As students head back into classrooms, focus will again turn to safety. That includes, of course, protocols for emergencies (i.e. fire drills, shooting response plans, etc.), but for parents of the six million school-aged children nationwide with food allergies, strategic planning also includes food safety.

Annually, 16 -18% of children in the U.S. with food allergies have an allergic reaction while at school. Life-threatening allergic reactions, called anaphylaxis, happen on school grounds more often than one might think and, tragically, fatalities do occur. A New England Journal of Medicine study found that four out of six deaths from food-induced anaphylaxis occurred at school, some of which have been reported through news media, including  the tragic death in 2012 of a first grader who was exposed to her food allergen (peanuts) at school in Chesterfield County, Va. (staff failed to recognize anaphylaxis symptoms).

“No school (in the county) can be declared peanut-free,” says Lora Gilbert, Senior Director of Food and Nutrition Services for Orange County Public Schools (OCPS). However, “There are a few schools that have requested that no peanut butter cups or sandwiches be delivered. But the district cannot guarantee that foods served are completely free of any allergen. Parents need to read labels and help their children select menu items.” Orange County Public Schools is committed to protecting students against harmful food allergens and houses helpful resources on their website, including a memo to parents and a listing of school menus.

Jan Hanson, founder of Educating for Food Allergies and author of Food Allergies: A Recipe for Success at School, explains that planning in advance is critical and recommends implementing a 3-Step Plan to manage food allergies at school:

Step 1: Avoidance

Share medical documentation, physician orders, and medicines (epinephrine auto-injectors) with the school nurse (and principal). Talk with the nurse about your child’s food allergies and other health concerns (such as asthma). Children with both asthma and food allergies are at a higher risk of developing anaphylaxis if exposed to their allergens. With the support of the nurse, develop a risk reduction strategy, which may take the form of either an Individual Healthcare Plan (IHP) or a 504 Plan. Children with life-threatening food allergies meet the definition of ‘disability’ under Section 504, which is a federal law, and are eligible for protection in all schools, public or private, that receive federal funding. [Orange County Public Schools has a ‘Dietary Order Form’ (shared with OFM via email) that helps to outline the appropriate steps for children with food allergies.]

According to Hanson, plans should address: 1.) All aspects of the school environment where your child will travel, 2.) All aspects of the school day, including before, during, and after-school hours at school-sponsored events, and 3.) The physical and emotional wellbeing of your child. Plans may include:

• Safe foods for snacks and at celebrations.
• Elimination of food allergens from curriculum (art, science, or cooking projects, for example).
• An allergen-safe table in the cafeteria.
• Hand washing for your child and classmates.
• Participation safety for field trips, bus transportation, and on substitute teacher days.
• Storage of medication.

Step 2: Education

Efforts to educate others, including staff, classmates, and other parents can include:

• A letter sent home at the start of the year to parents of classmates, which explains food allergies and why their cooperation is needed.
• A staff meeting about food allergies and the need for allergen avoidance.
• A PTO meeting that includes information on this subject.
• A classroom lesson about food allergies.

Step 3: Response

School staff must be able to quickly recognize and treat an allergic reaction and anaphylaxis. Parents should:

• Supply the school with at least two epinephrine auto-injectors and related medicines. These medicines should be kept wherever your child is at most risk for exposure to allergens, along with a physician-signed Emergency Treatment Plan (with contact information) that outlines treatment steps.
• Confirm that epinephrine auto-injector training will be conducted for all staff given the responsibility to treat your child in the event that a nurse is not available. This type of training can’t be required but, for staff who resist, it might help to remind them that epinephrine is the only treatment that can reverse the symptoms of anaphylaxis, and administering it could save a life. To access additional information from Jan Hanson, visit www.foodallergyed.com.

Does your child have food allergies that require school awareness? Or does your child have a classmate with food allergies? What advice do you have for parents and children regarding limiting exposure to allergens?