**1. Introduction**

Food allergy affects an estimated 7.0–8.0% of children worldwide, or about two children in an average-sized classroom of 25 children [1–5]. A food allergy is defined by Boyce et al. (2010) as "a potentially life-threatening immunological response that occurs reproducibly upon ingestion of the allergen" (p. 11) and has the potential to result in severe allergic reactions [6]. Anaphylaxis, the most severe type of allergic reactions, was operationalized by Sampson et al. (2006) as a "potentially fatal condition that involves multiple organ systems or, when exposed to a known allergen, low blood pressure" [7]. Anaphylaxis affects an estimated 2.0% of the North American population [6], with similar estimates (between 0.3% [8] to 3.1%) noted in European populations [9,10].

Prior to the coronavirus disease (2019-nCoV/COVID-19) pandemic, about 20.0% of anaphylactic reactions occurred in schools [11–13], an observation that is unsurprising

**Citation:** Santos, M.J.L.; Merrill, K.A.; Gerdts, J.D.; Ben-Shoshan, M.; Protudjer, J.L.P. 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

Academic Editor: Carla Mastrorilli

Received: 11 January 2022 Accepted: 31 January 2022 Published: 9 February 2022

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given that children typically spend the majority of their waking hours at school. Most in-school reactions occurred in the classroom, cafeteria, and playground [13–16]. Of concern is that an estimated 30.0% of allergic reactions occurred among children who were not previously known to have a food allergy or had an allergy that was not communicated to school staff [13,16].

Currently, policies surrounding food allergy management and its implementation are diverse both across and within jurisdictions [17–20]. Recently, international recommendations on the prevention and management for childcare centers and schools [11] was published based on the available scientific literature. Authors noted the utility of the guidelines as "conditional", wherein policymakers and stakeholders are to deliberate and adapt recommendations as needed to fit specific jurisdictional needs. Some of eight listed recommendations included school staff education and training, the removal of site-wide food bans and allergen-free zones, the requirement that children with a known food allergy had a current emergency anaphylaxis plan (EAP), and the availability of unassigned, or stock, epinephrine auto-injectors (EAI) in schools. Despite the need for further research in the topics described, this guideline may prompt jurisdictions to review and modify current policies.

The availability of EAI in school settings has been inconsistent. Students' access to and carriage of prescribed EAI also varies [21], and by socioeconomic advantage [22]. Even when a student has an EAI, school policy may render access difficult if it is locked in an office or exclusively carried by a staff member [12,13,16,21]. In cases where a prescribed EAI was unavailable, almost half of students requiring emergency medication were treated with stock epinephrine [23,24]. Additionally, trained staff available to administer EAI are also diverse. When available, school nurses administer EAI [13,14,23,25,26]. That said, only 50.0% of nurses reported food allergy management training, of which 35.0% described being "self-taught" [26]. As school nurses may work part-time [21] and among several schools [27], distributed responsibility and training among other school staff who are at school premises at all times is warranted. In brief, policies addressing stock EAI and EAP implementation are underused despite key recommendations and available resources [10,11,27,28].

Despite the above-described variation in policy, management, and treatment, there is, to our knowledge, no previous synthesis of the extant literature on teachers and school staff's knowledge and management practices of food allergy and anaphylaxis in schools. To this end, we aimed to conduct a scoping review on the in-school management of food allergies, and the perceived gaps or barriers in these management practices.
