A food allergy diagnosis can be emotional for many parents of school-age children. They are understandably worried about their child’s safety at school. There are good reasons for this concern: a variety of foods and even school supplies could potentially trigger an allergic reaction at school.
What can you and the school do to plan for your child’s safety at school? Education, advance planning, and clear, confident communication with school staff and other parents about food allergies are the best ways to ensure your child’s safety.
How do I prepare for the school year when my child has food allergies?
Make arrangements to see your child’s primary care doctor or allergist during the summer. Ask for an update to their medication forms and Allergy & Anaphylaxis Emergency Care Plan, if needed.
Check the expiration date on epinephrine medication that your child is taking to school. Mark down this date on your calendar and be ready to provide updated medication when needed.
Ask your child’s doctor for a note for the food service department identifying your child’s food allergy. You can include and any potential food substitutions. (If your child has a milk allergy, you may want them to substitute juice or water, for example.)
Make an appointment, preferably before the beginning of the school year, to meet with the school staff. Discuss your child’s allergy with the teacher(s), school nurse and/or the person designated to care for children at your school.
You can also talk about any accommodations that your child may need – in the cafeteria or classroom. Drop off forms, medication and your child’s emergency treatment plan. Consider providing the school with written permission to call your child’s pediatrician with any questions.
Make a plan to update the school with any new information about your child’s condition. Inform staff if your child has a severe allergic reaction outside of school.
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Quick 3-5 minute videos on asthma, allergies, and related conditions.
How do schools manage food allergies?
Allergy management at school has four major components:
Planning and coordination of care
The school needs to identify the students with food allergies and obtain a written statement from the doctor to confirm the allergy (there can be confusion about whether a child has a food intolerance or true allergy). The school should coordinate with the teachers, cafeteria staff and family to be sure that medication is at school, food substitutions are available and measures to prevent exposures are in place. And no matter how prepared the school is to prevent allergic reactions, they need to be ready to deliver emergency care if needed.
Educating staff, students and families
School staff, students and families need evidence-based information to be educated about:
- Signs and symptoms of an allergic reaction
- Prevention strategies to prevent exposures
- How to administer an Emergency Care Plan
- Understand federal laws that protect children including FERPA and Section 504
Providing a safe environment
Schools need to be aware of potential allergens and strategies to prevent allergen exposures. Policies and procedures need to be in place to protect all children at school.
Prompt emergency response
Any staff member who supervises a child needs to know how to identify anaphylaxis, get help, and administer the Emergency Care Plan. Staff need to know how to reach the school nurse or designated responder, how to access and administer epinephrine to the child, and what to do following an anaphylactic reaction.
NOTE: 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.
Should schools ban foods, especially peanuts?
Peanut-free policies may not be effective in preventing reactions. Schools must use proven strategies that include hand/mouth washing, no sharing of food and awareness of a child’s food restrictions. Studies have shown that:
- Peanut residue is easily cleaned from hands with soap and from surfaces with commercial products.
- Smelling peanut butter does not cause allergic reactions.
- Peanut dust or peanut residue may accumulate on surfaces where peanuts or peanut butter are eaten regularly. Touching the dust or residue on surfaces and then placing fingers in the mouth can cause an allergic reaction.
- Peanut proteins can become airborne during the grinding or pulverization of peanuts, and inhaling peanut protein in this type of situation could cause an allergic reaction.
Simply stating that a school is “peanut free” does not guarantee that it is. Even with strict measures, some peanut allergen can be present. “Peanut free” designations can decrease vigilance in the school community. It’s important to have school staff educated on food allergy and prevention strategies that lead to a “peanut-safe” environment.
Are students with food allergies bullied?
Children with food allergies are at a greater risk of being bullied.
What parents can do
- If you suspect bullying, talk to your child. If they are reluctant to talk, ask leading questions to open the conversation.
- Let your child know that if they see bullying or if they experience it, it’s important to talk about it with you, a school staff member or a sibling.
- Talk about how to stand up to children who bully. The best defense is to remain calm, ignore the remarks, tell the bully to stop and simply walk away.
- Don’t try and fight the battle alone. Talk to school professionals about how to protect your child.
What schools can do
- Put anti-bullying policies in place – make it a school responsibility to resolve conflicts in a positive manner.
- Teach specific skills and values in the classroom. Teach children how to problem solve.
- Establish and enforce consequences for bullying. Combine sanctions with supportive interventions that encourage positive behaviors.
Are schools allowed to have stock epinephrine?
Every U.S. state either mandates or allows stock epinephrine in the school setting. This means the school can keep a supply of undesignated epinephrine available in the event it’s needed for an emergency.
