Managing Allergies in Schools

A group of five children with backpacks are joyfully running down a covered walkway, possibly at a school, with their arms raised. They appear to be heading towards a building. The atmosphere is lively and energetic.

Allergies are increasingly common among American children. More than 1 in 4 children in the United States has some type of allergy – whether it’s seasonal, environmental, or food-related.

The 2021 National Health Interview Survey found that:

  • 27.2% of children have one or more allergic conditions
  • 18.9% have seasonal or environmental allergies
  • 5.8% have food allergies

With so many students affected, keeping children safe at school is a shared priority. Parents want to know their children will get quick help if they show signs of a serious allergic reaction, also called anaphylaxis. Schools must also be prepared to prevent allergen exposure and respond quickly if symptoms occur.

Teamwork and communication among parents, healthcare providers and schools is critical. By sharing information, planning ahead and building trust, schools can create safe environments – helping every child with allergies learn, feel included, and thrive.

A group of smiling children with backpacks stand near a yellow school bus. Two kids, a boy in a green shirt and a girl in glasses and pigtails, stand in the foreground, while others chat and wait by the bus.

What types of allergies can occur at school?

Children spend much of their week at school – so if they have allergies at home, those same allergies need attention in the classroom. Common allergies that may require a management plan at school include:

  • Environmental allergies (pollen, mold, dust mites in carpeting or upholstered furniture, or stuffed animals, dander from a classroom pet)
  • Food allergies (such as peanuts, tree nuts, milk, eggs, wheat, soy, fish, shellfish, sesame)
  • Insect venom allergies (bee, wasp, hornet, yellow jacket, fire ant stings)
  • Latex allergy (often triggered by balloons, gloves, rubber bands, goggles, or certain school supplies)

In addition, some cellphones, jewelry and metal items may contain nickel, a type of metal which can cause a skin reaction. It can lead to allergic contact dermatitis.

Allergic reactions can range from mild to severe. Some children also have asthma that is worsened by their allergies – a condition called allergic asthma. In addition to allergies, schools should be well-prepared to prevent and treat asthma.

By understanding your child’s allergens and working closely with school staff, you can help create a safe environment that reduces exposure and ensures quick treatment if a reaction occurs.

Seven children stand in front of a chalkboard in a classroom. They are smiling and wearing casual and semi-formal clothing. The chalkboard has math equations written on it. Classroom desks are partially visible in the foreground.

Before the school year begins

  • Make an appointment with your child’s allergy doctor.
  • Check that your child’s medicine dose is still right for weight. This applies to antihistamines for environmental allergies and epinephrine if needed for anaphylaxis.
  • Ask your doctor to update any medication orders if needed.
  • Update or complete an Allergy and Anaphylaxis Emergency Plan for home and at school if your child is at risk for serious allergic reactions.
  • Have school forms completed – get a letter from the doctor that lists your child’s allergies.
  • Schedule a meeting with school staff to talk about your child’s allergies, if needed.
  • If your child is going to a new school, it’s a great idea to meet with the new school staff.
  • For children with a food allergy or a risk for anaphylaxis:
  • Make sure your child has access to their epinephrine.
  • Go over the signs of an allergic reaction with your child so they know when to ask for help.
  • Teach your child how to use epinephrine if they are old enough to understand.
  • 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 allergic reactions worse.

During the school year

  • Check in with your child at the end of each school day. Ask how your child feels and if they had problems managing their allergies at school.
  • Keep track of when medications will expire and replace them when needed.
  • Let the school know if there are any changes to your child’s medicine or treatment plans.
  • If your child has an allergic reaction at home, tell the school nurse so they can watch for any issues. 
  • Encourage your child get involved in school activities. If your child ever feels left out or bullied because of their allergy, tell the school staff.

At the end of the school year

  • Pick up any leftover medicine on the last day of school.
  • Ask the school what forms or health care plans you will need for next year.
  • Talk with school staff about how things this school year and discuss plans for the next school year.
A smiling nurse in scrubs kneels beside a young girl sitting on an exam table. The nurse gently holds the girl's arms, and they both seem cheerful. A sink and medical equipment are visible in the background, indicating a doctor's office.

How to prevent allergic reactions at school?

