Abstract

Food allergy (FA) is a potentially life-threatening condition caused by exposure to a specific food allergen. Healthcare professionals play a critical role in providing educational programs for children affected by FA and their caregivers. Equally important is training for all school staff so that they have the knowledge and skills to manage an allergic emergency and minimize the risk of complications. This review was performed to summarize the evidence of school-based educational intervention for management of FA. Relevant studies were identified in the MEDLINE and CINAHL databases, up to June 2024. Thirteen articles resulted eligible for inclusion and data analysis as they investigated the effectiveness of school-based intervention with pre-post evaluation for several outcomes, such as knowledge, attitudes, experiences, and self-efficacy. Although the interventions were very heterogeneous (mostly mixed or based on digital methods), all studies showed that the different educational programs resulted in a significant improvement in the various parameters taken into consideration. The current evidence therefore supports the effectiveness of expert educational interventions in school and the importance of strong collaboration between school and health systems. Studies that carefully evaluate the efficacy of each intervention and the quality of methodology are needed to identify the best educational strategy.

References

  1. Calvani M, Anania C, Caffarelli C, et al. Food allergy: an updated review on pathogenesis, diagnosis, prevention and management. Acta Biomed 2020;91(11-S):e2020012. https://doi.org/10.23750/abm.v91i11-S.10316.
  2. Food Allergy Research & Education (FARE). Common Allergens - Peanut, Egg, and Sesame Allergies.
  3. Nocerino R, Carucci L, Coppola S, et al. Epidemiology of Paediatric Italian Food Allergy: Results of the EPIFA study. J Allergy Clin Immunol Glob 2024;3:100246. https://doi.org/10.1016/j.jacig.2024.100246.
  4. Spolidoro GCI, Amera YT, Ali MM, et al. Frequency of food allergy in Europe: An updated systematic review and meta-analysis. Allergy 2023;78:351-368. https://doi.org/10.1111/all.15560.
  5. Elghoudi A, Narchi H. Food allergy in children-the current status and the way forward. World J Clin Pediatr 2022;11:253-269. https://doi.org/10.5409/wjcp.v11.i3.253.
  6. Spolidoro GCI, Ali MM, Amera YT, et al. Prevalence estimates of eight big food allergies in Europe: Updated systematic review and meta-analysis. Allergy 2023;78:2361-2417. https://doi.org/10.1111/all.15801.
  7. Motosue MS, Li JT, Campbell RL. Anaphylaxis: Epidemiology and Differential Diagnosis. Immunol Allergy Clin North Am 2022;42:13-25. https://doi.org/10.1016/j.iac.2021.09.010.
  8. Drakouli A-E, Kontele I, Poulimeneas D, et al. Food Allergies and Quality of Life among School-Aged Children and Adolescents: A Systematic Review. Children 2023;10:433. https://doi.org/10.3390/children10030433.
  9. Thörnqvist V, Middelveld R, Wai HM, et al. Health-related quality of life worsens by school age amongst children with food allergy. Clin Transl Allergy 2019;9:10. https://doi.org/10.1186/s13601-019-0244-0.
  10. Stjerna ML, Brady G. Inter-embodied parental vigilance; the case of child food allergy. Front Sociol 2023;8:1213769. https://doi.org/10.3389/fsoc.2023.1213769.
  11. Kachru R. Psychosocial issues and quality of life associated with food allergy. J Food Allergy 2020;2:95-98. https://doi.org/10.2500/jfa.2020.2.200025.
  12. Muraro A, Werfel T, Hoffmann-Sommergruber K, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 2014;69:1008-1025. https://doi.org/10.1111/all.12429.
  13. Santos MJL, Merrill KA, Gerdts JD, et al. Food Allergy Education and Management in Schools: A Scoping Review on Current Practices and Gaps. Nutrients 2022;14:732. https://doi.org/10.3390/nu14040732.
  14. Commissione Federasma Onlus - SIAIP per la tutela del bambino allergico. Raccomandazioni per la gestione del bambino allergico a scuola - 2015.
