Managing Allergies in School: A Guide for Parents
Allergies are among the most common medical conditions affecting children in the United States. According to the American College of Allergy, Asthma and Immunology:
- 8.4% of U.S. children under age 18 have allergic rhinitis (hay fever);
- 10% have respiratory allergies;
- 5.4% have food allergies; and
- 11.6% have skin allergies (hives or eczema).
With so many children living with one or more allergies, it’s important for families to learn about how to send their child off to school safely with these conditions.
Should I send my kid to school with allergies?
Absolutely! Schools are prepared to manage food allergies, environmental allergies and latex allergy.
When sending your child off to school, though, it’s important to make sure school staff is aware of your child’s allergies. Parents play a key role in working collaboratively with school staff on allergy management. That way, staff will be prepared to manage any symptoms that occur. You will work together to create a plan so your child will be able to fully participate in school and remain safe.
Everyone has their responsibilities – the staff, the parents, even the student.
What types of allergies may need managing at school?
Children spend most of their time during the week at school. That means if they have an allergy that needs managing at home, they likely will also need this allergy managed at school should symptoms occur. Here are common allergies that may need managing at school:
Natural rubber latex can be present in school supplies, rubber bands, mouse pads, goggles, balloons, sports equipment and other materials.
People with latex allergy may also experience an allergic reaction to certain fruits and vegetables, such as bananas, kiwi and avocados. This happens because proteins in natural rubber latex are similar to those found in cross-reactive fruits and vegetables.
Also see products containing latex.
Any type of food allergy needs to be reported to the school so the staff can read labels and make sure children avoid exposure to any food to which they are allergic. The most common allergies are clearly labeled on most foods. If your child has a food allergy outside of the top 9 required on package labels, it is important to let your child’s school know about the allergy so they can prevent accidental exposure.
The nine most common food allergies are:
- cow’s milk
- tree nuts
How to deal with allergies at school
Get started early so you can set your child up for a safe and healthy school year. Education, advance planning and clear, confident communication with school staff about your child’s allergies are the best ways to avoid allergic reactions and ensure your child’s health and safety.
School Allergy Planning Checklist for Parents
Each year there seems to be more and more to remember when your child is in school. We’re here to help — please see below for a checklist that will help you partner in your child’s care at school, from the first day to the last. This checklist can be downloaded as a printable pdf.
Before the school year begins
- Make an appointment to see your child’s allergy specialist.
- Be sure your child’s medication dose is appropriate for their weight. This applies to antihistamines for a mild allergy and epinephrine if needed for anaphylaxis.
- Update medication orders if needed.
- Update or complete an Anaphylaxis Emergency Care Plan for use at home and at school.
- Have school forms completed – get a statement from the doctor about any foods to which your child is allergic so that it can be filed at school.
- Make an appointment to visit the school to discuss your allergy if needed.
- If your child is starting a new school, it’s a great idea to have a conversation with school staff.
- For managing a food allergy or an allergy with risk for anaphylaxis:
- Be sure your child/teen has full access to their epinephrine.
- Review signs of an allergic reaction with your child so they are sure when they need their emergency medication.
- Review how to use an epinephrine auto-injector if age appropriate.
- If needed, review your child’s Anaphylaxis Emergency Care Plan with your child and school staff.
- Be sure your child knows when to get help and who to go to in an emergency.
- If asthma is part of your child’s diagnosis, have the healthcare provider check if asthma is under control. Asthma symptoms can mimic anaphylaxis and also make an allergic reaction more severe.
When school starts
Deliver your child’s epinephrine auto-injector, medication permission forms and Anaphylaxis Emergency Care Plan to school either on or before the first day. It’s essential that parents are prepared on or before the first day of school to turn in all signed and updated health forms and a fresh supply of medications. Accidents are never planned. Emergencies can happen even during the early weeks of school.
Check the expiration date on any epinephrine auto-injector medications that you are providing. Make sure the fresh supply you pick up at the pharmacy will not expire during the school year. If needed, ask the pharmacist for medication with an expiration date as far in the future as possible.
Find out what the process is for allowing your child to self-carry medications if that is what you want your child to do. All 50 states have laws that allow students to self-carry epinephrine auto-injectors.