The best way to keep students with allergies safe at school is to prevent reactions before they can start.
Parents, caregivers, students and school staff should be familiar with:

Key federal laws that protect students with allergies – ensuring every child’s right to a safe learning environment.t reduces exposure and ensures quick treatment if a reaction occurs.

How to recognize an allergic reaction – spotting early signs can save lives when symptoms are severe.

Ways to avoid allergens – from safe food practices to reducing environmental triggers.

Preventive medications and treatment – antihistamines can help mild allergies, while epinephrine treats severe reactions.

How to follow a school healthcare plan – this includes an Allergy and Anaphylaxis Emergency Plan.

A teacher stands at the front of a classroom explaining a biology lesson. Students sit at desks in rows, listening attentively. The room has large windows and is decorated with potted plants. A green chalkboard is visible on the right.

Environmental allergies occur when the immune system reacts to allergens found in our everyday surroundings. This includes at school, both indoors and outdoors. (They may also be referred to as seasonal allergies for people with symptoms that occur during specific seasons.) The reaction can trigger allergic rhinitis and other symptoms that affect daily life.

Common allergy symptoms include:

  • Runny or stuffy nose
  • Sneezing or coughing
  • Itchy, red, or watery eyes
  • Itchy skin, rashes or hives

Outdoor allergies

Here are some common outdoor allergens that can cause symptoms during the school day:

Indoor allergies

Now let’s look at things inside schools that can cause symptoms:  

school busses lined up in a parking lot

What are some environmental irritants that can trigger symptoms?

Certain irritants can trigger allergy-like symptoms in children, and also asthma. These irritants include:

  • Exhaust from idling school buses – it can come into classrooms through open windows and affect children with allergies.
  • Strong smells from perfumes, colognes, air fresheners (including the plug-in kind), hair products and soaps/lotions may trigger allergy-like symptoms in some children.
  • Cleaning products and school supplies may have strong chemicals, including formaldehyde. This can make it hard for some children to breathe and cause burning in the eyes and throat.
  • Pesticides to control weed growth or ward off insects and rodents. (However, most schools today prioritize non-pesticide solutions to minimize pesticide use.)

What medications can help children with allergies in schools?

Your healthcare provider may recommend your child take allergy medication to pre-treat or relieve daily symptoms at school. These medications may include:

  • antihistamines
  • nasal spray (containing corticosteroids)
  • eye drops
  • cough medicine

Many antihistamines and cough medicines are available over-the-counter as pills or liquid. They can be taken at home, either in the morning before school or in the evening before bedtime.

Parents should talk with the school nurse if they want their child to take allergy medication at school. Even though environmental allergies do not usually rise to the level of an emergency, staff should still be trained to recognize symptoms and know how to respond. Establish a clear procedure for when your child should visit the school nurse to receive allergy care.

How can schools help children with environmental allergies?

Schools can help create a safer school environment for students with allergies:

  • Maintain good air circulation throughout classrooms by ensure adequate ventilation.
  • Keep windows closed during high pollen days.
  • Allow students to stay indoors during recess when pollen counts are high.
  • Clean mold damage right away.
  • Use a dehumidifier in damp classrooms or common areas.
  • Remove or limit access to furry or feathered classroom pets if they trigger symptoms.
  • Encourage schoolchildren to wash their hands and face after outdoor activities.
  • Avoid strong scents (perfume, cologne, air fresheners, strong cleaning products).
  • Use unscented cleaning products and avoid strong air fresheners.
A young girl with curly hair stands in a school cafeteria holding a plate of food. Behind her, a line of children in uniforms wait to be served by a woman in a white coat. Various dishes are visible on a serving counter.

Food Allergy

Approximately 1 in 12 U.S. children have a food allergy. That translates into about two children with a food allergy into every classroom. Further, approximately 25% of allergic reactions in school occur in a student without a previous allergy diagnosis.

If your child has a food allergy, it’s essential to inform the school. This helps teachers, cafeteria staff, and nurses take the right precautions – such as avoiding foods that could cause a reaction. The nine most common food allergens are:

  • Cow’s milk
  • Soy
  • Egg
  • Peanut
  • Tree nuts
  • Fish
  • Shellfish
  • Wheat
  • Sesame

Share your child’s food allergen(s), including those outside of the top 9, with school officials, teachers and coaches (if your child is involved in sports). Schools need to know so they can watch for hidden ingredients in food labels or cross-contact.

