Research
Managing food allergies in schools requires a compassionate and evidence-based approach. The following research studies explore common practices and environments, including touching or smelling peanut products, and the level of risk for people with peanut allergies. You will also find credible resources for best practices and what works to keep students with food allergies safer.
Casual contact presents an extremely low risk for anaphylaxis.
A study of 30 peanut allergic children who smelled peanut butter for 10 minutes resulted in zero reactions. Skin contact in this study also resulted in zero life-threatening reactions; redness and irritation occurred for some where the peanut butter touched the skin. (Simonte S., 2003)
Further research found that washing hands with soap and water and using common household cleaners on surfaces can remove peanut proteins to mitigate cross contact. (Perry T., 2004)
More recently, allergists documented their practice of placing peanut butter in close proximity to peanut allergic patients to show them that just being near peanut foods does not cause anaphylaxis. Similarly, they applied peanut butter to the skin of allergic patients. In their article, the clinicians reported that none of their patients has experienced a systemic reaction and only one had a hive at the site of application. (Dinakar C., 2016)
Links
- Simonte S, M. S. (2003). Relevance of casual contact with peanut butter in children with peanut allergy. J Allergy Clin Immunology, 180–182.
- Perry T, e. a. (2004). Distribution of peanut allergen in the environment. J of Clin Immunology, 973-976.
- Dinakar C., S. J. (2016). The transforming power of proximity food challenges. Annals of Allergy, Asthma & Immunol, 135-137.
Bans do not work and are not medically necessary
Banning peanuts from schools does not reduce the risk of food allergy reactions. In a study of 567 food allergy reactions in a Canadian pediatric cohort, 4.9% of reactions occurred in “peanut-free” schools compared to 3% in schools that allow peanut foods. Authors warned about a false sense of security when foods are banned. (Cherkaoui S., 2015)
Banning peanuts does not reduce the use of epinephrine in schools. According to a study of schools in Massachusetts, schools with policies that restricted peanut foods from being brought from home, served in the school cafeteria or in the classroom did not reduce the use of epinephrine to treat food allergy reactions compared to schools that did not have peanut-free policies. (Bartnikas L., 2017)
Experts do not recommend bans as a means to manage food allergies. According to guidance on the role of the allergist in school food allergy management, there is no evidence that supports bans as a way to reduce the risk of reactions. They can also increase the burden on schools and students, while creating a false sense of security. Finally, they are impractical when multiple allergenic foods are banned. (Wang J., 2018)
Links
- Cherkaoui S., B. M. (2015). Accidental exposures to peanut in a large cohort of Canadian children with peanut allergy. Clinical and Translational Allergy.
- Bartnikas L., H. M. (2017). Impact of school peanut-free policies on epinephrine administration. J Allergy Clin Immunol, 467-473.
- Wang J., B. T. (2018). The Allergist’s Role in Anaphylaxis and Food Allergy Management in the School and Childcare Setting. JACI-In Practice, 427-435.
Best Practices
Start with the Experts – refer to the CDC’s Voluntary Guidelines for Managing Food Allergies in Schools and Early Child Education.
Start with the Experts – refer to the CDC’s Voluntary Guidelines for Managing Food Allergies in Schools and Early Child Education.
Focus on Training – everyone who provides oversight, care and services for a food-allergic student should be trained on identifying symptoms of a reaction and how to respond. That means foodservice, teachers, bus drivers, and after school staff, plus any others with direct student supervision.
Be Prepared for Reactions – as the evidence proves, nothing completely prevents reactions from happening. Be sure every food-allergic student has an emergency anaphylaxis plan, access to emergency medication, and that everyone knows what to do in case of an allergic reaction.
Create a Supportive Community – communicate your food allergy management plans early and often with parents and stakeholders. Let them know you take allergies seriously and that you are “allergy aware.”