During the school year
Check in with your child at the end of each school day. Ask how your child feels and if there was any difficulty managing the allergy at school.
Keep track of the expiration dates of medications and replace them when needed.
Communicate any changes in medications or treatment plans to the school.
Report any allergic reactions that happen at home to the school health staff so they can watch for any further issues.
Encourage your child to fully participate in school programming. If your child ever feels excluded or bullied because of the allergy, notify the school for appropriate action.
At the end of the school year
- Plan to pick up any unused medication on the last day of school.
- Ask for any forms or health care plans that need to be completed for the next school year.
- If you have time, make a connection with school staff about how things went during the school year and discuss plans for the next school year.
Discussion points for parents
The connection between home, your student’s medical home and the school is an important partnership to keep your child healthy and ready to learn. It’s important to approach the school administration, staff and nurse in a collaborative way. Building bridges between home and school will promote a positive school experience every school year.
What to discuss with the school nurse
Plan to meet with the school nurse to get the conversation started. Do this well in advance of the first day of school. By working together, you and the school nurse can partner on creating an allergy-aware environment at school. The school nurse can help you determine what types of written school plans need to be in place and what accommodations are reasonable and necessary for your child. The school nurse can also lead in the development of emergency care plans and educate staff.
- Talk about your child’s allergies.
- Talk about any accommodations that your child may need – in the cafeteria or classroom – and drop off forms, medication and your child’s Anaphylaxis Emergency Care Plan.
- Consider providing the school with written permission to call your child’s pediatrician with any questions.
- Update the school with any new information or inform them of any anaphylactic reactions that your child experiences outside of school.
What to discuss during an office visit with your child’s allergy and asthma specialist
Make arrangements to see your doctor or allergist during the summer to monitor your child’s food or environmental allergies.
Update their medication forms and Anaphylaxis Emergency Care Plan. Some schools may refer to this as an Anaphylaxis Action Plan.
Talk about concerns you may have and include your child in the discussion about allergy management.
What to discuss with the food services department
If your child has food allergies, find out how the school’s nutrition specialist will manage substitution requests. Make sure you turn in the signed special dietary needs request form from your child’s doctor identifying your child’s food allergy. This should include any needed food substitutions (for example, if your child has a milk allergy, you may want the school to substitute juice or water). Your school’s food services director or other school nutrition professionals can assist you as needed.
What to discuss when you meet your child’s teacher
Schedule a meeting with the teacher. It will be important to form a positive, collaborative partnership. Create open lines of communication with teachers and staff.
What do you want school staff to know about how you manage your child’s allergies? What does your child want them to know? Involve your child in building relationships with teachers. Discuss how to share information without publicly singling out your child.
Visit the classroom – is the environment as free of allergens as possible?
Is there a class pet?
Is there upholstered furniture, pillows and/or rugs that may hold dust mites?
Is food available in the classroom? Do children eat snacks or meals in the classroom? Is the environment safe for students with food allergies?
Is food used for classroom celebrations? How will you learn about upcoming special events, parties, field trips or other events that may involve food?
Is there any evidence of mold? (More often seen in older buildings.)
Are the classrooms dusted regularly?
What to discuss with your child
It’s very important to prepare your child with age-appropriate self-management skills.
When plans are in place for your child, it reduces anxiety that can come with a new school year. When you communicate confidence, your child can learn to follow practical management strategies and feel safe at school.
Your child has responsibilities, too. Each child should learn to self-manage, in an age-appropriate way, including:
- Avoid pets and wash hands after touching animals.
- Know triggers and work with school staff to avoid them.
- Tell a grown up if you’re experiencing allergy symptoms.
- Wash hands before and after eating.
- No sharing of food.
- Refuse food offered if you’re not sure it’s safe.
- Be responsible if you’re self-carrying medications.
- Know who to talk to if bullying is happening.
- Tell a grown up if you’re experiencing an allergic reaction.
Questions & Answers on allergy policies in schools (Q&A)
Usually, a school district will have a written policy on allergy management at school. Parents can ask to review the policy. Some districts also have written protocols on dealing with an allergic reaction or allergy emergencies at school.
Do students need an allergy form for school?
It is highly recommended that children with food allergies or children who are at risk for anaphylaxis have written school plans and forms in place. A school health care plan can include one or more of the following:
- Individualized health care plan (IHP). The school nurse writes this plan.
