Stronger policies in schools can curb the anxieties of students with food allergies

Lisa Bartnikas, MD is a pediatric allergist at Boston Children’s Hospital, whose research has focused around the differences between and psychosocial impacts of peanut-free policies in schools.

Bartnikas said she fell in love with food allergies because of all the unknowns and room for further research and greater understanding in the field. Major questions — like what factors play into why some people have severe reactions to certain foods while others have no reaction at all — are what encourage Bartnikas to strive to make a difference in her patients’ lives.

This article has been edited for clarity. In the context of pediatric allergy patients, what are the biggest concerns and questions? Some of the [questions] that really always came [up] about food allergies were how do you manage this, how do I keep my child safe? Kids spend most of their time at school, so how do you keep them safe at school? … Is the school peanut-free or not, or nut-free or not, should they be at the nut-free table, nut-free classroom? There's all of these questions around it and no one knows the answer for how to best keep people safe … It's frustrating for families to not have these answers but there's just so much room to try to answer questions and make a difference.

Your research is more in the realm of social impacts of allergies. Can you tell me about your research in local schools? Ours was the first study in Massachusetts looking comprehensively at [peanut-free policies], because nobody knows what the numbers are, how common it is. A lot of schools do have various policies around can you bring in certain food allergens mainly focused on peanuts and tree nuts, can the school serve them, are there nut-free classrooms, are there special tables for kids with food allergies to sit at.

And what were some things you found? What factors played a role in the differences in policies between schools? The socioeconomics, interestingly do seem to make a difference and it was honestly the total opposite of what I would have [expected]. The schools that had more students of lower socioeconomic status and more racial minority students tended to have more restrictive policies than the ones without … But other studies showed that the more restrictive policies didn't make a difference in reducing reaction, like putting up more roadblocks without helping fix a problem.

In what ways is the life of a child with food allergies, and the family, skewed from the “norm”? The quality of life and the psychosocial impact is huge and it's different for people at different ages and impacts different people. The average three-year-old probably isn't worrying about accidentally eating peanut because they don't have that perception of the world yet, but their parents are probably very worried when they send them off to daycare or school or a friend's house … [In] the younger elementary school there are some kids who will start to get anxious about the food allergies [if] they've been listening to all the conversations their parents have been having at the doctor … where all of a sudden some kids will get very fearful of eating the food at school.

Do you often see cases of children who deal with being bullied for having a food allergy? Some studies have shown that kids with food allergies are twice as likely to be bullied compared to kids without, which is terrible, and one of the most common places that bullying happens is at schools … Just the sense of being different. We all have stuff that makes us different but there's this concept, especially for food allergy, when special becomes different. Think of birthday parties for a kid with a milk and egg allergy and everyone's having birthday cake and pizza, and they can't have any of that.That's really isolating.

From what you’ve seen in schools, what about the policies work? What needs to be changed? There's so many nuances and differences in policies. And we don't know what works best and I think with food allergies, there's a huge safety component but there's such a huge psychological component too and I think there's a lot of good information, there's also a lot of misinformation out there … Food allergy policies impact everybody, not just the food allergy [patients], because if you're restricting what food can be brought in, now nobody can bring in peanut butter … You're placing things in the hands of people who don't have food allergies to help keep the people with food allergies safe, and they may or may not pay attention to it.

What is the main way you suggest for both schools and families to deal with a child’s food allergy? My hope and my dream is to boil it down to two or three things for schools to do and to keep kids safe … The big picture for food allergies is don't eat what you're allergic to and have the epinephrine [injector]. If you do those two things, everybody will be safe.