Symptoms of food allergies can vary from person to person and from reaction to reaction. They can be mild or severe. Symptoms usually occur within minutes of eating the food allergen, though they can sometimes occur hours later.

Symptoms of a mild food-allergic reaction include:

  • Itchy or runny nose, sneezing
  • Itchy or tingling sensation in the mouth
  • A few hives, mild itching of skin
  • Mild nausea or discomfort

Symptoms of a severe food-allergic reaction, also known as anaphylaxis, involve more than one body organ:

  • Hives on the skin, sometimes on several parts of the body
  • Shortness of breath, wheezing, repetitive cough
  • Appears pale, faint, dizzy, confused
  • Tightness in throat, hoarse, trouble breathing or swallowing
  • Stomach discomfort such as abdominal cramps
  • Diarrhea or vomiting
  • Swelling of tongue, lips or throat
  • Blood pressure changes
  • Feeling of impending doom

It’s critical that school administrators, nurses, teachers and coaches are able to recognize symptoms. They should know what steps to take in an emergency situation.

Infographic titled "Going to School with Food Allergies" lists stats, emphasizes epinephrine, and provides 10 safety tips for parents. Includes icons, a bus, and child; color scheme is blue and yellow.

Managing Food Allergies at School

Most schools have experience with planning for and managing food allergies. Every child’s food allergy needs are unique, though. Parents should share with the school staff the following:

At most schools, the school nurse is the main point of contact for student healthcare concerns. Be sure you know who is responsible at your child’s school for managing food allergies. Some schools do not have a full-time school nurse. If there is no full-time school nurse, find out which staff member will help in an emergency. School staff, including teachers, should be ready to help if your child has an allergic reaction.

Clear communication and advance planning are the best ways to lower the risk of food allergy reactions at school. These approaches can help keep children with food allergies feel safe and included.

Chalk dust is made with dairy products. Use dry-erase boards with unscented markers instead of chalkboards.

A smiling young boy in a white shirt and tie holds a red tray with a water bottle, apple, and snack bag. He stands in a school cafeteria with empty tables and chairs in the background.

How can schools help a child with food allergies?

Schools are prepared to help children with food allergies stay safe. Here are some of the ways they can provide protection and support:

  • Avoiding allergen exposure – Staff work to keep students away from foods that could trigger a reaction.
  • Creating safe environments – Allergens may be removed from classrooms, lunchrooms, and activity areas.
  • Protecting privacy – A student’s health information is kept confidential.
  • Providing safe meals – Cafeteria staff can prepare meals that are free of the child’s specific allergens.
  • Preparing for emergencies – Teachers and staff receive training on how to respond quickly and appropriately if an allergic reaction occurs.

What treatments should parents and schools use for severe allergic reactions?

Epinephrine is the first-line treatment for severe allergic reactions, or anaphylaxis. Use epinephrine first, epinephrine fast. Any delay in treatment could increase the risk of worsened symptoms and a fatality.

Epinephrine can provide immediate relief from severe symptoms. Do not substitute antihistamines for epinephrine in treating a severe allergic reaction. Antihistamines only treat a few symptoms such as hives and they can take about 30 minutes to have an effect. Epinephrine will treat a life-threatening allergic reaction immediately – antihistamines will not.

Epinephrine is available as a nasal spray, a pre-filled auto-injector, a strip of film placed under the tongue, or as a vial that can be used to fill a syringe.

The School Access to Emergency Epinephrine Act permits trained school staff to give epinephrine to anyone having a life-threatening allergic reaction. The law also allows schools to stock emergency supplies of epinephrine in an easily accessible and secure location.

All 50 states allow students to self-carry and administer epinephrine in school. If your age-appropriate child needs to self-carry epinephrine, make sure to coordinate with the school nurse and/or teachers.

How can schools get epinephrine for use in their school?

EpiPen® is available through the EpiPen4Schools program. This program provides free epinephrine auto-injectors for schools.

The epinephrine nasal spray neffy® has a school program to provide eligible public and private K-12 schools in the United States with free stock neffy devices. Participating schools receive two cartons (four single-use doses), with replacement doses available as needed.

How to reduce food allergy risks at school?