- Anaphylaxis Emergency Care Plan (ECP). This may also be called an Emergency Action Plan, an Allergy Action Plan or an Allergy & Anaphylaxis Action Plan. Your child’s doctor writes this treatment plan.
- Section 504 Plan. This is written by the school team and parents. A child would also have an ECP to manage allergy emergencies.
- Individualized Education Plan. This is for students that also have an educational disability. This is written by the school team.
Section 504 of the Rehabilitation Act of 1973 and the Individuals with Disabilities in Education Act are federal laws that protect students with disabilities in the school setting.
What is an Anaphylaxis Emergency Care Plan?
An Anaphylaxis Emergency Care Plan, or Allergy Action Plan, will identify your child’s allergy and your child’s symptoms. It will provide instructions as to what action should be taken in the event of a serious allergic reaction, including medication to be given. This can help school staff and also with other caregivers who need to understand allergies.
Examples as printable pdf:
Do I need an allergy awareness letter for schools?
You should provide the school with a statement of your child’s medical diagnosis stating their allergen(s). This may be on a form you are required to submit or you can write a letter explaining your child’s allergies. Your child’s doctor should provide the Anaphylaxis Emergency Care Plan and any written orders for medications.
If you want a letter to go home to classroom families, one can be sent without identifying your child.
Can kids with allergies carry their epinephrine devices at school?
If your child is prescribed an EpiPen(R), Auvi-Q(R) or other type of epinephrine auto-injector, the doctor and school nurse can determine if your child is developmentally ready to carry medication at school. Most states allow children to carry epinephrine at school.
Can you take allergy medicine to school?
Allergy medication can be kept in the school health office to be administered to your child as needed. Students are sometimes not permitted to carry medications at school. Check with school officials to determine how they handle medications that are given on an “as-needed” basis.
Questions & Answers on food allergy in school (Q&A)
If a student comes to school with a food allergy, the school can make accommodations to reduce the risk of an allergic reaction.
Most school staff have a lot of experience in managing food allergies in schools, but as a parent, it’s important for you to share your child’s unique experience with allergies with the school staff.
In most schools, the school nurse will be your point of contact and the person designated to direct care. Be sure you know who is responsible at your child’s school for managing food allergies. Many schools do not have a full-time school nurse. Learn who will respond to food allergy emergencies and collaborate with that staff person.
How can the school help a child with food allergies?
Schools are familiar with managing food allergies. They evaluate ways to prevent an exposure to the student’s allergen.
- Staff can be vigilant about avoiding your child’s allergens.
- School staff can manage your child’s needs while ensuring that the environment is “allergy-safe.”
- Staff can respect the right to confidentiality for students with food allergies about their health condition.
- Food service professionals can offer an allergen-safe meal to the student.
- Staff can prepare for an emergency response as needed.
Here’s more information on food allergy management at school.
Questions & Answers on latex allergy in school (Q&A)
If a student comes to school with a latex allergy, the school can make accommodations to reduce the risk of an allergic reaction. Latex allergy is an allergic reaction to the proteins found in the milky sap of the Hevea brasiliensis rubber tree. Latex allergy is also known as a natural rubber latex allergy.
How do you know if your child is allergic to latex?
If your child reacts to objects that contain natural latex or certain foods that cross-react with latex, schedule a visit with a doctor or allergist to determine if a latex allergy is present.
Do desks and other items in school have latex?
Most desks don’t contain latex. Latex appears in items commonly used in school, including many brands of erasers, balloons, rubber bands, gloves, balls and mats used in physical education. The school needs to identify latex-free school products and latex-free sports equipment when a student has an allergy.
What is a school's responsibility for protecting students with a latex allergy?
As with all allergies, the school is responsible for providing a safe environment for a student. While latex allergy is rare, affecting up to 6 percent of the population, and children who have undergone multiple surgeries – such as children with spina bifida – are at an increased risk for latex allergy.
The only way for people with latex allergy to prevent an allergic reaction is strict avoidance of latex.
Latex allergy management at school is as complex as it is important. Some articles with latex are easy to spot – latex balloons, rubber gloves, rubber bands, while some aspects of latex allergy are harder to spot. Many people don’t realize that latex can cross-react with foods that have similar proteins, especially fruits such as banana, avocado, chestnut and kiwi. Special attention must be paid to both the classroom and cafeteria settings in the school setting.
