By: Sonja O'Leary, MD, FAAP & Michael Pistiner, MD, MMSc, FAAP
About 1 in every 10 children and teens in the U.S. has a
food allergy. That's roughly two kids per classroom. A food allergy is an abnormal immune response to a specific food. The immune system normally protects the body by fighting off germs like bacteria and viruses. But when someone has a food allergy, their immune system treats a certain food like it's a harmful germ.
While 90% of food allergies involve the
top 9 allergens (peanuts, tree nuts, dairy/milk, eggs, sesame, wheat, soy, fish and shellfish), people can be allergic to many other foods. Even small amounts of a food allergen can cause a reaction that can be very serious.
Avoiding allergic reactions means being prepared for allergic emergencies—wherever and whenever they might happen, including at school. Since kids spend roughly 1,000 hours at school each year, it's essential to ensure they are safe, supported and ready to learn. Here's how to help ensure a healthy school environment where kids with food allergies can thrive.
School safety starts with a diagnosis
It's important to talk with your child's doctor if you think that they may have a food allergy. Your healthcare team will ask detailed questions about the reaction. This includes signs and symptoms your child experienced, as well as the timing of the reaction (how long it took to start and finish in relation to the possible trigger food).
Your doctor can use specific testing to help confirm a food allergy. They may also recommend that your child be evaluated by a board-certified allergist. Allergists can perform
skin testing and oral food challenge, if needed, to confirm a food allergy diagnosis. This can also help keep a child from having an overly restricted diet, while avoiding the foods that truly cause a reaction.
If your child is diagnosed with a food allergy, it's important to have a clear plan to help them stay safe—especially at school. This includes knowing which foods to avoid and being prepared in case of an emergency. They'll need an
allergy and anaphylaxis emergency plan, as well as a medicine called
epinephrine readily available (more on this, below).
Coordinated care for all school children with food allergies: AAP policy explained
Food allergies have risen by 50% since the 1990s. With this in mind, the American Academy of Pediatrics (AAP)
advocates for the health of all children who must avoid certain foods to stay healthy.
We believe that a team approach among parents, pediatricians and schools is the best way to ensure that kids with food allergies can stay safe at school. State and federal laws can make this partnership even more effective. For example, many states have authorized schools to keep
open stocks of epinephrine on hand so they can treat any child showing signs of an allergy flare-up, whether or not a prescription has been issued.
How can schools prevent exposure to food allergens?
Meals & snacks
Kids eat meals, snacks and treats during the school day, so having a system to prevent accidental exposures to food allergens is important.
A child allergic to dairy products could have an allergic reaction after eating a butter cookie brought in by a classmate.
Two students could trade snacks without reading the labels, causing a reaction if one of them has a peanut allergy.
A child with fish allergies could become ill if cutting boards aren't properly washed after making tuna sandwiches.
Other food allergen exposures
Although eating an allergen is the most common and important trigger of severe allergic reactions, there are also other ways to come in contact with a food allergen. Some
classroom materials may contain hidden food allergens. For example:
Play dough and modeling clay can contain wheat.
Certain finger paints can contain milk proteins or wheat.
Animal feed used in science or farm-related lessons may include allergens like peanuts, soy, eggs or wheat
These products don't always list their ingredients. So, it's a good idea to ask your child's teacher or school staff about the materials they use. Let them know about your child's allergies so they can help keep your child safe.
Rarely, food allergens can get into the air. For example, steam from cooking or powders used in class can be breathed in and cause a reaction. A child's skin usually does a good job keeping allergens out of the body. But if they touch a food allergen with their finger and then put it in their mouth, they can have a reaction.
Schools and students can follow simple steps to avoid these types of reactions, such as hand washing, surface and dishware/utensil cleaning. As students get older, they can gradually take on more responsibility. You can also coach your child to ask for help when they feel allergy symptoms starting
What is anaphylaxis?
Anaphylaxis is a serious allergic reaction. It can progress quickly, and can be life- threatening. Serious allergic reactions like anaphylaxis are reported in about 1 out of every 15 schools in the United States each year.
It's important to recognize the signs of anaphylaxis right away. Using epinephrine early—before the reaction gets worse—can keep a reaction from becoming life-threatening. That's why having an allergy and anaphylaxis emergency care plan is so helpful. Ideally, your doctor will create one for your child right when they are diagnosed with a food allergy, at the beginning of the school year and when the allergy list changes. These plans show parents and school staff what symptoms to look for and how to respond with epinephrine.
Treating food allergy reactions during school hours
If your child is diagnosed with a food allergy, their doctor will prescribe medications to treat an allergic reaction.
Epinephrine is the treatment for severe reactions. It treats symptoms—such as hives, swelling, coughing, wheezing, dizziness, vomiting and diarrhea, anaphylaxis—and also works to keep a reaction from progressing. There are various forms of epinephrine designed to be easy to carry, store and use, including auto-injectors and nasal sprays.
To help your child stay safe, give their school:
An Allergy and Anaphylaxis Emergency Plan signed by your child's doctor. This tells staff what symptoms to look for and what to do.
Any school-specific forms required to give your child medicine. These are usually kept by the school nurse or health office.
Epinephrine, which treats serious allergic reactions. It comes in easy-to-use forms like auto-injectors or nasal sprays.
Among ways school staff—including nurses, teachers and coaches—can help:
Learning about each child's specific allergies and recognizing symptoms
Encouraging non-food items for classroom celebrations
Enforcing no-food-sharing rules
Administering medication as directed
Contacting you promptly if a reaction occurs
Calling 911 if your child has a serious reaction (anaphylaxis)
For more detailed guidance, parents and school staff can read and share
Food Allergy Management in Schools (FAMS): Expert Recommendations for K–12 guidelines from Food Allergy Research and Education (FARE).
What are individualized health care & 504 plans?
Some schools also use an Individualized Health Care Plan (IHCP)—a nursing document that outlines how your child's allergy will be managed throughout the school day.
Because food allergies can interfere with breathing and restrict diet, your child may qualify for special accommodations under
Section 504 of the Rehabilitation Act of 1973. A
504 plan is a legally binding document that ensures your child can safely participate in their daily activities at school alongside their peers. It also provides legal protections if the school is unable to meet your child's needs.
Remember
Managing food allergies at school takes preparation and teamwork. Families, healthcare teams and schools need to work together to care for students with food allergies. With a good plan and clear communication, your child can feel safe and ready to learn every day.
More information
About Dr. O'Leary
Sonja O'Leary, MD, FAAP, is an Associate Professor of Pediatrics at the University of Colorado School of Medicine. She is currently the Chair for Ambulatory Pediatrics and School and Community Programs and previously served as the Medical Director of Denver Health Pediatrics at Denver Public Schools. She recently served as the chair of the Council on School Health (COSH) for the American Academy of Pediatrics (AAP) and has continued working with COSH most recently as editor of the upcoming 8th edition of the
School Health Manual. As a native Spanish-speaker and a Colombian, she knows that different heritages, cultures and experiences bring important perspective to medicine.
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About Dr. Pistiner
 Michael Pistiner, MD, MMSc, FAAP, is a pediatric allergist and the Director of Food Allergy Advocacy, Education and Prevention at Mass General for Children, Harvard Medical School. Dr. Pistiner has served as Chair of the Food Allergy Management in Schools Advisory Council and member of the CDC/USDA Workgroup for School Guideline Development for Managing Food Allergy in School. Dr. Pistiner has been deeply engaged in school food allergy advocacy and education at the local, state and national level. He is a member of the American Academy of Pediatrics Section on Allergy and Immunology and Council on School Health.
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