Schools can help lower food allergy risks by:

  • Keeping allergy-safe foods from unsafe foods.
  • Making sure staff and students wash their hands with soap and clean surfaces to reduce the risk of exposure to food allergens.
  • Encouraging children to never share food.
  • Making sure all food in the classroom has ingredients listed on a label. No homemade treats allowed.
  • Teaching staff and students how to read food labels to identify food allergens.
  • Developing policies and procedures to make classrooms, cafeterias, field trips and other school events “allergy-safe.”

Hand sanitizers work well to help kill viruses on hands, but they do not “clean away” food allergens. Continue to use soap and water or wipes to remove food allergens from hands and surfaces.

A close-up of a person's fingers wrapped around their arm, with the middle finger swollen and red, possibly indicating an allergic reaction or injury. The person is wearing a white shirt with blue designs.

Insect Venom Allergy

When schoolchildren are outdoors, they are exposed to stinging insects. They are also potentially exposed indoors should the insects get inside the school.

For some children, an insect sting isn’t just painful. It can cause a serious allergic reaction, or anaphylaxis. Bees, wasps, hornets, yellow jackets, and fire ants are the most common culprits. Reactions can happen quickly. It’s essential that schools are prepared to respond immediately.

What should parents do if their child has an insect venom allergy at school?

Parents should notify the school if their child has an insect sting allergy. They should provide:

  • An Allergy and Anaphylaxis Emergency Plan from the child’s healthcare provider
  • Emergency medication (epinephrine product), if needed
  • Clear instructions on what to do in case of an anaphylaxis emergency
  • Updates on any changes in diagnosis or treatment

Some students may get stung or show signs of an insect venom allergy for the first time at school. That is why it’s important for schools to have undesignated stock epinephrine on hand. If you are concerned your child has an insect venom allergy, speak with the school nurse or administrators about stock epinephrine policies and easy access to the medication.

What can schools do to protect children with insect venom allergy?

Schools can take practical steps to lower the risk of insect stings on campus.

  • Keep outdoor trash cans covered and away from play areas.
  • Inspect playgrounds and fields for nests or hives.
  • Encourage students to wear shoes when outdoors.
  • Avoid serving sweet drinks or food outdoors that may attract insects.
  • Hold physical education classes indoors in the gym or, if outdoors, away from areas where there may be stinging insects.

In addition, staff should be trained to:

  • Recognize signs of a severe allergic reaction, or anaphylaxis (swelling, hives, trouble breathing, dizziness, fainting).
  • Administer epinephrine immediately if symptoms of anaphylaxis appear.
  • Call emergency medical services and notify parents.
  • Follow the student’s Allergy and Anaphylaxis Emergency Plan.

Make sure coaches are aware and involved with the child’s allergy plan. Many school sports, such as football, soccer, lacrosse, baseball or softball, are outdoor sports. Ask coaches to keep the Allergy and Anaphylaxis Emergency Plan with them on a clipboard when at practice or at games.

Two young girls sit at a classroom table, talking and smiling. One girl is wearing a pink hijab, and both are holding pencils and notebooks. The background shows a bulletin board with colorful decorations.

Latex Allergy

Latex allergy occurs when the body reacts to proteins found in the sap of the Hevea Brasiliensis rubber tree. This sap is used to make more than 40,000 products. Latex proteins can also be carried on small particles in the air. If the proteins are breathed into the airways, it can cause an allergic reaction.

How do you know if your child has a latex allergy? If your child has a reaction (usually involving the skin, but can include other body systems) after touching a latex products, then latex allergy is likely present.

What school products contain latex?

Latex is found in many common school items:

  • Rubber bands
  • Balloons
  • Erasers
  • Pencil grips
  • Art supplies (including glue)
  • Sports equipment
  • Rubber balls
  • Mats
  • Racquet handles
  • Goggles in science class
  • Headphones
  • Computer mouse pads
  • Latex gloves (sometimes used in food service)

Schools should use latex-free school products and latex-free sports equipment when a student has an allergy.

Schools must also be aware of foods that can cause latex allergy reactions. About half of people with a latex allergy may also react to certain foods because they have similar proteins as latex. Foods most likely to cause a cross-reaction to latex:

  • Avocado
  • Bananas
  • Chestnut
  • Kiwi

How can a school protect students with a latex allergy?

The only way for people with latex allergy to avoid a reaction is to stay completely away from latex. That means schools should try to limit or eliminate the use of latex products.