Consider allergen-safe tables in cafeterias – since they did reduce the risk of epinephrine use in one study. (Bartnikas L., 2017)
Links
- https://www.cdc.gov/healthyschools/foodallergies/ pdf/20_316712-A_FA_guide_508tag.pdf
- Bartnikas L., H. M. (2017). Impact of school peanut-free policies on epinephrine administration. J Allergy Clin Immunol, 467-473.
Videos
School nutrition professionals love peanuts and peanut butter, and they also understand that allergen management is essential to keeping them on the menu. Watch this collection of brief and informative videos to learn the benefits of peanut foods in as part of school meals, address common misconceptions about peanuts in schools and discover best practices and tips for building and communicating an allergen management plan. You will be well on your way to understanding how to keep students with food allergies safe while providing other students with nutritious, delicious, and affordable peanut butter and peanuts.
How Peanuts Meet Today’s School Nutrition Challenges
Now that we’re entering the third pandemic year, K-12 is stretched to the limit with supply chain issues, staffing shortages and rising food prices. School nutrition experts Dayle Hayes, MS, RD, and Jeanne Reilly, NDTR, SNS talk about overcoming obstacles, how and why peanuts and peanut butter are essential in these trying times and how to manage this common allergen in a school setting.
Communicating Food Allergy Management: Keys to Success
Sometimes it can be hard to talk about food allergy management in schools. Registered dietitian nutritionist and former school nutrition professional Sherry Coleman Collins shares five tips, inspired by the CDC’s Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs for more effective communication on this issue.
Why Peanut Butter Matters for Schools
School nutrition pros have many factors to consider when making menu decisions, from acceptability and nutrition to value and versatility. Learn why peanut foods are important for school nutrition programs from Marietta City Schools Nutrition Director Cindy Culver, RDN, and Sherry Coleman Collins, MS, RDN, LD.
How to Safely Serve Peanut Butter in Schools
Peanut foods and other allergens, like milk, eggs, and fish, are served safely in schools every day. Sherry Coleman Collins, registered dietitian nutritionist, food allergy expert and former school nutrition professional, shares the steps to consider to reduce risk, keep children with food allergy safer and provide nutritious, affordable, and delicious options with peanut ingredients to students without peanut allergy.
Why Peanut Butter Should Not be Banned from Schools
Food allergen management is a complex issue that cannot be solved by simply banning a food. Registered dietitian Sherry Coleman Collins talks with food allergy parent and President & CEO of Food Allergy and Anaphylaxis Connection Team (FAACT) Eleanor Garrow-Holding about evidence-based practices and accommodations that work.
An Allergist Addresses Common Peanut Allergy Myths
Can a person with a peanut allergy be near someone eating peanut foods? Are peanuts the only food that can cause a serious reaction? Pediatric allergist, researcher and food allergy parent Michael Pistiner addresses these questions and other common misconceptions about peanuts in schools.
How to Create an Allergen Management Plan
An allergen management plan is vital in school nutrition and Sherry Coleman Collins, MS, RDN, LD, provides resources to help you start or update this important document. From location considerations and team members to stock epinephrine and communication, you will have the makings of a comprehensive plan. View the CDC’s Voluntary Guidelines for Managing Food Allergies in Schools for more details.
Best Practices for Handling Food Allergens in School Foodservice
Registered dietitian nutritionist and chef Garrett Berdan and food allergy expert Sherry Coleman Collins, MS, RDN, LD, share tips for effectively managing food allergens in K-12 school foodservice.
Preparing Peanut Butter and Jelly Sandwiches in School Foodservice
Making PB&Js, while preventing cross-contact of food allergens, is made simple with these step-by-step instructions from registered dietitians and foodservice professionals.
Preparing All Purpose Peanut Sauce in School Foodservice
School nutrition pros can take peanut butter beyond the classic PB&J and add a tasty element to a variety of dishes with this simple recipe for all-purpose peanut sauce.
