Impact of School Nurses on Children with Food Allergies: A Comprehensive Review

Abstract

Background: Food allergies (FAs) are a significant public health concern, affecting 6-8% of children worldwide, with a growing prevalence. Schools are high-risk environments for allergic reactions, including anaphylaxis, which can be life-threatening. Alarmingly, up to 16-18% of children with FAs experience allergic reactions at school, often due to accidental exposure. Additionally, up to 25% of anaphylactic reactions in schools occur in children with no prior diagnosis of FA, emphasizing the critical need for school-wide preparedness and robust emergency action plans. School nurses play a pivotal role in managing FAs through individualized health plans, emergency preparedness, staff training, and psychosocial support. This review aims to evaluate the multifaceted role of school nurses in ensuring the safety, health, and psychosocial well-being of children with FAs. It also seeks to identify systemic challenges and gaps in allergy management to inform targeted interventions and future research.

Methods: This comprehensive review synthesizes evidence on the role of school nurses in FA management. A systematic literature search was conducted across PubMed, CINAHL, Scopus, and Cochrane, targeting studies published between 2014 and 2024. The search identified 6313 articles, of which 5490 remained after duplicate removal. After title and abstract screening, 60 articles were selected for full-text evaluation, with 59 included in the final review. Thematic analysis identified six domains: preventive measures, emergency preparedness, communication, health outcomes, psychosocial support, and systemic challenges.

Results: The review highlights the critical contributions of school nurses to FA management. They improve safety by implementing Individualized Health Plans (IHPs) and Emergency Action Plans (EAPs), ensuring timely administration of epinephrine and reducing delays during emergencies. Preventive strategies, such as allergen-free zones and comprehensive training for staff, minimize exposure risks. Psychosocial interventions led by nurses alleviate stigma, bullying, and anxiety, enhancing the quality of life for children with FAs. Despite these benefits, barriers persist, including insufficient nurse-to-student ratios, limited access to emergency resources like stock epinephrine, and disparities in allergy management across socioeconomic and geographic contexts.

Conclusions: School nurses are integral to managing FAs, ensuring safety, fostering inclusion, and addressing psychosocial needs. Addressing systemic barriers and ensuring equitable resource distribution are essential to optimize their impact. Future research should focus on the long-term outcomes of nurse-led interventions, strategies to reduce disparities, and the potential role of digital tools in improving allergy management.

Keywords: allergy safety policies; anaphylaxis prevention; emergency preparedness; epinephrine auto-injectors; food allergy management; inclusive education; individualized health plans (IHPs); pediatric health; psychosocial support; school nurses.

Figure 1

Flow diagram illustrating the selection process.