Food allergies are a growing food safety and public health concern that affect an estimated 4%–6% of children in the United States. The prevalence of food allergies among children increased 18% during 1997–2007, and allergic reactions to foods have become the most common cause of severe allergic reaction (anaphylaxis) in community health settings.
About Food Allergies
A food allergy occurs when the body has a specific and reproducible immune response to certain foods. The body’s immune response can be severe and life threatening. Although the immune system normally protects people from germs, in people with food allergies, the immune system mistakenly responds to food as if it was harmful. The substance in food that cause this reaction is called the food allergen. When exposed to the food allergen, the body’s immune system releases powerful substances that cause symptoms that can affect the respiratory system, gastrointestinal tract, skin, or cardiovascular system and lead to a life-threatening reaction called anaphylaxis.
More than 170 foods are known to cause food allergies. Eight foods or food groups account for 90% of serious allergic reactions in the United States: milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts, and tree nuts.
School Health Services Food Allergy Management
The School Health Services department has developed guidelines for the care of students with food allergies in accordance with priorities for food allergy management identified by the Centers for Disease Control (CDC), Pennsylvania Departments of Education and Health, National School Boards Association (NSBA), and the National Association of School Nurses (NASN). School specific guidelines may be in place taking into consideration your child’s developmental age and school building. Please contact your child’s school nurse with any questions or concerns.
Identification of Students with Food Allergies
Parents are asked to complete forms regarding their child’s health conditions upon enrollment and annually in the fall. Information regarding food allergies is specifically requested on these forms. Additionally, parents are encouraged to communicate with the building school nurse at any time throughout the school year regarding the new diagnosis of a food allergy.
Once a food allergy is identified by the parent, the school nurse will follow up to get a complete understanding of the student’s allergy and request additional information in order to develop plans necessary for managing individual care.
Plan for the Daily Management of Food Allergies in Individual Students
Planning for individual students takes into consideration information collected from the parental food allergy questionnaire as well as other communications. In addition, for life threatening food allergies, individualized health plans will include a Food Allergy Medical Management Plan (completed by the parents) and the physician orders. Physician’s orders confirm the diagnosis and outline the student’s prescribed health care regimen and must be signed by a board- certified allergist, family physician, physician assistant or certified registered nurse practitioner. In addition, a signed parent consent must be provided. Emergency care plans will be specified in the orders signed by the healthcare provider and parent.
Individual student food allergen information will be communicated, confidentially, on a need to know basis to staff who have regular contact with the student.
Strategies to Reduce Risk of Exposure
Avoidance of exposure to allergens is the key to preventing a life-threatening allergic reaction. The following are important components of a risk reduction plan:
- Annual general allergy awareness staff education.
- Specific, confidential communication regarding individual student’s allergies to staff who work directly with identified students. Individual student information will include the specific food allergen(s), food that the student is permitted to eat and whether or not separate cafeteria seating is required.
- An Allergy Aware table is offered in each school cafeteria. Generally, this table is available to any child who has no peanuts, nuts, or anything made with peanuts, nuts, or their products as part of their lunch. Any guest to the table must buy their lunch and purchase from those items that food service states do not “contain” or “may contain” the food allergen.
- Allergy Aware classrooms if indicated in a student’s individual plan.
- If your child is in an Allergy Aware classroom you will be asked to not send in foods to be eaten in the classroom which contain the specific food allergen (for example peanuts or nuts).
- Non-food celebrations are an option to celebrate special events while reducing risk of allergic reaction. Ideas for these celebrations must be discussed with the teacher in advance.
Prepare for Food Allergy Emergencies
All medications, must be sent to the School Nurse in the original container from the pharmacy and marked with the student’s name. A written licensed prescriber order and parent consent is required for all medication administration while in school. The latter applies to both prescription and over-the-counter medications. Unless prearranged with the nurse, all medications will be stored in the nurse’s office.
Some students, as they get older, may want to start taking responsibility for managing their own food allergies, including carrying and using an inhaler or epinephrine when needed. In order for a student to carry and use emergency medications, proper permissions must be on file in the nurse’s office and the nurse will review certain guidelines which must be followed. Even if a student is carrying their own medications an additional complete supply of medications should also be kept in the nurse’s office at the school.
In the case of the occurrence of a severe allergic reaction, specific building emergency response procedures will be put into place. In addition, the student’s physician ordered emergency plan will be activated by the school nurse.
The SDST nurses' offices have a supply of epinephrine intended specifically for students, without a previous severe allergy diagnosis, who have their first life threatening allergic reaction during school hours while on the school campus. The Pennsylvania Public School Code, Section 1414.2(g) allows parents/guardians to request an exemption to the administration of an epinephrine auto-injector for their student. In order to request this exemption, contact the school nurse to make an appointment to discuss this decision, review and sign the opt-out form.
Provide Professional Development on Food Allergies for Staff Members
Training is provided annually to all building staff who have regular contact with students who may require emergency epinephrine. The training includes signs/symptoms of an allergic reaction, strategies for allergen avoidance, and appropriate response to a suspected allergic reaction (including activating building and community emergency response protocol and epinephrine administration).
Provide Allergy Education to Students and Parents
- Community Food Allergy Awareness Presentation: This presentation from www.allergyhome.org is helpful for all parents in the community and highlights the basic facts about food allergies and constant need for prevention and preparedness.
- Infographic Food Allergies in the U.S. - This infographic displays the basics about food allergies in America and speaks to the prevalence and severity of food allergies today.
- How to Read Food Labels - Read important information about tips on how to read nutrition labels to avoid specific food allergens.
- What Is a Food Allergy? Kids Awareness Module This 4 1/2 minute awareness module from www.allergyhome.org is designed for elementary age children without food allergies with the purpose of increasing empathy and support and discouraging bullying.
- Be a PAL Handout - Handout from the Food Allergy Research and Education explains what it means to have a food allergy and how children can be a good friend to children who are managing food allergies
- Be a PAL Poster - Poster from the Food Allergy Research and Education which helps to reinforce the messages of the Be a PAL program