Frequently Asked Questions
Serving common allergens in schools can be a tough task and we know you have questions. The most common questions we hear from the school community are below, along with evidence-based answers and links to credible, third-party sources. If you would like an answer direct from our team, email peanuts@nationalpeanutboard.org.
Do food bans help prevent allergic reactions?
Banning peanuts from schools does not reduce the risk of food allergy reactions.
Food bans take the focus off education and onto enforcement. Being “allergen free” gives a false sense of security. Allergic children and school officials can become lax about the precautions needed, potentially increasing the risk for allergic reactions.
In a study of 567 food allergy reactions in a Canadian pediatric cohort, 4.9% of reactions occurred in “peanut-free” schools compared to 3% in schools that allow peanut foods. The study authors warned about a false sense of security when foods are banned. (Cherkaoui S., 2015)
Banning peanuts does not reduce the use of epinephrine in schools. According to a study of schools in Massachusetts, schools with policies that restricted peanut foods from being brought from home, served in the school cafeteria or in the classroom did not reduce the use of epinephrine to treat food allergy reactions compared to schools that did not have peanut-free policies. (Bartnikas L., 2017)
- Cherkaoui S., B. M. (2015). Accidental exposures to peanut in a large cohort of Canadian children with peanut allergy. Clinical and Translational Allergy.
- Bartnikas L., H. M. (2017). Impact of school peanut-free policies on epinephrine administration. J Allergy Clin Immunol, 467-473.
How prevalent is peanut allergy?
It is estimated that about 4% of teens and adults and 5% of children have food allergies, with less than 1% of Americans allergic to peanuts. Estimating the number of people with food allergies in the United States is a challenge, which means that current estimates are just that—the best approximations of the numbers of people with food allergies. According to the National Academies of Sciences, Engineering and Medicine’s Committee on Food Allergies report Finding a Pathway to Safety’s Key Messages, “ there is no estimate of true prevalence of food allergy in the U.S.” (National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee on Food Allergies, 2017)
- National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee on Food Allergies. (2017). National Academies Press. Retrieved from https://www.nap.edu/catalog/23658/finding-a-path-to-safety-in-food-allergy-assessment-of
- https://www.nap.edu/resource/23658/Food-Allergies-message.pdf
What resources are available to help school nutrition professionals?
There are many expert resources available to help you manage food allergies in schools.
What is the right approach for managing food allergies in schools?
- Start with the Experts – refer to the CDC’s Voluntary Guidelines for Managing Food Allergies in Schools
and Early Child Education. - Focus on Training – everyone who provides oversight, care and services for a food-allergic student should be trained on identifying symptoms of a reaction and how to respond. That means foodservice, teachers, bus drivers, and after school staff, plus any others with direct student supervision.
- Be Prepared for Reactions – as the evidence proves, nothing completely prevents reactions from happening. Be sure every food-allergic student has an emergency anaphylaxis plan, access to emergency medication, and that everyone knows what to do in case of an allergic reaction.
- Create a Supportive Community – communicate your food allergy management plans early and often with parents and stakeholders. Let them know you take allergies seriously and that you are “allergy aware.”
- Consider Allergen-Safe Tables in Cafeterias – since they did reduce the risk of epinephrine use in one study. (Bartnikas L., 2017)
- https://www.cdc.gov/healthyschools/foodallergies/pdf/20_316712-A_FA_guide_508tag.pdf
- Bartnikas L., H. M. (2017). Impact of school peanut-free policies on epinephrine administration. J Allergy Clin Immunol, 467-473.
Are schools required to provide accommodations for students with food allergies?
USDA requires that a student whose allergies are determined, as a result of an evaluation by a qualified healthcare provider, to have a physical or mental impairment that substantially limits one or more major life activity, such as breathing, will qualify for coverage under Section 504 of the Rehabilitation Act. Section 504 is the primary law governing accommodations for those with disabilities in the educational setting. Since food allergy reactions have the potential to substantially limit the major life activity of breathing even if a student has never had an anaphylactic reaction, they can still qualify under Section 504. Schools can still be required to provide reasonable accommodations for food allergic students who are evaluated as being eligible for Section 504.
