The updated guidance incorporates the latest national guidelines and laws, including support for stock epinephrine in schools.
ITASCA, IL—As many as 1 in 10 children have food allergies that can lead to severe allergic reactions, including anaphylaxis -- a critical reason why schools and childcare providers must be prepared to handle these types of medical emergencies.
Updated clinical guidance from the American Academy of Pediatrics describes the essential role that pediatricians play in food allergy management in schools. The report, “Management of Food Allergy in Schools,” replaces a 2010 report and incorporates the latest relevant national guidelines and laws. It is published in the December 2025, Pediatrics (published Sept. 25 online).
Clinical reports created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.
“Pediatricians diagnose allergies and prescribe medications like epinephrine, but they are also an important source of education for families and school staff on how to prevent allergic reactions and respond to them,” said Scott H. Sicherer, MD, FAAP, lead author of the report, written by the AAP Section on Allergy and Immunology and the AAP Council on School Health.
“Right now, 1 in 15 schools experience a case of anaphylaxis each year. That can be a scary and potentially devastating scenario without a predetermined plan in place on how to respond,” he said.
The management of food allergies requires a coordination of care that includes the pediatrician, the school nurse, parents, and other caregivers in the child’s life, according to the AAP.
Getting an appropriate diagnosis of food allergy is the first step,” said Sonja O’Leary, MD, FAAP, co-author of the report. “But there are many cases where the child has never had an allergic reaction before. It is important for schools to be prepared for any emergency due to allergy.”
The AAP provides instruction on prescribing epinephrine devices for anaphylaxis management and recommendations on stocking epinephrine in schools, which may vary according to state and federal laws.
Although any food may trigger an allergic reaction, the most serious reactions are attributable to peanut, tree nuts, milk, egg, soy, wheat, fish, shellfish, and sesame.
The report describes symptoms of anaphylaxis, including the onset of hives, itching or flushing skin within minutes or a few hours of exposure to an allergen; trouble breathing or wheezing; dizziness or fainting.
The AAP also discusses the social and emotional impact of allergies on children, who may experience anxiety, teasing or bullying. Students should be encouraged to report bullying, and anti-bullying programs can be implemented. General education about food allergy for students and staff may promote peer support, according to AAP.
“While awareness about allergies has increased over the years, a child’s safety really depends on a team approach – in which school staff are trained and emergency supplies are on hand in case of a severe allergic reaction,” Dr. Sicherer said. “There are a number of actions everyone can take to reduce risks of allergic reactions, as well. Your pediatrician can help provide that information.”
For an interview with an author, contact AAP Public Affairs.
Other resources include:
Anaphylaxis in Infants & Children: Responding to Severe Allergic Reactions - HealthyChildren.org
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