School Allergy Policies Across the States: A Holistic Review of State-Level Guidelines


Food allergies affect approximately two children per average-sized classroom, and prevalence has increased in recent decades (Gupta et al., 2011; Pawankar et al., 2013). This increase has important implications for school psychologists and counselors because allergies can impact various psychosocial aspects of students’ lives (Vale et al., 2015). Unfortunately, psychosocial considerations related to allergy management are often treated as peripheral in school food allergy policy development (Behrmann, 2010a). The purpose of the current review was to examine the availability of state-level guidelines and to evaluate available guidelines according to research supported practices for students including those impacting psychosocial facets of students’ lives. Guideline documents identified varied in size and form and when available tended to provide limited coverage of social and emotional factors. Our review provides insight into scope of attention to psychosocial facets of well-being in state-level allergy policy guidelines and concludes with implications for practice across multiple tiers of support.

This is a preview of subscription content, access via your institution.

Fig. 1

Availability of data and materials

Data and additional information regarding analyses can be accessed upon request.

Code availability



  1. Adams, C. D., Hinojosa, S., Armstong, K., Takagishi, J., & Dabrow, S. (2016). An innovative model of integrated behavioral health: School psychologists in pediatric primary care settings. Advances in School Mental Health Promotion, 9, 188–200.

    Article  Google Scholar 

  2. Alabama State Department of Education. (2015). Anaphylaxis preparedness guidelines.

  3. American Academy of Allergy, Asthma, and Immunology. (2021). Practice parameters and other guidelines.

  4. Arizona Department of Education. (2012). Arizona resource guide for supporting children with life-threatening food allergies.

  5. Bartnikas, L. M., Huffaker, M. F., Sheehan, W. J., Kanchongkittiphon, W., Petty, C. R., Leibowitz, R., et al. (2017). Impact of school peanut-free policies on epinephrine administration. Journal of Allergy and Clinical Immunology, 140(2), 465–473.

    Article  Google Scholar 

  6. Baumgart, K., Brown, S., Gold, M., Kemp, A., Loblay, R., Loh, R., Mitrou, D., Mullins, R., Peake, J., Ruhno, J., Said, M., Smith, V., Smith, W., Solley, G., Soutter, V., Tang, M., & Ziegler, J. (2004). ASCIA guidelines for prevention of food anaphylactic reactions in schools, preschools and child-care centres. Journal of Paediatrics and Child Health, 40(12), 669–671.

    Article  PubMed  Google Scholar 

  7. Behrmann, J. (2010a). Ethical principles as a guide in implementing policies for the management of food allergies in schools. The Journal of School Nursing, 26(3), 183–193.

    Article  PubMed  Google Scholar 

  8. Behrmann, J. (2010b). Allergies and asthma: Employing principles of social justice as a guide in public health policy development. Les Ateliers De Léthique Dossier : L’Éthique Et l’Impact Des Politiques Publiques Sur La Santé, 5(1), 119–130.

    Chapter  Google Scholar 

  9. Bollinger, M. E., Dahlquist, L. M., Mudd, K., Sonntag, C., Dillinger, L., & Mckenna, K. (2006). The impact of food allergy on the daily activities of children and their families. Annals of Allergy, Asthma & Immunology, 96(3), 415–421.

    Article  Google Scholar 

  10. Carley, K. (1993). Coding choices for textual analysis: A comparison of content analysis and map analysis. Sociological Methodology, 23, 75–126.

    Article  Google Scholar 

  11. Centers for Disease Control and Prevention. (2013). Voluntary guidelines for managing food allergies in schools and early care and education programs (pp. 1-106). : US Department of Health and Human Services.

  12. Coffman, J., Cabana, M., & Yelin, E. (2009). Do school-based asthma education programs improve self-management and health outcomes. Pediatrics, 124(2), 729–742.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Connecticut State Department of Education. (2012). Guidelines for managing life-threatening allergies in Connecticut schools. Middletown, CT.

  14. Fong, A. T., Katelaris, C. H., & Wainstein, B. (2017). Bullying and quality of life in children and adolescents with food allergy. Journal of Paediatrics and Child Health, 53(7), 630–635.

    Article  PubMed  Google Scholar 

  15. Food Allergy Research and Education. (2019). Food allergy myths and misconceptions.

  16. Friedman, A. H., & Morris, T. L. (2006). Allergies and anxiety in children and adolescents: A review of the literature. Journal of Clinical Psychology in Medical Settings, 13(3), 318–331.