Latex Allergy: A Practical Guide for Patients & Providers is a printable pdf and guide to manage latex allergy in schools.
Questions & Answers on environmental allergies at schools (Q&A)
Environmental allergies can be mild and annoying or serious and debilitating. Either way, they impact your child’s everyday life. And they may need to be managed at school.
What are environmental allergies?
Environmental allergies are caused by substances in the indoor or outdoor environment.
Symptoms include runny nose, nasal congestion, postnasal drip, sneezing, coughing and shortness of breath. Eyes may begin to itch, become red or get watery. Skin may develop eczema or hives.
How do you deal with environmental allergies?
Avoiding the allergen is important, but not always practical – it’s hard to avoid pollen in the spring!. Here are some tips:
- Minimize contact with pollen – watch local pollen reports.
- Change clothes and remove shoes immediately after being outdoors.
- Bathe before going to bed.
- Clean or replace filters in HVAC systems once a month.
- Keep windows closed and limit outdoor activity when mold levels are high,
- Use a dehumidifier in damp areas.
- Eliminate indoor molds with a bleach solution or nontoxic mixture of 1T baking soda, 2T white vinegar and 1 quart of water.
How can the school help a child with environmental allergies?
The school can create a healthy environment for children with environmental allergies.
- Remove pets that trigger allergy symptoms.
- Promote an odor-free environment, including no perfumes, no strong odors from cleaning supplies.
- Ensure adequate ventilation.
- Allow the child to stay in from recess on days when pollen counts are impacting their day.
- Close windows during times of high pollen counts to reduce allergens in the environment.
Other Questions & Answers on allergies in schools (Q&A)
Allergies at school bring up many questions. While we’ve already looked at many in the sections above, we answer a few more here. With allergies, always think about keeping the child away from the allergen or keeping the allergen away from the child.
Why does my child's allergies only kick in when school starts back?
Any time that a child with allergies changes their routine, there is a risk for an allergic reaction. With environmental allergies, when the child returns to school, it is often the season for ragweed pollen.
Many allergens are indoor irritants. Some students can be very sensitive to odors, including perfumes or cleaning supplies.
It’s important for students with environmental allergies to know the air quality index each day to manage their allergies well. You can use the Asthma and Allergy Forecast to help gauge outdoor conditions for asthma, allergy and the flu in your zip code any day of the year.
What is the best way to prevent anaphylaxis in schools?
Anaphylaxis, a life-threatening allergic reaction, is best prevented by avoiding the child’s allergen and preventing an exposure. This can be very difficult with cross-contact and hidden ingredients, but this is the only way to truly prevent an allergic reaction.
Anaphylaxis is most often seen in allergies to food, insect venom, latex and medications. Sometimes the cause of anaphylaxis may be unknown. Work with your child’s allergist to identify a cause.
Why do my allergies get worse in school?
Parents are very used to managing their child’s allergies at home. They often have a routine that avoids exposure to the allergen. They also provide medicine whenever needed. Schools interrupt the home routine and put the child in a different environment. Both of these may cause allergies to seemingly “get worse.”
How to get rid of allergies at school?
Allergies can be managed, but rarely can we “get rid of” an allergy. With vigilance in avoiding allergen exposures, proper medication when needed, and a collaborative relationship between home and school, your child can achieve a high quality of life even with allergies.
Are allergies a good reason to miss school?
In most cases, it is always advisable to send a child with allergies to school. The school can help manage the allergy and your child will benefit from the school’s educational program on a daily basis.
Can allergies affect school performance?
Students’ school performance can be affected any time they don’t feel well. This can happen during high pollen seasons as well as exposure to other allergens. Working with the school to minimize allergen exposure can help your child do well in school.
School Health Resources
Don Bukstein, MD, FACAAI, is a board-certified allergist and immunologist and pediatric pulmonologist. He serves as Medical Director for Allergy & Asthma Network. Dr. Bukstein also volunteers at a Medicaid clinic in inner city Milwaukee. He is the former Director of Allergy and Asthma Research at Dean Medical Center in Madison, Wisconsin.