Severe latex reactions are rare, but they can lead to anaphylaxis. Talk to your child’s pediatrician or an allergist about treatment. Epinephrine is the first-line medication for a severe latex reaction. Meet with the school nurse and/or staff about access to epinephrine at school, whether it’s through self-carry or stock epinephrine.

Latex Allergy Store Items

Two young girls sit on stairs with backpacks, reading a book together. They appear focused and engaged. Other students are visible in the background.

School Policies for Allergies and Anaphylaxis Management

A school allergy policy is a set of written guidelines designed to keep students with allergies safe and supported. It is usually intended for schoolchildren at risk for severe allergies, but it should apply to all those with all types of allergies. These policies outline how staff should manage a student’s allergies, prevent exposures, and respond in the event of a reaction.

A strong allergy policy should include:

  • Coordinated care planning for students with allergies
  • Education for staff, students, and parents about allergies and anaphylaxis
  • Creating a safe environment by minimizing exposure to allergens
  • Anti-bullying and anti-discrimination measures to protect students with medical needs
  • Clear emergency response plans, including rapid administration of medication when needed

School allergy policies must follow federal and state laws, as well as established school nurse practice standards. This helps ensure all students have a safe, inclusive environment and can fully participate in school activities and events.

It’s important to know your state’s school health guidelines so that school policies reflect what your state allows.

Two children in school uniforms sit at a cafeteria table, enjoying a meal. The focus is on a girl holding a yellow cup and smiling, with fruits and sandwiches visible on trays in the background.

Role of the school nurse: planning and coordination of care

School nurses play a significant role in helping students with allergies. They serve as a care coordinator, working with the child’s family, the child’s doctor and school staff. Here are some ways a school nurse can direct allergy management:

  • Maintaining medical documentation – Ensure the school has a written diagnosis of the child’s allergy. For students at risk of severe allergic reactions, an Allergy and Anaphylaxis Emergency Plan from the child’s doctor should be on file.
  • Coordinating care plans – Develop and oversee individualized plans such as a 504 Plan or Individualized Healthcare Plan (IHP) to address the student’s needs.
  • Educating staff – Provide training for teachers, cafeteria workers, and other staff about allergy triggers in classrooms, cafeterias, and other school areas.
  • Establishing policies – Help create school-wide food allergy policies and emergency response plans for anaphylaxis.
  • Supporting student well-being – Collaborate with school counselors to address anxiety, social concerns, or feelings of exclusion that students with allergies may experience.

The school nurse can also help parents decide if their child is ready to self-carry and self-administer their allergy medication.y. Each state has a unique Nurse Practice Act and specific laws and regulations addressing allergy management in school.

How can school nurses address allergies and anaphylaxis with staff?

School staff, including teachers and coaches, should have an understanding of allergies and anaphylaxis at school. Training should include the following:

Signs and symptoms of an allergic reaction

All school staff should know the signs and symptoms of an allergic reaction. They should be taught that every child’s allergies are different, and that each reaction might be different from the last reaction. If possible, display a chart in each classroom that outlines the signs and symptoms of a severe allergic reaction.

Infographic titled “Life-Threatening Allergy Symptoms: A Guide for School Staff,” listing symptoms such as trouble breathing, hoarse voice, vomiting, fainting, and instructions to seek quick medical help.

Print and display above phone in each classroom.

How to prevent an allergic reaction

All school staff must be aware of how to keep allergens and irritants out of the classroom. This includes keeping windows closed to keep pollen out, requiring peanut-free snacks, and removing latex-based products like rubber bands.

How to respond to an allergic reaction

If a student has a severe allergic reaction, staff should be trained on when and how to give medication, including emergency epinephrine. They should have access to and follow the student’s Allergy and Anaphylaxis Emergency Plan.

Staff should also know what to do if a student without a prior history of severe allergies shows signs of anaphylaxis.

How to manage allergy risks during the school day

School staff should provide support for students with allergies to be fully included in school activities. Policies should cover:

  • classrooms
  • meals in the cafeteria
  • nonacademic outings
  • field trips
  • before- and after-school programs and sports
  • school-sponsored events held outside of regular hours
A child wearing a striped shirt stands outdoors with a backpack, smiling and leaning against an adult. Other children and backpacks are visible in the blurred background.