    Article  Google Scholar 

  17. Greenhawt, M. J., Green, T. D., Pistiner, M., & Mitchell, L. (2011). Empathy, understanding, and objectivity need to prevail for students with food allergies. Annals of Allergy, Asthma & Immunology, 107(2), 93–94.

    Article  Google Scholar 

  18. Gupta, R. S., Springston, E. E., Warrier, M. R., Smith, B., Kumar, R., Pongracic, J., & Holl, J. L. (2011). The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics, 128(1).

  19. Hu, W., Kerridge, I., & Kemp, A. (2004). Reducing the risks for food allergic children in schools and preschools. Journal of Paediatrics and Child Health, 40, 672–673.

    Article  PubMed  Google Scholar 

  20. Huber, M., Knottnerus, J. A., Green, L., Horst, H. V. D., Jadad, A. R., Kromhout, D., Leonard, B., Lorig, K., Loureiro, M., Meer, J., Schnabel, P., Smith, R., Weel, C., & Smid, H. (2011). How should we define health. Bmj, 343, 4163–4163.

    Article  Google Scholar 

  21. Illinois State Board of Education, Illinois Department of Public Health. (2010). Guidelines for managing life-threatening food allergies in Illinois schools.

  22. Krippendorff, K. (2019). Content analysis an introduction to its methodology. Sage.

  23. Leech, N. L., & Onwuegbuzie, A. J. (2008). Qualitative data analysis: A compendium of techniques and a framework for selection for school psychology research and beyond. School Psychology Quarterly, 23(4), 587–604.

    Article  Google Scholar 

  24. Leroy, Z. C., Wallin, R., & Lee, S. (2016). The role of school health services in addressing the needs of students with chronic health conditions. The Journal of School Nursing, 33(1), 64–72.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lyons, A. C., & Forde, E. M. E. (2004). Food allergy in young adults: Perceptions and psychological effects. Journal of Health Psychology, 9(4), 497–504. 10.1177/1359105304044032

  26. Maine Department of Education. (2015) Allergies: Revised January 2015.

  27. Marklund, B., Wilde-Larsson, B., Ahlstedt, S., & Nordström, G. (2007). Adolescents experiences of being food-hypersensitive: A qualitative study. BMC Nursing, 6(1).

  28. Maryland State Department of Education. (2009). Maryland School Health Services Guideline—Management of students at risk for anaphylactic reaction.

  29. Massachusetts Department of Elementary and Secondary Education. (2016). Managing life-threatening allergies in schools.

  30. Matthews, C. (2013). Critical pedagogy in health education. Health Education Journal, 73(5), 600–609.

    Article  Google Scholar 

  31. Mcintyre, C. L., Sheetz, A. H., Carroll, C. R., & Young, M. C. (2005). Administration of epinephrine for life-threatening allergic reactions in school settings. Pediatrics, 116(5).

  32. Michigan Department of Education. (2016). Food allergy guidelines for Michigan schools.

  33. Mikkonen, K., & Kääriäinen, M. (2019). Content analysis in systematic reviews. The Application of Content Analysis in Nursing Science Research, 105–115.

  34. Mississippi Department of Education/Office of Healthy Schools. (2008). Managing food allergies in Mississippi schools guidelines.

  35. Missouri Department of Health and Senior Services. (2014). Guidelines for allergy prevention and response.

  36. Murdoch, B., Adams, E. M., & Caulfield, T. (2018). The law of food allergy and accommodation in Canadian schools. Allergy, Asthma & Clinical Immunology, 14(1).

  37. National Association of School Psychologists Principles for Professional Ethics (2010). School Psychology Review, 39(2), 302–319.

  38. National School Boards Association. (2011). Safe at school and ready to learn a comprehensive policy guide for protecting students with life threatening food allergies.

  39. New Jersey Department of Education. (2008). Guidelines for the management of life-threatening food allergies in schools.

  40. New York State Department of Health, New York State Education Department, New York Statewide School Health Services Center. (2008). Making the difference; caring for students with life-threatening allergies.

  41. Office of Superintendent of Public Instruction. (2008). Guidelines for care of students with life-threatening food allergies.

  42. Pawankar, R., Holgate, S. T., Walter Canonica, G., Lockey, R. F., & Blaiss, M. (2013). WAO White Book on Allergy Executive Summary (pp. 1-13, Executive Summary). Milwaukee, WI: World Allergy Organization.

  43. Pennsylvania Department of Education, Pennsylvania Department of Health. (2011). Pennsylvania guidelines for management of food allergies in schools.

  44. Pistiner, M., & Lee, J. J. (2012). Creating a new community of support for students with food allergies. NASN School Nurse, 27(5), 260–266.

    Article  PubMed  Google Scholar 

  45. Pistiner, M., & Wang, J. (2020). Management of food allergy in the school setting: The clinician’s role. In R. Gupta (Ed.), Pediatric food allergy. Springer.

  46. Power, T. J., & Bradley-Klug, K. L. (2013). School-based practice in action. Pediatric school psychology: Conceptualization, applications, and strategies for leadership development. Routledge/Taylor & Francis Group.

  47. Power, T. J., DuPaul, G. J., Shapiro, E. S., & Parrish, J. M. (1995). Pediatric school psychology: The emergence of a subspecialty. School Psychology Review, 24, 244–257.

    Article  Google Scholar 

  48. Power, T. J., McGoey, K. E., Heathfield, L. T., & Blum, N. J. (1999). Managing and preventing chronic health problems in children and youth: School psychology’s expanded mission. School Psychology Review, 28, 251–263.

    Article  Google Scholar 

  49. Ravid, N., Annunziato, R., Ambrose, M., Chuang, K., Mullarkey, C., Sicherer, S., Shemesh, E., & Cox, A. (2012). Mental health and quality-of-life concerns related to the burden of food allergy. Immunology and Allergy Clinics of North America, 32(1), 83–95.

    Article  PubMed  Google Scholar 

  50. Schmitt, A. J., Wodrich, D. L., & Lorenzi-Quigley, L. (2019). Current status of pediatric topics in five school psychology journals: Publication trends between 2002 and 2019. School Psychology, 35(3), 171–178.

    Article  PubMed  Google Scholar 

  51. Shah, S. S., Parker, C. L., & Davis, C. M. (2013). Improvement of teacher food allergy knowledge in socioeconomically diverse schools after educational intervention. Clinical Pediatrics, 52(9), 812–820.

    Article  PubMed  Google Scholar 

  52. Shemesh, E., Annunziato, R. A., Ambrose, M. A., Ravid, N. L., Mullarkey, C., Rubes, M., Chuang, K., Sicherer, M., & Sicherer, S. H. (2012). Child and parental reports of bullying in a consecutive sample of children with food allergy. Pediatrics, 131(1).

  53. Sicherer, S. H., & Mahr, T. (2010). Management of food allergy in the school setting. Pediatrics, 126(6), 1232–1239.

    Article  PubMed  Google Scholar 

  54. Simpson, K., & Freeman, R. (2004). Critical health promotion and education—A new research challenge. Health Education Research, 19(3), 340–348.

    Article  PubMed  Google Scholar 

  55. Texas Department of State Health Services. (2011). Guidelines for the care of students with food allergies at-risk for anaphylaxis.

  56. Vale, S., Smith, J., Said, M., Mullins, R. J., & Loh, R. (2015). ASCIA guidelines for prevention of anaphylaxis in schools, pre-schools and childcare: 2015 update. Journal of Paediatrics and Child Health, 51(10), 949–954.

    Article  PubMed  Google Scholar 

  57. Walkner, M., Warren, C., & Gupta, R. S. (2015). Quality of life in food allergy patients and their families. Pediatric Clinics of North America, 62(6), 1453-1461.

  58. Weiss, C., Muñoz-Furlong, A., Furlong, T. J., & Arbit, J. (2004). Impact of food allergies on school nursing practice. The Journal of School Nursing, 20(5), 268–278.

    Article  PubMed  Google Scholar 

  59. West Virginia Department of Education. (2017). Guidelines for allergies in the school setting.

  60. Willgerodt, M. A., Brock, D. M., & Maughan, E. D. (2018). Public school nursing practice in the United States. The Journal of School Nursing, 34(3), 232–244.

  61. Young, M. C., Mun ̃ oz-Furlong, A., & Sicherer, S. (2009). Management of food allergies in schools: A perspective for allergists. Journal of Allergy and Clinical Immunology, 124(2).

Download references

Author information





Corresponding author

Correspondence to Sadie C. Cathcart.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cathcart, S.C., Bender, S.L. & Li, K. School Allergy Policies Across the States: A Holistic Review of State-Level Guidelines. Contemp School Psychol (2021).

Download citation


  • Allergy
  • School policy
  • Biopsychosocial
  • Holistic
  • Systematic review