Food allergies at school are becoming increasingly common among young people and can have very serious consequences. Here are the main questions (and our answers) to learn more about food allergies in schools and how to prevent and manage them on a daily basis.

How can food allergies be described?

Food allergies are abnormal reactions of the body following ingestion or contact with a food or a substance present in a food. The food or substance in question will then be called "allergen."

What allergens can students be exposed to at school?

The most common food allergens in children include:

• cereals containing gluten: wheat, rye, barley, oats, spelt, Kamut (and their derivatives);
• crustaceans;
• mollusks;
• eggs;
• fish;
• peanuts;
• nuts: Almonds, hazelnuts, cashews, pistachios, Brazil nuts, macadamia nuts, pecans;
• soy;
• milk (including lactose);
• celery;
• mustard;
• sesame seeds;
• sulfur dioxide and sulfites (> 10 mg/kg or 10 mg/L).

What are the signs of food allergies in children?

Here are some potential food allergy symptoms to watch out for in children at school. These allergic reactions generally occur within minutes or an hour of the child consuming the allergen:

• skin rashes and itching;
• abdominal pain, nausea, vomiting or diarrhea;
• swelling of the face, lips, tongue or throat;
• runny or stuffy nose;
• irritability or unusual fatigue.

How can food allergies be explained?

Food allergies are caused by a malfunction of the immune system, which goes into overdrive and attempts to protect the body against the allergen it perceives as a threat. The defensive reaction that follows can be very strong and manifests itself in a cascade of symptoms.

Sometimes, the mere presence of traces of the allergen is enough to trigger an allergic reaction. At the same time, some of these symptoms can be even more dangerous for people with allergies, especially if they have a reaction called “anaphylaxis.”

What is an anaphylactic-type allergic reaction?

Anaphylactic reaction, or anaphylaxis, refers to severe, acute allergic symptoms, which can sometimes cause death. The severity of an allergic reaction, and the nature of the symptoms it provokes, can vary from one person to another, and from one episode to the next.

Symptoms of an anaphylactic allergic reaction include, but are not limited to:

• swelling of the throat, lips or tongue;
• difficulty breathing or swallowing;
• a feeling of suffocation;
• hot flashes;
• itching or generalized redness of the skin;
• an accelerated pulse;
• a drop in blood pressure;
• pallor;
• sudden weakness;
• loss of consciousness.

Fortunately, with a good allergy management process and a clear, detailed emergency plan, it is possible to reduce the risk of exposure to allergens, prevent allergic reactions, and provide better care when they do occur.

What to do if you have a food allergy at school?

Effectively responding to food allergies in the school environment requires a rigorous, structured action plan, as well as a good allergy management process.

Constant vigilance with children with a food allergy is in order, since the allergen can be found just about anywhere. This is especially important in schools, where it can be more difficult to control the environment in order to eliminate allergens. However, it can be very dangerous if a person has an allergic reaction and those around them are unable to respond appropriately.

Here are some good practices to implement to ensure a sound action plan and standardization of practices against food allergies in schools:

• Inform the child, their family, and all school staff about their food allergy.
• Call on your child's doctor to help you draw up an action plan;
• Distribute the action plan to everyone who may be involved in responding to a severe allergic reaction in a child (teachers, daycare staff, cafeteria staff, secretary, school administration, etc.).
• Ensure rapid access to an epinephrine auto-injector at all times.

What menus should be offered to children with food allergies at school?

It is entirely possible for every school cafeteria to offer a completely allergen-free menu: all it takes is a structured approach.

1. Choose certified trace-free raw materials (flours, milks, cold cuts);
2. Plan dishes in parallel to avoid cross-contamination;
3. Clearly label specially prepared allergen-free products;
4. Train your staff to guarantee a balanced, varied and safe meal for all children;
5. Rely on committed suppliers.

With proper preparation, every school can easily offer tasty meals that comply with regulations and are perfectly suited to students with allergies, while reassuring parents and teaching staff.

What should your food allergy action plan contain?

Your food allergy action plan should contain all the relevant information you need to know about the allergic child, and present it accurately and concisely.

Here are a few examples of the information it should contain:

• The child's name and photo;
• The allergen in question (peanuts, eggs, soy, etc.);
• The name of the epinephrine auto-injector to be used in case of allergy;
• Where the epinephrine auto-injectors are stored;
• A description of any allergy symptoms that may be observed;
• A description of the steps to follow in case of allergy;
• Illustrated instructions on how to inject epinephrine;
• A list of emergency contacts.

Your pharmacist can also help you develop your action plan and provide information on the safe and optimal use of epinephrine auto-injectors. They can also prescribe such a device and call you to let you know when the auto-injector has expired and needs replacing.

A few tips for parents of allergic children

Whether or not your child suffers from food allergies, it is a good idea to apply these few tips:

• Avoid putting foods containing the most common allergens in your child's school lunch box (nuts, peanuts, egg, fish, etc.);
• Teach your child to wash their hands before and after eating;
• Encourage your child to ask about food allergies among their friends and those around them.

Here are a few additional tips for parents of a child with a food allergy:

• Prepare all their meals and snacks yourself;
• Tell them not to eat food offered by friends or classmates;
• Make sure they always carry their auto-injector with them, for example, on their belt.
• If you think your child is too young to keep their device with them, discuss the best option with their school team.
• Make sure they always wear a medical identification device, such as a MedicAlert bracelet.
• Provide the school with a sufficient number of emergency epinephrine auto-injectors, which should be strategically located and known to key people;
• Replace epinephrine auto-injectors before their expiry date;
• Review the steps for administering epinephrine at school, and encourage your family and friends to do the same. The manufacturer's website provides a demonstration of how to use the auto-injector, in the form of images or video clips;
• Visit the auto-injector manufacturer's website for information materials, such as posters that can be strategically placed around the school.

For more information on treating and managing food allergies at school, feel free to consult your pharmacist and the Allergy Quebec website.