  15. Muraro A, Agache I, Clark A, et al. EAACI food allergy and anaphylaxis guidelines: managing patients with food allergy in the community [published correction appears in Allergy. 2014 Oct;69(10):1428]. Allergy 2014;69:1046-1057. https://doi.org/10.1111/all.12441.
  16. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009;62:e1-34. https://doi.org/10.1016/j.jclinepi.2009.06.006.
  17. Shah SS, Parker CL, Davis CM. Improvement of teacher food allergy knowledge in socioeconomically diverse schools after educational intervention. Clin Pediatr (Phila) 2013;52:812-820. https://doi.org/10.1177/0009922813497425.
  18. Ravarotto L, Mascarello G, Pinto A, et al. Food allergies in school: design and evaluation of a teacher-oriented training action. Ital J Pediatr 2014;40:100. https://doi.org/10.1186/s13052-014-0100-8.
  19. Sasaki K, Sugiura S, Matsui T, et al. A workshop with practical training for anaphylaxis management improves the self-efficacy of school personnel. Allergol Int 2015;64:156-160. https://doi.org/10.1016/j.alit.2014.10.005.
  20. White L, Aubin J, Bradford C, et al. Effectiveness of a computer module to augment the training of school staff in the management of students with food allergies. Ann Allergy Asthma Immunol 2015;114:254-255.e3. https://doi.org/10.1016/j.anai.2014.11.020.
  21. Gonzalez-Mancebo E, Gandolfo-Cano MM, Trujillo-Trujillo MJ, et al. Analysis of the effectiveness of training school personnel in the management of food allergy and anaphylaxis. Allergol Immunopathol (Madr) 2019;47:60-63. https://doi.org/10.1016/j.aller.2018.05.005.
  22. Canon N, Gharfeh M, Guffey D, et al. Role of Food Allergy Education: Measuring Teacher Knowledge, Attitudes, and Beliefs. Allergy Rhinol (Providence) 2019;10:2152656719856324. https://doi.org/10.1177/2152656719856324.
  23. Rodríguez Ferran L, Gómez Tornero N, Cortés Álvarez N, et al. Anaphylaxis at school. Are we prepared? Could we improve?. Allergol Immunopathol (Madr) 2020;48:384-389. https://doi.org/10.1016/j.aller.2019.10.006.
  24. Polloni L, Baldi I, Lazzarotto F, et al. Multidisciplinary education improves school personnel’s self-efficacy in managing food allergy and anaphylaxis. Pediatr Allergy Immunol 2020;31:380-387. https://doi.org/10.1111/pai.13212
  25. Poza-Guedes P, González-Pérez R. Implementing information and communication technology education on food allergy and anaphylaxis in the school setting. Clin Transl Allergy 2021;11:e12039. https://doi.org/10.1002/clt2.12039.
  26. Raptis G, Totterdell R, Gerasimidis K, et al. School allergy training promotes internal policy review and enhances staff’s preparedness in managing pupils with food allergy. Clin Transl Allergy 2021;11:e12042. https://doi.org/10.1002/clt2.12042.
  27. Yıldırım A, Haney MO. Effects of training on teachers’ food allergy and anaphylaxis management self-efficacy levels. Allergol Immunopathol (Madr) 2023;51:158-163. https://doi.org/10.15586/aei.v51i4.849.
  28. Lejtman P, Hetroit-Vasseur E, Morello R, et al. Evaluation of a video training program’s impact on primary teachers’ knowledge of allergies and skills in using an adrenaline autoinjector during the 2021-2022 school year. Arch Pediatr 2024;31:299-305. https://doi.org/10.1016/j.arcped.2024.03.003.
  29. Licata J, Evatt M, Pasek T, et al. Empowering middle school students to save lives through increasing awareness of food allergies and anaphylaxis through virtual media: A quality improvement project. J Pediatr Nurs 2024;75:221-223. https://doi.org/10.1016/j.pedn.2023.12.006.
  30. Mecarelli O, Capovilla G, Romeo A, et al. Knowledge and attitudes toward epilepsy among primary and secondary schoolteachers in Italy. Epilepsy Behav 2011;22:285-292. https://doi.org/10.1016/j.yebeh.2011.06.019.