Laws that protect students with allergies

It is important that the school staff understand laws, such as:

  • Americans with Disabilities Act (ADA)
  • Section 504 Plan, which protects students with health conditions
  • Family Educational Rights and Privacy Act (FERPA) that protects student health information
  • Any state law, regulations or district policies that apply to allergies and anaphylaxis

All 50 U.S. states allow students to self-carry their epinephrine. Most states allow schools to stock epinephrine.

A woman in a green sweater smiles as she writes in a notebook, surrounded by stacked books. An apple sits on the table. She is seated in front of a chalkboard filled with calculations and equations.

What are the different types of student healthcare plans?

Taking care of allergies at school requires planning, prevention and preparation. A student health care plan helps to document the process. School nurses and administration make sure each student who needs one has a healthcare plan are in place.

There are four types of plans used in the school setting:

Individualized Healthcare Plans

  • Written and used by the school nurse
  • Outlines the plan of care for students with complex and long-term health needs at school.
  • It lists the student’s needs for medication, treatment and education.

Emergency Action or Care Plans

  • Written (usually by a doctor) to direct care for a student experiencing an allergic emergency.
  • Lists the specific steps to respond to an allergic reaction.
  • Written in easy-to-understand language for non-medical staff to use.

Section 504 Plans

  • A 504 Plan is a federal law that protects the civil rights of persons with disabilities.
  • Prevents organizations from discriminating against people because of a disability.
  • Outlines the accommodations needed for a student to fully participate in school.

Individualized Education Plan or Program (IEP)

Most students with allergies don’t need an IEP unless they also have an educational disability.

An IEP is a plan or program for students who need special education or special services because of a learning disability. 

A teacher stands in front of a world map, engaging with students sitting at desks in a classroom. The students, with diverse hairstyles and clothing, face the teacher attentively, indicating a geography or social studies lesson.

Are allergy policies the same at every school?

No. Allergy policies can vary from one school district to another. Each district typically develops its own guidelines, often with input from school nurses and staff to ensure they reflect best practices for student safety.

In addition, some states have specific food allergy requirements that schools must follow. These policies are shaped by state laws and nursing practice standards. This means the details can differ depending on where the school is located.

How can schools prepare for an allergy or anaphylaxis emergency?

It’s critical for school staff to be prepared to respond to severe allergic reactions, or anaphylaxis. Allergic reactions can escalate quickly and become life-threatening within minutes. Immediate recognition and action – especially giving epinephrine – can save a student’s life.

Training ensures staff remains calm, follows the emergency plan, and responds effectively. When everyone knows what to do, schools become safer places for students with allergies.

Before an emergency:

  • Learn the signs and symptoms of an allergic reaction or anaphylaxis.
  • Know where the student’s epinephrine is kept and/or where the school’s stock epinephrine is located. (Epinephrine should be easy to access for school staff.)
  • Review state laws and regulations about who can give epinephrine medication at school.
  • Know how to administer epinephrine if needed. Provide training to appropriate staff members.
  • Develop a plan to monitor the expiration date of epinephrine medication. Replace when it’s out of date.

After an emergency

After an allergic reaction at school, staff should meet to talk about what happened. This will help staff learn what went well and what can be done better next time.

  • What caused the allergic reaction?
  • Who helped and how did things turn out?
  • How did the student and classmates feel about the response?
  • Did the staff respond appropriately?
  • Was staff comfortable with their roles?
  • What can be improved for the next time?
A classroom scene with a young student raising their hand. Several children sit at desks facing a chalkboard, where a teacher stands reading from a book. The classroom is bright and colorful with educational materials on the walls.

Are schools allowed to stock epinephrine?

Yes. In every state, schools are either required or allowed to keep a supply of epinephrine in the event of an emergency. Epinephrine is a medication used for serious allergic reactions. It can be used to treat severe food allergy, insect venom and latex allergies. It can also be used to treat a severe reaction to medications, but this occurrence is rare in the school setting.

Get familiar with stock epinephrine laws in your state so that you will know whether your child’s school is able to have it available. How to implement a stock epinephrine program in your school? It’s important to follow the “Steps to Stock,” which are:

Policy

The school district needs to adopt a policy to guide the use of stock epinephrine. The National Association of School Nurses (NASN) offers a sample school district policy.

Protocol

The school district supports procedures that guide use of stock epinephrine. NASN offers a sample anaphylaxis and emergency epinephrine administration protocol.

