Bringing food allergy management and awareness to your community

The Management of Life Threatening Allergies in School: Lessons Learned from Massachusetts
Ongoing Challenges and Take Home Points

Although the management of life threatening allergies in Massachusetts’ schools has greatly improved, there remain ongoing challenges.

antihistaminePhysicians’ ordering Benadryl: Epinephrine is the first line treatment of anaphylaxis. This must be reflected in allergy action plans. Antihistamines are second line and if used, should only be used in conjunction with epinephrine in the treatment of anaphylaxis.
Antihistamines are slow to act (30-60 minutes), have no effect on platelet activating factor, leukotrienes, prostoglandins, or other mediators, and are ineffective for GI, respiratory, and circulatory symptoms. . Additionally, there is no high quality evidence either for or against the use of H1-antihistamines in anaphylaxis as per a recent Cochrane Review.

Students who like peanut-butter and those allergic to it: Schools need to develop strong communication systems with all families to advise them of the prevention strategies for students with LTAs. Additionally they need to be aware of the potential divisiveness of this issue and help bridge the gap between the families of the food allergic and those without allergies (Of note is that the policies concomitant to wellness and obesity prevention are actually assisting in making the food allergy environment safer.)

Peanut free schools: An ongoing controversy is the issue of peanut-free schools versus allergy aware zones. Stating a school is peanut free tends to give a false security. Many Massachusetts schools have allergy aware zones or tables with strict policies.
An additional consideration is the importance of a child’s participation in food allergy management that will help them develop skills that they will inevitably need when they leave their school.

Teaching unlicensed personnel: A wide range of school personnel need education about the issues relating to food allergies, as well as training to administer the epinephrine by auto-injector should an unintended exposure occur; these staff may include teachers, athletics personnel, administrators and school bus drivers.

ambulanceEducation regarding biphasic reactions and the potential need for additional epinephrine: Some episodes of anaphylaxis may be biphasic, where there is a return of anaphylaxis after the resolution of symptoms. It is difficult to predict which patients may experience a biphasic reaction, but there seems to be increased likelihood with increased severity, higher epinephrine requirements, and in cases where there was a delayed administration of epinephrine. . Taking the biphasic reaction into account, students should be taken by ambulance to the emergency department and observed for a minimum of four to six hours, with longer observation times and hospital admissions for severe symptoms . In addition to the potential for a biphasic reaction, episodes of anaphylaxis may require more than one dose of epinephrine, supporting recommendations to have two doses available

Take Home Point

Massachusetts has accrued valuable information and has developed a well thought out and ever evolving set of guidelines that has improved the management of life threatening allergies in school. It is our hope that Massachusetts’ experience may be used as a building block or guide for new and changing policies nation wide, and used as a guide to assist pediatricians in their collaboration with schools.

All excerpts taken from the Management of Life Threatening Allergies in School: The Massachusetts Experience.
Written by: Michael Pistiner MD, MMSc and Anne H. Sheetz RN, MPH, NEA-BC.
This piece was originally published in the American Academy of Pediatrics, Council on School Health, Spring/Summer 2009 Newsletter.
We thank the AAP for granting permission to post and to update mandated reporting data within this article.

All information contained on the website is intended for informational and educational purposes. The information provided on this website is not intended to be a replacement or substitute for professional medical advice. Any information that you have received from should be verified with your licensed health care provider. Furthermore, decisions regarding medical care should not be based solely upon the content of this website but made after discussions with your health care provider. Consumers should never disregard or delay seeking medical advice due to the content of this site.

Your use of this site does not create a patient-physician relationship between you and

Medical information changes constantly. Therefore the information on this site or on the linked websites should not be considered current, complete or exhaustive, nor should you rely on such information to recommend a course of treatment for you or any other individual. Reliance on any information provided on this site or any linked websites is solely at your own risk.

Please note that AllergyHome is not affiliated with Boston Children’s Hospital

Accept Decline