Section 504 accommodations are meant to ensure equal access for students. Examples of accommodations that can help ensure equal access to education for students with food allergies include:
- Ensuring access to non-allergenic foods during times when foods are being provided to all students.
- Designating “allergen-aware” tables in the cafeteria where the top eight allergens are not allowed.
- Creating “food free” classrooms and shared spaces, such as computer rooms and libraries, where food is not allowed – to reduce the risk of accidental ingestion.
USDA Guidance for Accommodating children with special dietary needs in the school nutrition program. Available at: https://www.fns.usda.gov/sites/default/files/special_dietary_needs.pdf
Can someone with a peanut allergy have a life-threatening reaction just by smelling or touching peanuts or peanut butter?
Research shows that casual contact presents an extremely low risk for anaphylaxis. A study of 30 peanut allergic children who smelled peanut butter for 10 minutes resulted in zero reactions. Skin contact in this study also resulted in zero life-threatening reactions; redness and irritation occurred for some where the peanut butter touched the skin. (Simonte S., 2003) Further research found that washing hands with soap and water and using common household cleaners on surfaces can remove peanut proteins to mitigate cross contact. (Perry T., 2004) More recently, allergists documented their practice of placing peanut butter
near peanut allergic patients to show them that just being near peanut foods does not cause
anaphylaxis. Similarly, they applied peanut butter to the skin of allergic patients. In their article, the clinicians
reported that none of their patients has experienced a systemic reaction and only one had a hive at the
site of application. (Dinakar C., 2016)
- Simonte S, M. S. (2003). Relevance of casual contact with peanut butter in children with peanut allergy. J Allergy Clin Immunology, 180–182.
- Perry T, e. a. (2004). Distribution of peanut allergen in the environment. J of Clin Immunology, 973-976.
- Dinakar C., S. J. (2016). The transforming power of proximity food challenges. Annals of Allergy, Asthma & Immunol, 135-137.
Are schools required to stock epinephrine?
The 2013 School Access to Emergency Epinephrine Law incentivizes schools to have epinephrine injectors available in the school in case of a severe allergy attack. Some states are moving in this direction. For more information on managing food allergies in your child’s school, contact the school district to find out more about the status in your state.
Everyone on the education/care team should be trained to administer epinephrine, the only medication approved for treating anaphylaxis, a potentially life-threatening allergic reaction, in an emergency situation.
Are most schools nut-free?
Only about 15% of K-12 schools ban any specific food. The most used practice to manage food allergies is providing allergen-safe zones on campus, such as food-free classrooms or a nut-free table in the cafeteria.
What do I do if school community members request removing peanut butter from the menu?
Some parents, nurses, school boards, administrators or others may advocate for banning a particular food from school menus; however, the Section 504 Committee need not do that if other accommodations can be made to allow students with food allergies equal access to educational opportunities. Furthermore, this approach is not medically necessary.
Food bans take the focus off education and onto enforcement when all resources are needed to provide education. Claiming to be “allergen free” gives food allergic students a false sense of security. Allergic children and school officials can become lax about the precautions needed, potentially increasing the risk for allergic reactions.
Instead, it is recommended that schools model their food allergy management programs after the CDC Voluntary Guidelines for Managing Food Allergies in Schools and Early Child Education.
Handouts and Articles
Advice and best practices for managing food allergies in schools are based on evidence, science and real-world experience. Here you will find free handouts to share with your team and school community that advises the do’s and don’ts, as well as guidance and experience from school nutrition leaders and allergy experts.
Instead of Peanut Free, Be Allergen Aware
This front-and-back handout provides 5 key reasons why food bans are not the best approach for managing food allergies in schools and highlights evidence-based best practices.