Prescription

The school district must identify a prescriber to write the prescription and standing order. The American College of Allergy, Asthma & Immunology (ACAAI) offers information about this in its Allergists’ Toolkit.

Partnership

School health officials such as the nurse partner to implement stock epinephrine policy with staff, including the child’s teacher and coaches (if the child is involved in sports).

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Helping Your Child Stay Safe: Allergy Safety at School

Parents and school staff can work together to build a bridge between home, school and the doctor. This way the approach to preventing and treating allergies at home is the same as or similar to school.

Get your child involved in the process of managing allergies at school (if age appropriate). This can help develop a sense of responsibility. Teach your child to know his or her allergy triggers, how to avoid the triggers, and to tell a grown-up if symptoms arise.

Here are key points that parents can bring up with school staff to promote a safe and healthy school environment for their child:

For the school nurse

Meet with the school nurse (or health official) before the school year starts to develop a plan to keep your child safe. Be sure to:

  • Talk about your child’s allergies, including risk for severe reactions.
  • Discuss any accommodations that your child may need – in the classroom, cafeteria or on school trips.
  • Drop off necessary forms, medications, and your child’s Allergy and Anaphylaxis Emergency Plan or Asthma Action Plan.
  • Discuss whether the school needs written permission to call your child’s doctor with any questions.
  • Let the school know about any severe allergic reactions that have occurred outside of school.

For your child’s doctor

Schedule your child for a checkup prior to the start of the school year. Be sure to:

  • Review any changes in your child’s allergies.
  • Get updated medication forms and an Allergy and Anaphylaxis Emergency Plan or Asthma Action Plan.
  • Discuss concerns you may have about your child’s health.
  • Include your child in the conversation about their care. 

For the food services department

If your child has food allergies, find out how the school handles special food requests. Turn in any forms for special dietary needs. This can include any food substitutions. For example, if your child has a milk allergy, you may ask the school to substitute juice or water. Your school’s food services director or other cafeteria workers can help as needed.

For your child’s teacher(s)

Schedule a meeting with the teacher prior to the start of school or early in the school year. Form a strong, positive partnership with open lines of communication. Involve your child.

What do you want teachers to know about your child’s allergies? What can they do to ensure your child has quick access to medication? What does your child want them to know? Discuss ways to share allergy information without making your child feel singled out or excluded from activities.

Ask if you can visit the classroom to check for potential allergens:

  • Are there furry or feathered pets that bring dander into the classroom?
  • Is there upholstered furniture, pillows and/or rugs that may collect dust mites?
  • Is food available in the classroom? Do children eat snacks or meals in the classroom?
  • Is food used for classroom celebrations? How will you find out about upcoming special events, parties, field trips or other events that may involve food?
  • Is there mold in the room? (This is more common in older school buildings.)
  • How often is the classroom cleaned? What cleaning products are used?

For your child’s coaches

Share important details about your child’s allergy needs with coaches so they are prepared during games, practices and team events. Open communication ensures the coach knows how to prevent exposure and respond quickly if needed. Share with coaches:

  • Specific allergens – foods, environmental triggers, or materials that cause reactions.
  • Signs of a reaction – what symptoms look like for their child.
  • Avoidance strategies – safe snacks, hydration, and equipment precautions.
  • Emergency medication – where epinephrine or other medicines are stored and how to use them.
  • Emergency contacts – who to call and the steps outlined in the child’s Allergy Action Plan.

Resources for Managing Allergies at School

Get the right resources to prevent, manage and treat allergies at school to help keep students safe and healthy. Quick access to emergency medication, clear action plans, and trained staff ensures prompt and effective response when reactions occur. These resources give parents, students, and educators confidence that the school is prepared for any situation.

CDC Voluntary Guidelines for the Management of Food Allergies in Schools and Early Care and Education Centers

The U.S. Centers for Disease Control and Prevention (CDC), in partnership with the U.S. Department of Education and other federal agencies, developed the Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Centers[t13] . This was part of the 2011 FDA Food Safety Modernization Act to improve food safety in the United States.

