A guideline endorsed by the American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology favors allergy training, action plans, and stocked epinephrine over site-wide food bans and allergen-restricted zones at children care centers and schools. Published in the Journal of Allergy and Clinical Immunology, the guideline is the result of systematic literature reviews of the anticipated health effects of selected interventions for managing food allergy in child care centers and schools and compiled data on the costs, feasibility, acceptability, and effects on health equity of the selected interventions.

Labeled “conditional” due to the low quality of available evidence and the need for more research to determine with greater certainty which interventions are likely to be the most beneficial, the recommendations include the suggestions that:

  • Child care centers and schools implement training for teachers and other personnel in the prevention, recognition, and treatment of allergic reactions to food.
  • Child care centers and schools require all parents of students with diagnosed food allergy to provide an up-to-date allergy action plan.
  • Child care centers and schools implement site-wide protocols for the management of suspected allergic reactions to food in individuals with no allergy action plans on file.
  • Child care and school personnel use epinephrine only when they suspect that someone is experiencing anaphylaxis, rather than use epinephrine as the first universal treatment for all suspected allergic reactions. For special circumstances, see the full guideline.
  • Child care and school personnel do not preemptively administer epinephrine in cases when no signs or symptoms of an allergic reaction have developed, even if a student has eaten a food to which they have a known allergy or history of anaphylaxis. For special circumstances, see the full guideline.
  • When laws permit, child care centers and schools stock unassigned epinephrine autoinjectors on site, instead of requiring students with allergy to submit personal autoinjectors to be stored on site for designated at-school use. For special circumstances, see the full guideline.
  • Child care centers and schools not prohibit specific foods site-wide.
  • Child care centers and schools not establish allergen-restricted zones, except in the special circumstances identified in the full guideline.