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Guideline Resources

  • Title: Management of Food Allergy in Schools
  • Society: American Academy of Pediatrics
  • Publish Date:  September 25, 2025
  • Summary
  • Full-text

Video Transcription

Just published September 25th, 2025 The American Academy of Pediatrics' newest clinical report on Management of Food Allergy in Schools.

This updated clinical report utilizes resources and additional studies to provide pediatricians and primary care clinicians with the information necessary to counsel patients, families, school personnel, and policy makers on effective food allergy management practices.

In today’s video, we’ll just be going over a summary of key takeaways on the sections documentation of food allergy, stock epinephrine, risk reduction strategies, and school emergency management, so for the full clinical report, make sure to check it out on guidelinecentral.com. Let’s get started.

Starting with Documentation of Food Allergy, the following are key points of note:

  • Although any food may trigger an allergic reaction, most serious reactions are attributable to peanut, tree nuts, milk, egg, soy, wheat, fish, shellfish, and sesame
  • Reactions may include anaphylaxis, which, in rare cases, may be fatal.
  • Establishing a food allergy diagnosis includes a clinical history consistent with IgE-mediated allergy and confirmation of the relevant allergen with testing. Although increasingly large skin tests and elevated levels of food-specific IgE antibodies correlate with increased risk of allergy, an isolated positive test alone is not diagnostic, and tests do not reliably predict severity. 

Next on the topic of stock epinephrine, considerations for the pediatric health care clinician include: 

  • Stock epinephrine prescriptions must be written by a licensed medical professional, and rules vary by state.
  • Benefits of stock epinephrine may include expanding availability for those unable to afford or provide personal devices and to those without a known diagnosis.
  • Challenges to implementation may include costs, training, acceptability, and supportive laws as well as the need to monitor and replace expired or used medication.
  • Provisions may be made to ensure campus-wide coverage and coverage for field trips. Devices are best stored in accessible, unlocked secure locations, laws permitting. 
  • Whether or not stock epinephrine is implemented, in addition to the school nurse, school personnel can be trained to administer epinephrine. Regardless of who can administer epinephrine, education on food allergies and anaphylaxis can be provided to all school staff including cafeteria workers, sports staff, and bus drivers. The content of any required epinephrine training for school staff varies by state.

Moving on to Risk Reduction Strategies. Key points that may be helpful to clinicians are as follows:

  • Reading ingredient labels and working to reduce the risk of cross-contact of allergens during food preparation is good practice.
  • The primary route of allergen exposure causing severe allergic reactions is by oral ingestion.
  • Allergen exposures through skin contact or inhalation are unlikely to trigger severe allergic reactions; however:
    • In some cases, allergic reactions can be triggered by inhalation of actively aerosolized food allergens. Therefore, participation in school cooking activities involving known allergens may pose a risk for some students with food allergy.
    • Some art or science supplies may contain hidden allergens that can trigger allergic reactions. 
    • The CDC guidelines encourage children to wash hands before and after handling or consuming food.
  • In one study, nearly a quarter of reactions occurred during special celebrations, so vigilance is important, especially when there is a break from routine school activities.
  • Conventional cleaning agents can be used to remove allergens from hands and surfaces.
  • The CDC voluntary guidelines and others suggest strict “no food sharing” policies and policies of no eating on the school bus and having a means of communication on the bus.
  • Restrictions on allergens require careful consideration.
  • As part of a comprehensive plan for managing food allergy, the CDC recommends that school staff be trained on allergen avoidance.

On to the next section, School Emergency Management. According to the CDC guidelines, all staff at a school with a student with food allergy should be trained to recognize anaphylaxis and to begin the emergency protocol. Recent evidence-based guidelines also support that child care centers and schools implement food allergy training for staff and require families to provide written emergency plans. Many families do not provide allergy information to schools, so the guidelines suggest schools implement site-wide food allergy and anaphylaxis protocols to be ready for any student with known or unknown allergies. Training objectives and processes can vary across the country as states and school districts create differing policies or guidelines for these trainings, which are often coordinated through the school nurse.

In summary, the pediatrician or pediatric primary care clinician can support food allergy management in school or child care settings by:

  • Ensuring an appropriate diagnosis of food allergy
  • Providing individualized documentation of allergy and anaphylaxis risks and management using a written allergy and anaphylaxis emergency plan
  • Prescribing epinephrine devices for anaphylaxis management; and
  • Being a resource to patients, families, and schools in providing evidence-based advice on food allergy management.

And there you have it. Make sure to check out the full clinical report from The American Academy of Pediatrics and other related clinical decision support tools at guidelinecentral.com.

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