Psychological Impacts for Families Living with Food Allergy
Food allergy may affect as many as 32 million Americans, including 6 million children, and is a growing concern. According to the Centers for Disease Control and Prevention (CDC), between 1997 and 2011, the prevalence of food allergies rose 50 percent.
Food allergies require considerable time to manage and constant vigilance, which can pose a burden for both the food-allergic individual and his or her caregiver. Caregivers’ and food-allergic individuals’ quality of life is often negatively affected. Another source of anxiety may be harassment of the food-allergic individual. For information on bullying and harassment, please visit our bullying page.
Several groups in the US and in Europe are hard at work to learn more about what affects quality of life in food allergy among caregivers and patients of all ages. Quality of life is an important patient-oriented outcome, and key to understanding the psychological impact of food allergy.
Although several studies have demonstrated poor quality of life of caregivers of food-allergic children and the negative impact of food allergy, more data is needed. In recent studies, caregivers of children who were seen in the emergency room within the past year for a food-allergic complication felt the most burden among caregivers. Similarly, caregivers of children managing multiple food allergies, allergic to specific foods, and/or who have more knowledge about food allergy were significantly likely to have a poorer quality of life.
All children must be given the opportunity to make new friends, develop more autonomy, expand their social skills, and improve their problem-solving skills in social situations. There may be a tendency for parents to try to shield food-allergic children from adversity and risk. However, although food allergy may restrict a child’s social interactions, the goal is to provide as normal a childhood experience as possible. Excessive or long-standing restrictions (e.g., isolation at meal times or policies that result in limiting the child’s participation in celebrations) could result in increased social isolation and associated feelings of depression or social anxiety. So it is important to provide a as inclusive an environment as possible for the food-allergic child to foster these developmental stages.
Impact of Food Allergies on the Daily Activities of Children and Their Families
Food allergies affect everyone in the family. In surveys of parents or caregivers of children with food allergies,
60 percent reported that food allergies significantly affected meal preparation.
49 percent or more indicated that food allergies affected family social activities.
41 percent reported a significant impact on their stress levels.
34 percent reported that food allergy had an impact on the child’s school attendance.
10 percent choose to home-school their children because of food allergies.
50 percent or more indicated that food allergies significantly affected their family social activities.
58 percent thought that food allergy affected their child’s “playing at friends’ house.”
53-70 percent reported that activities such as birthday parties and sleepovers were significantly affected by food allergies.
59 percent reported school field trips were affected by food allergies.
68 percent reported school parties were affected by food allergies.
The number of food allergies had a significant impact on activity scores, but the addition of other conditions, such as asthma and eczema, did not significantly affect the results.
Parent Perspectives on School Food Allergy Policy
Food allergy affects up to 8% of children in the U.S. There is minimal research to date on food allergy policies that are currently in place in schools and the opinions of parents of children with food allergy on the effectiveness of or need for these policies.
Of the 289 parent respondents, 27.4% were unsure or felt school was unsafe for their child with food allergy. While the majority felt that the polices in their child’s school were helpful, most also believed that implementation of additional polices was necessary, including availability of stock epinephrine (94.2%), lunch menus with allergen information (86%), ingredient labels on food items (81%), and direct food allergy education for students (86%). There were significant differences in school food allergy policy depending on the age of the student body, private versus public school, and geographic location.
While most schools reportedly have one or more food allergy policies in place, many parents have concerns over the safety of their child at school and feel that additional policies are necessary to improve the safety of the school environment for children with food allergy. The availability of stock epinephrine, improved allergen labeling of food and menus and increased food allergy education may be key policy areas on which to focus.
School Nurse Perspectives on School Policies for Food Allergy and Anaphylaxis
Although school health care professionals are integral to the management of students with food allergy, their views on school food allergy policies have not yet been reported.
A total of 242 completed surveys were included in the analysis. Thirty-two percent of nurses reported an allergic reaction in their school in the past year. Most schools used a variety of policies, including anaphylaxis training for staff (96.7%), stock epinephrine availability (81.7%), designated lunch areas (62.2%), and food guidelines for classrooms (61.8%). Barriers to implementation included financial, time, and attitudinal considerations. Schools with pre-K or kindergarten students had higher odds of having designated lunch areas (adjusted odds ratio [OR], 2.1; 95% confidence interval [CI], 1.0–4.1; P < .05). The odds of having emergency epinephrine available were higher in schools with a full-time nurse (OR, 2.6; 95% CI, 1.1–6.3; P < .05) and in schools reporting at least 1 severe reaction in the past year (OR, 3.2; 95% CI, 1.2–8.5; P < .05).
With one-third of school nurses reporting an allergic reaction in the past year, schools use many strategies to minimize allergen exposures and increase anaphylaxis preparedness. Most school nurses favor these policies and acknowledge barriers to implementation.
Food Allergy Management and Anaphylaxis Preparedness in a Suburban School District Varies by School Level
Food allergy (FA) affects up to 8% of school-age children,1 and management of FA in schools has become a major public health issue. Although there are few proven strategies for improving FA safety in schools, consensus guidelines recommend that all students at risk for anaphylaxis due to FA have an individualized emergency action plan (EAP), as well as an epinephrine autoinjector (EAI) available at all times.2,3 Few studies have evaluated the percentage of children with FA with an EAP and an EAI available at school and, to our knowledge, none have evaluated for differences between school levels.4,5 The objective of our study was to determine the percentage of students with FA who had an EAP and EAI available, according to school level in a suburban school district.
The school district assessed had a total of 5,738 students, with a mean household income of $106,134, per United States Census data. The district was comprised of 5 elementary schools (grades K–5), 2 junior high schools (grades 6–8), and 2 high schools (grades 9–12). All 9 schools in the district were staffed with a school nurse, and each school nurse provided data for grades K–12 for the 2015– 2016 school year. Data were collected at the start of the school year, and included the types of self-reported FA for each student and whether these students had an EAP and EAI available at school. Students with permission to self-carry an EAI were also required to provide an EAP to the school nurse. All schools had undesignated stock EAIs.
In conclusion, this study shows that, despite similar rates and types of self-reported FAs in grades K–12, there was a significantly lower percentage of students with EAPs and EAIs at school in grades 9–12 compared with grades 6–8 and K–5, thus identifying an educational opportunity within this high-risk population.