Guidelines for Managing Food Allergies in Schools
Educators and parents alike are asking, “what is the best solution for accommodating children with food allergies in schools?” Approximately 98 percent of Americans can enjoy peanuts without any issue, and about 2 percent of school-aged children in the U.S. may have peanut allergy. This handout provides guidelines from the experts on how to manage food allergies in schools.
Managing Food Allergy in Schools During the COVID-19 Pandemic
The global pandemic disrupted school routines across the country, including where and how students were served school meals. Leading allergists came together to publish this article in the Journal of Allergy and Clinical Immunology, highlighting best practices for keeping students with food allergies safe during this uncertain time.
How School Nutrition Experts Serve Peanuts and Peanut Butter
In this article, two experts in K-12 school nutrition share their insights on the importance of peanut butter in nutrition programs, advice on managing food allergies and culinary tips to elevate school meals with peanut butter.
Prevention and Management of Allergic Reactions to Food in Child Care and Schools: Practice guidelines
Experts from around the world came together to evaluate and assemble the latest evidence-based recommendations for how to reduce the risk of allergic reactions to food in schools. In this document, this prestigious group of allergists provide detailed information about how schools can take a comprehensive approach to managing allergens and keeping students safer.
Learn More
There is a wealth of information available to help you safely serve allergens in your school nutrition operation. Learn from case studies of programs that have added peanuts back to the menu as well as find referrals to credible trainings, webinars, toolkits and more.
School Nutrition Association Food Allergy Resource Center
SNA’s Food Allergy Resource Center is a one-stop shop for school nutrition professionals to learn about managing food allergies in schools. Submit a question to Ask the Allergy Expert, learn more about the Big 9 allergens, explore trainings and more.
CDC Food Allergy Management Toolkit
CDC’s toolkit contains tip sheets, training presentations and podcasts to help school staff implement the Voluntary Guidelines for Managing Food Allergies to prevent and manage severe allergic reactions in schools. The toolkit emphasizes the role that administrators, superintendents, nutrition pros, teachers, mental health professionals, transportation staff and nurses all play in successfully managing food allergies in the K-12 environment.
FAACT School/Education Resource Center
Food Allergy & Anaphylaxis Connection Team provides resources for schools including a curricula program, posters, guidance on building a food allergen management plan and more.
FARE
Food Allergy Research and Education provides free information, materials, and trainings for anyone in the school environment who is looking for education on food allergies.
SNA Webinar: Bringing Nutritious, Affordable, and Delicious School Meals to Life while Managing Common Allergens
Get inspired by creative ideas from a school chef to meet the needs of today’s savvy students. A nutrition scientist and research director reviews important nutrition considerations for menu planning and product selection considering the current supply chain challenges. And a registered dietitian nutritionist provides best practices for managing common allergens in school meals.
SNA Webinar: School Nutrition, Food Allergies & Food Insecurity
Explore the intersection of food insecurity and food allergies and the role of the school nutrition team from speakers Sherry Coleman Collins, MS, RDN, LD and former school nutrition professional; Emily Brown, president & founder of Food Equality Initiative; and Jeremy Bergman, foodservice director in New Castle, Pa.
SNA Webinar: Adopting Top Food trends & Managing Allergies at School Breakfast
School breakfast is an important part of the success of your program – and students. Learn to harness hot trends like plant-based eating, while managing common food allergens like peanuts. And receive valuable tools to help with marketing, crediting, and managing allergens. Speakers: Sherry Coleman Collins, MS, RDN, LD and former school nutrition professional; and Director of the School Nutrition Program in Burke County, GA and Past-President of the Academy of Nutrition and Dietetics, Donna Martin
SNA Webinar: Ask the Expert: Food Allergies Edition
Pediatrician JJ Levenstein and school nurse Jessica discuss the common questions that they hear about food allergy management, as well as answered many of those submitted through the SNA’s Food Allergy Resource Center.