatment

was 10 min.” (Portnoy & Shroba, 2014)

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

lower socioeconomic areas. (Portnoy et at., 2014)

Social aspects of food allergies in the classroom

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

classmates” (Shemesh et al., 2013, p. e10).

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Social Ramifications of Banning Foods for Allergy Purposes

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

become negligent in the care or concern in case of emergency.

Bullying and the Ties to Food Allergies

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,

and “relational victimization” such as intentionally excluding someone or targeting someone as a

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

the role of electronic technology in cyber bullying.” (Mudd,Wood,2014)

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

plague their lives into adulthood. (Bratsis, M. E. 2013)

“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

despite a history of anaphylaxis.” (Mudd et at., 2014)

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,
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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,

classmates and friends so that life can be as fluid as possible.

There are several intervention programs that are implemented in the school system, but

their effectiveness varies. “Campbell Corporation systematic review of school-based programs to

reduce bullying and victimization found that in general, school-based programs are effective as

evidenced by an average bullying decrease of 20–23%, with intervention programs of a longer

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

allergies, RA Annuziato concluded that,

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
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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.
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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

schools. Current Opinion In Allergy & Clinical Immunology, 16(3), 291-296.

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-

1689. doi: 10.1111/cea.12599

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.

187-194. doi: 10.1177/1059840511429686

Rousa, Trevor, Hunt. (2004).Governing peanuts: the regulation of the social bodies of children

and the risks off food allergies.825-836. Retrieved from www.elsevier.com/locate/socscimed

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.
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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

Early Childhood, 41(4), 115-122.