Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Peanut allergies: What is the best policy for schools?

Roy Benaroch, MD
Conditions
January 14, 2019
Share
Tweet
Share

Peanut allergies can be a serious problem, and many exposures happen when our kids are at school. On average, there are probably about 5 peanut-allergic children in each of our nation’s 100,000 school buildings. What’s the best policy for schools to use to help protect these kids from potentially fatal reactions?

Different schools have taken different approaches, and as far as I can tell there is no authoritative national guideline to tell them what to do. So they’re “winging it.” Choices include:

  1. Having a 100 percent peanut-free school – no peanuts served, no peanuts allowed to be brought in.
  2. Not allowing peanuts to be served, but allowing kids to bring their own peanut-containing foods if they wish.
  3. Setting aside peanut-free classrooms.
  4. Setting aside peanut-free lunch tables.
  5. Having no specific policy, and hoping for the best.

Some schools have combined or blended these policies, and (hopefully) most also include an educational component for both teachers and students not to share foods. But the question remains: which of these really works to help prevent serious allergic reactions?

An August, 2017 study in the Journal of Allergy and Clinical Immunology provides some clues. The study was done in Massachusetts, where school nurses are required to report any administration of epinephrine. Since epinephrine should always be used for serious allergic reactions, those reports are a good way to track what’s going on. The circumstances of every epinephrine administration were reviewed, and only those given for nut or peanut reactions were included in the analysis. The authors also surveyed all of the Massachusetts’ school nurses to compile feedback on each school’s peanut policies, to see which policies were most successful in reducing the need for epinephrine.

The results might surprise you. Self-designated “peanut-free” schools had higher rates of administration of epinephrine than schools without a peanut-free policy. Now, the numbers of reactions were small, here, and different schools defined or enforced their policy of “peanut-free” in different ways. Still, a “peanut-free” designation was no panacea. It did not make epinephrine unnecessary, and was associated with an increased rate of peanut reactions. The authors speculate that this may be because the “peanut-free” school label may lead to a false sense of security.

The only policy that was associated with a decreased rate of epinephrine use was setting aside peanut-free tables in eating areas. Perhaps that’s because this kind of policy is easier to enforce.

Peanut-restrictive policies are an important part of protecting allergic kids, but they may have some downsides. Peanut-allergic children may be socially excluded or suffer bullying. And non-allergic kids may rely on peanut products as a healthy and inexpensive part of their diet. Whatever policies are pursued, they should be guided by the best evidence – what really works, and what best promotes the overall health of all of a school’s students?

Blanket policies may be less effective than a combination of several elements. Schools at every grade need to teach their students and faculty about food allergies and how to avoid exposures. And every food-allergic child needs an individualized plan that considers their risk of a life-threatening reaction along with their own ability to monitor their food intake. Epinephrine should be readily available in classrooms and eating areas (without requiring each individual child to have their own personal devices – that’s wasteful and expensive and awkward.) I know, that’s complicated and takes work. Schools prefer an easy-to-spell, one-sized-fits-all approach. Kids deserve better.

Roy Benaroch is a pediatrician who blogs at the Pediatric Insider. He is also the author of A Guide to Getting the Best Health Care for Your Child and the creator of The Great Courses’ Medical School for Everyone: Grand Rounds Cases.

Image credit: Shutterstock.com

Prev

There is no room for racism in medicine

January 14, 2019 Kevin 15
…
Next

Physician income shouldn't be what determines your level of success

January 15, 2019 Kevin 0
…

Tagged as: Allergies & Immunology, Pediatrics

Post navigation

< Previous Post
There is no room for racism in medicine
Next Post >
Physician income shouldn't be what determines your level of success

ADVERTISEMENT

More by Roy Benaroch, MD

  • Goodbye, Benadryl: It is time for you to retire

    Roy Benaroch, MD
  • Telemedicine overprescribes antibiotics: Are you really receiving the best care over the phone?

    Roy Benaroch, MD
  • No, phones don’t cause horns to grow on skulls

    Roy Benaroch, MD

Related Posts

  • A physician-parent’s thoughts on reopening schools

    Joyce Varughese, MD
  • Opening schools? The devil is in the details. 

    Raghav Gupta, MD
  • When celebrities attack children with food allergies

    Lianne Mandelbaum, PT
  • Food allergies are frightening, not funny

    Lianne Mandelbaum, PT
  • Inaccurate penicillin allergies worsens antimicrobial resistance

    Jasmine Riviere Marcelin
  • Settlements in the opioid cases need these non-negotiable conditions

    Rosanne Aulino, RN

More in Conditions

  • What Elon Musk and Diddy reveal about the price of power

    Osmund Agbo, MD
  • Understanding depression beyond biology: the power of therapy and meaning

    Maire Daugharty, MD
  • Why medicine must stop worshipping burnout and start valuing humanity

    Sarah White, APRN
  • Why perinatal mental health is the top cause of maternal death in the U.S.

    Sheila Noon
  • A world without vaccines: What history teaches us about public health

    Drew Remignanti, MD, MPH
  • Unraveling the mystery behind one of the most dangerous pregnancy complications: preeclampsia

    Thomas McElrath, MD, PhD and Kara Rood, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Who will train the next generation of primary care clinicians without physician mentorship? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • The CDC’s restructuring: Where is the voice of health care in the room?

      Tarek Khrisat, MD | Policy
    • Choosing between care and country: a dual citizen’s Independence Day reflection

      Kathleen Muldoon, PhD | Policy
    • What Elon Musk and Diddy reveal about the price of power

      Osmund Agbo, MD | Conditions
    • 3 tips for using AI medical scribes to save time charting

      Erica Dorn, FNP | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Who will train the next generation of primary care clinicians without physician mentorship? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • The CDC’s restructuring: Where is the voice of health care in the room?

      Tarek Khrisat, MD | Policy
    • Choosing between care and country: a dual citizen’s Independence Day reflection

      Kathleen Muldoon, PhD | Policy
    • What Elon Musk and Diddy reveal about the price of power

      Osmund Agbo, MD | Conditions
    • 3 tips for using AI medical scribes to save time charting

      Erica Dorn, FNP | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...