These guidelines share helpful tips and steps for parents, school leaders, teachers, and early childhood workers to make or improve plans to keep kids with food allergies safe. The guidelines focus on five areas that every school or early childhood program should follow:

  • Daily management of food allergies in children
  • Preparation for food allergy emergencies
  • Professional development on food allergies for staff members
  • Teaching children and their families about food allergies
  • Creating and maintaining a healthy and safe educational environment

AllergyHome.org

The AllergyHome School Staff Training Module is a 30-minute session that assists school nurses in training staff about food allergy awareness and managing life-threatening allergic reactions.

The training module follows CDC’s Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs. It includes:

  • School Staff Quiz – a certificate of completion is available
  • Label Reading Handout
  • Preventing Cross-Contact Handout
  • Be Prepared to R.E.A.C.T. (Recognize allergic reaction; Epinephrine; ACTivate emergency response)
  • AllergyHome Resource Flyer for School Nurses

Food Allergy Management & Education (FAME)

The Food Allergy Management & Education (FAME) manual and toolkit helps school nurses, administrators and staff work with parents and students to create a safer school environment and develop a school-based food allergy program. It features a 504 Plan decision chart and a list of accommodations in classrooms, the cafeteria, and on school buses and field trips.

Free resources from Allergy & Asthma Network

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.

There is a risk of allergies any time there is a change in routine or location. When school restarts in the fall, certain triggers such as ragweed pollen are more common. Your child may be more likely to be exposed to things that cause symptoms. These include food allergens, latex products, respiratory viruses and colds, and indoor mold.

Allergies can seem worse at school because children are exposed to more potential triggers throughout the day. Classrooms, cafeterias, gyms, and playgrounds may contain allergens like dust, pollen, cleaning products, certain foods, or latex. Increased activity, stress, or changes in routine can also make symptoms more noticeable. Schools are busy environments, so even small exposures can add up. Working with the school to identify and reduce triggers can help keep symptoms under control.

Certain odors and poor indoor air quality can cause allergy-like symptoms. These irritants include perfumes or cologne and cleaning products. Indoor allergens like dust or mold can also be a problem indoors.

The best way to prevent anaphylaxis at school is to avoid exposure to known allergens. This starts with clear communication between parents, school staff, and students about the child’s specific triggers. Schools should have allergy-aware practices in place, such as safe food handling and careful label reading.

Staff should be trained to recognize early signs of a reaction and know how to respond quickly. Having an up-to-date Allergy and Anaphylaxis Emergency Plan and ready access to epinephrine are essential for safety.

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.

Most children with allergies can safely attend school as long as their symptoms are well managed and the school has a plan in place to prevent and respond to reactions. The only time to consider keeping a child with allergies home from school is in the days following a severe allergic reaction. This time away from school could allow your child time to fully recover.

Work with your child’s healthcare provider and the school to keep symptoms under control so they can participate fully in class.

Yes, allergies can make it harder for some students to do well in school. Symptoms like congestion, itching, coughing, or fatigue can make it difficult to concentrate or participate fully in class. Poor sleep from nighttime symptoms can also affect focus, memory, and energy during the day. With proper allergy management and support at school, most students can overcome these challenges and succeed academically.

Parents can provide the school with a doctor’s letter that explains their child’s allergies. Parents should also provide any required forms prior to the start of the school year. If parents want to tell other families about their child’s allergy, they can work with the school nurse to compose a letter that does not name the child. This can protect the child’s privacy.

The Family Education Rights and Privacy Act, or FERPA, says that a child’s health information should only be shared with people who need to know. Staff should talk about a child’s allergies in private and not in public areas. They should not share a child’s allergy information with other parents.

This is a written plan developed by parents and a doctor, preferably a pediatrician or an allergist. It was developed by the American Academy of Pediatrics. The document lists your child’s allergies and what symptoms to watch for that indicate a severe allergic reaction. It tells school staff what to do if a child has a severe allergic reaction and what medicine to give to the child. It is sometimes referred to as an Anaphylaxis Action Plan.

There is no required school health care plan, but it is good for your school district to pick one to avoid confusion during an allergy emergency.

Examples include:

Yes, all U.S. states allow children to carry epinephrine at school. Your child’s doctor and school nurse can help you determine if your child is ready to carry this medication at school.

Yes, but most medicine for seasonal or environmental allergies will be kept in the school health office to be given to your child as needed. Check with your school to learn how they handle medications that are given on an as-needed basis. You may need to provide written approval for a school nurse or teacher to give the medicine, including on field trips.


Reviewed by:
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.