It’s important to be familiar with the law for stock epinephrine in your state. Not all schools agree to stock epinephrine, so check with your child’s school to confirm if it is 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. National Association of School Nurses offers a sample school district policy.
Protocol
The school district supports a protocol to guide use of stock epinephrine
National Association of School Nurses offers a sample anaphylaxis and emergency epinephrine administration protocol.
Prescription
The school district needs to identify a prescriber to write the prescription and standing order. The American College of Allergy, Asthma and Immunology offers an Allergists’ Toolkit.
Partnership
The administrator and school nurse partner to implement stock epinephrine policy with school staff. The U.S. Centers for Disease Control (CDC) and Prevention offers guidance for school administrators in implementing a policy.
What additional school training resources are available?
Education of school staff, students, parents and guardians need to be able to point to material and resources that are based on evidence. All school staff, particularly those responsible for students with severe allergies, should receive allergy education that is evidence-based. It should be emphasized that no two reactions are alike – students experience different reactions and even individual reactions will vary from one episode to the next.
Practical points:
- School staff can be trained on food allergies at a school-wide faculty meeting to teach signs and symptoms and generalized allergy care.
- Personalized instruction should be provided to staff supervising a student with a known allergy who is at risk for anaphylaxis.
Epinephrine procurement programs
Schools can obtain free epinephrine devices from EpiPen® and its EpiPen4Schools program.
Forms
Allergy and Anaphylaxis Emergency Plan
Every student identified as at-risk for anaphylaxis needs to have a completed Allergy and Anaphylaxis Emergency Plan or its equivalent.
Posters
Staff Training Resources
CDC Voluntary Guidelines for the Management of Food Allergies in Schools and Early Care and Education Centers
The CDC developed the Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Centers in fulfillment of the 2011 FDA Food Safety Modernization Act to improve food safety in the United States.
The Voluntary Guidelines for Managing Food Allergies provide practical information and planning steps for parents, district administrators, school administrators and staff, and ECE program administrators and staff to develop or strengthen plans for food allergy management and prevention. The Voluntary Guidelines include recommendations for each of the five priority areas that should be addressed in each school’s or ECE program’s Food Allergy Management Prevention Plan:
- Ensure the daily management of food allergies in individual children.
- Prepare for food allergy emergencies.
- Provide professional development on food allergies for staff members.
- Educate children and family members about food allergies.
- Create and maintain a healthy and safe educational environment.
National Association of School Nurses
The National Association of School Nurses (NASN) offers its Get Trained training tools and sample policies regarding the management and care of students with food allergies and anaphylaxis. The training tools cover:
Trainer Preparation
- Presentation Slides
- School Nurse Trainer Notes
- Training Program Checklist
Training Tools
- Presentation: Get Trained for School Staff
- Presentation Handouts
- Handout: Preventing Allergic Reactions
- Scenarios for School Staff
Sample Policies and Protocols
Epinephrine Policies and Protocols
AllergyHome.org: Schools
AllergyHome’s School Staff Training Module is a 30-minute module to assist the school nurse in training school staff to manage life-threatening allergic reactions and increasing food allergy awareness. The training module is consistent with the CDC’s Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs. The training module includes:
- School Staff Quiz – A certificate of completion is available to be printed or emailed after passing the exam.
- Label Reading Handout
- Preventing Cross-contact Handout
- Be Prepared to R.E.A.C.T.
- AllergyHome Resource Flyer for School Nurses
FAME
The Food Allergy Management & Education (FAME) manual and tool-kit is designed to help school nurses, administrators, and staff work with parents and students to create a safer school environment and develop a comprehensive school-based food allergy program. Features a 504 Plan decision chart and a list of accommodations in classrooms, the cafeteria, and on school buses and field trips.
School Nurse Chronic Health Assessment Tool – SN CHAT
Resources from the National Association of School Nurses (NASN)
A tool developed for school nurses by a school nurse, SN CHAT offers tools and resources to help school nurses manage chronic health conditions in the school setting.
School nurses can use SN CHAT®:
- Guide conversations in person or via phone with a student’s parent, guardian, or caregivers
- Learn about the health needs of an individual student
- Decide if you should create a school plan for a student, which may include an Emergency Action Plan (EAP) and/or an Individualized Healthcare Plan (IHP)
Are there other conditions that can look like or complicate allergies?
There are other types of conditions that can mimic allergies, but these are different than an IgE-mediated allergy. The symptoms, diagnosis and treatment can vary depending upon the condition. Here are some of them.
Food-related conditions that can have symptoms similar to food allergies include:
