Q & A with Dr. Shahzad Mustafa Managing Food Allergies in Schools During the Pandemic

School nutrition professionals have definitely felt the direct impact of the pandemic. The paper  Managing Food Allergies in Schools During the COVID-19 Pandemic was published in 2020, in the midst of the pandemic, as a way to provide guidance on some of the keys to helping manage food allergies safely in this unprecedented time. In the paper the following guidelines were outlined:


8 Guidelines from the Experts:

  1. Wash hands, clean surfaces, and don’t share food
  2. Food allergen bans are not medically necessary
  3. Adapt 504 plans to work with new school restrictions
  4. Stock epinephrine in all schools
  5. Train all school personnel to recognize and treat anaphylaxis
  6. Zero tolerance for bullying
  7. Unique approaches may be necessary in some schools & classrooms
  8. Communication is paramount to ensure success

Jada Linton, RDN, LD, the National Peanut Board’s Registered Dietitian, reached out to Dr. Shahzad Mustafa, allergist from Rochester Regional Health System and father of a child with food allergies, for his thoughts on these recommended guidelines.

Jada: I really wanted to get your professional opinion of the paper and how it impacts your life as a father of a child with allergies.

Dr. Shahzad: The paper has really well-done guidelines. I think one of the most important parts of that paper is that it stresses that [food allergy management] is not a “one size fits all,” every situation is unique, and you really need to tailor the management plan to the situation. Whether it’s the age of the students, elementary is different than high school, is it a small school, is it an overcrowded school, all sorts of considerations, so I really like that about the paper. It’s a nice guideline, but it’s definitely not dogma. I think the authors do a great job of getting out the guidelines without putting things in black and white. Managing food allergies in a school can always be a bit challenging and anxiety provoking for families and parents. There are more layers to it right now and everything feels more anxiety provoking in the world. It is a real thing so there may be some additional potential challenges at home and at school, but there may also be some advantages too. A lot of kids are eating lunch in the classroom rather than the lunch room; that can be a change, but that doesn’t necessarily have to be increased danger, it could be increased safety too, potentially. There’s a lot of considerations. People have adapted well, I think with this situation whether it’s school food allergies or anything it requires a lot of flexibility, and I think people have done a pretty good job of it.

Jada: What are some of the keys schools should keep in mind when thinking about managing food allergies during this unusual time (perhaps when thinking about serving food in the classroom or outside the cafeteria)?

Dr. Shahzad: I think the biggest key remains the same [as pre-pandemic]: recognizing severe systemic allergic reactions and treating with epinephrine. The old paradigm of giving Benadryl or an antihistamine and “watching and waiting” is something that we really need to change. For significant reactions, you lead with epinephrine. That’s the case whether it’s a global pandemic or not, I think that’s the biggest thing that I stress. Another key is certainly being aware of students in the classroom, if they are moving less, potentially foods being eaten at desks or other areas, be aware of that space, be aware of other individuals in the classroom. At the end of the day there are some changes and considerations, but the basic management backdrop remains very similar to before, and I think that’s important. Again, there are a lot of changes, the world has changed it feels like, but at the end of the day the basics remain the basics.

Jada: How does the pandemic change what those with food allergies and their caregivers do during the pandemic with regard to management in schools?

Dr. Shahzad: It has made, for some people, grocery shopping more difficult. There have been supply chain changes, so your typical go-to things at the grocery store is not always there. Certainly, that’s the case for my family. My seven-year-old son he’s eating lunch in his classroom usually as before it was in the cafeteria. So we just have to be a little bit more aware of that, and that his teacher may have a little bit more of a role in the management of food allergies and she’s certainly aware of it. Everyone has an emergency action plan which remains the same as before so again there are some subtle changes dietary wise, but again the basics are the basics: food avoidance, epinephrine for systemic reactions, everyone should have an emergency action plan, kids should not be food sharing, they should be respectful of space — these guidelines remain the same. We stress for my son things are going to be different this year, but nothing changes with your food allergy; you don’t share food, you eat your food; if you feel anything tell your teacher or your lunch aid right away– these things remain the same.

Jada: One of the most notable things in the paper is that “Food Allergen Bans Are Not Medically Necessary”. This is a big misconception we encounter in our work with schools. What is your advice to school staff when communicating this to caregivers and administrators who may hold the misconception that bans are necessary?

Dr. Shahzad: I think the guidelines are really nice at the end of the day as an allergist that works with schools if there’s disagreements among parents it’s really not from a place of maliciousness. Schools want to take care of their kids and usually it’s an opportunity for education. Frankly, the education goes both ways. Sometimes the school personnel don’t know [food allergy management basics] and families are asking for things coming from a place of misinformation. It’s not that they’re trying to be difficult but provided with the adequate counseling sometimes their demands or desires change.

One of the [statements] of the document is that food ban are not advisable in many settings, and that’s a request and question that comes up a lot. With a food ban there are no guarantees and we don’t want to provide anyone with a false sense of security. You still have to take all the precautions.

We are genuinely in unique times during this pandemic. Dr. Shahzad’s expert opinion rings true when it comes to managing food allergies. Keeping kids with food allergies safe at school is really all about the basics. With these guidelines, make sure to share with others and apply to your own practices. Remember, adequate education and training can be the change that pivots concerned parents and school personnel from a place of misinformation to food allergy management understanding.

For  more information please visit the following resources to learn more:

Peanut Allergy Facts

Guidelines & Research on Preventing Peanut Allergy

Managing Food Allergy in Schools During the COVID-19 Pandemic

Additional Resources