  31. Mecarelli O, Messina P, Capovilla G, et al. An educational campaign toward epilepsy among Italian primary school teachers: 1. Survey on knowledge and attitudes. Epilepsy Behav 2014;32:84-91. https://doi.org/10.1016/j.yebeh.2014.01.009.
  32. Iannone LF, Roberti R, Arena G, et al. Assessing knowledge and attitudes toward epilepsy among schoolteachers and students: Implications for inclusion and safety in the educational system. PLoS One 2021;16:e0249681. https://doi.org/10.1371/journal.pone.0249681.
  33. Jones C, Atkinson P, Helen Cross J, et al. Knowledge of and attitudes towards epilepsy among teachers: A systematic review. Epilepsy Behav 2018;87:59-68. https://doi.org/10.1016/j.yebeh.2018.06.044.
  34. Jaramillo Y, Reznik M. Do United States’ teachers know and adhere to the national guidelines on asthma management in the classroom? A systematic review. Scientific World Journal 2015;2015:624828. https://doi.org/10.1155/2015/624828.
  35. Le TM, Kummeling I, Dixon D, et al. Low preparedness for food allergy as perceived by school staff: a EuroPrevall survey across Europe. J Allergy Clin Immunol Pract 2014;2:480-482.e1. https://doi.org/10.1016/j.jaip.2014.02.019.
  36. Juliá-Benito JC, Escarrer-Jaume M, Guerra-Pérez MT, et al. Knowledge of asthma and anaphylaxis among teachers in Spanish schools. Allergol Immunopathol (Madr) 2017;45:369-374. https://doi.org/10.1016/j.aller.2016.10.019.
  37. Lim SM, Law BP. Food allergy knowledge, attitude and management among preschool personnel in Malaysia. J Hum Nutr Diet 2023;36:2073-2084. https://doi.org/10.1111/jhn.13213.
  38. Madooh L, Allahou S, Alshallal H, et al. Food allergy knowledge, attitudes and beliefs of kindergarten teachers in Kuwait: a cross-sectional study. BMJ Paediatr Open 2023;7:e001795. https://doi.org/10.1136/bmjpo-2022-001795.
  39. Raptis G, Perez-Botella M, Totterdell R, et al. A survey of school’s preparedness for managing anaphylaxis in pupils with food allergy. Eur J Pediatr 2020;179:1537-1545. https://doi.org/10.1007/s00431-020-03645-0.
  40. Polloni L, Baldi I, Lazzarotto F, et al. School personnel’s self-efficacy in managing food allergy and anaphylaxis. Pediatr Allergy Immunol 2016;27:356-360. https://doi.org/10.1111/pai.12550.
  41. Schunk DH, DiBenedetto MK. Motivation and social cognitive theory. Contemp Educ Psychol 2020;60:101832. https://doi.org/10.1016/j.cedpsych.2019.101832.
  42. Muraro A, Agache I, Clark A, et al. EAACI food allergy and anaphylaxis guidelines: managing patients with food allergy in the community [published correction appears in Allergy. 2014 Oct;69(10):1428]. Allergy 2014;69:1046-1057. https://doi.org/10.1111/all.12441.
  43. Nielsen WW, Lindsey K. When there is no school nurse--are teachers prepared for students with peanut allergies? School Nurse News 2010;27:12-15.
  44. UNESCO Institute for Lifelong Learning. 5th global report on adult learning and education: citizenship education: empowering adults for change - 2022.
  45. Food Allergy Research and Education (FARE). Food Allergy Management in Schools (FAMS): Expert Recommendations. 2024.
  46. Western Australian School Canteen Association (WASCA). Food allergen management guide for school canteens - 2021.

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Marianna Riccio - Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy

Aurora Decembrini - Department of Pediatrics, Sapienza University of Rome, Rome, Italy

Marzia Duse - Department of Pediatrics, Sapienza University of Rome, Rome, Italy

Anna Maria Zicari - Department of Pediatrics, Sapienza University of Rome, Rome, Italy

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Riccio, M., Decembrini, A., Duse, M., & Zicari, A. M. (2025). The characteristics and effectiveness of school-based educational interventions in the management of children with food allergies: a systematic review . Italian Journal of Pediatric Allergy and Immunology, 39(1). https://doi.org/10.53151/2531-3916/2025-868
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