Food Allergies in Inner-City Schools: Addressing Disparities and Improving Management

Abstract

Objective: Food allergy (FA) affects approximately 8% of children in the United States. Management comprises both preventing and treating allergic reactions, which poses unique challenges in the inner-city school setting. In this article, we review the epidemiology of FA in school-aged children and management challenges and opportunities specific to the inner-city population.

Data sources: A literature search of the PubMed database was performed to identify published literature on FA epidemiology, FA management, school policies, disparities, inner-city, race, ethnicity, and socioeconomic status.

Study selections: Relevant articles on FA management best practices and challenges in schools, with a particular emphasis on inner-city schools and populations and socioeconomic, racial, and ethnic disparities, were reviewed in detail.

Results: Disparities in FA prevalence, management, and treatment exist. Additional research is needed to better characterize these disparities and elucidate the mechanisms leading to them. There is a lack of evidence-based interventions for the prevention and treatment of food allergic reactions in schools and specifically in inner-city schools, in which a greater proportion of students may rely on school food.

Conclusion: There are opportunities for partnership among health care providers, schools, and communities to address unmet needs in FA management and disparities in the inner-city school setting.

Figure 1.

Risk factors for food allergy in inner-city children. Risk factors for food allergy development and severity, and the possible interaction with social determinants of health and other social and environmental factors, are summarized.

Figure 2.

Socioecological model of barriers to and facilitators for inner-city school food allergy management. Individual-level comprises children with food allergies and their parents. Interpersonal level comprises relationships among patients, families, peers, school staff, and health care providers. School-level comprises school nurses, teachers, and other school staff. Community and public policy level comprises relationships among institutions, laws, and policies.