ManagingFoodAllergiesintheSchoolSetting:
GuidanceforParents
TheFoodAllergy&AnaphylaxisNetwork(FAAN)
www.foodallergy.org
ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
ThispublicationwasdevelopedwithsupportfromtheCentersforDiseaseControlandPrevention,NationalCenterforChronicDisease
PreventionandHealthPromotion,DivisionofAdolescentandSchoolHealth;contract#200Ͳ2009ͲMͲ31692.Itscontentsaresolelythe
responsibilityoftheauthorsanddonotnecessarilyrepresenttheofficialviewsoftheCentersforDiseaseControlandPrevention.
2
ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
ManagingFoodAllergiesintheSchoolSetting:
GuidanceforParents
Forsomeparents,sendingachildwithlifeͲthreateningfoodallergiesofftoschoolcanfeellikean
overwhelmingtask.Successfullytransitioningyourchildintoschoolrequiresformingapartnershipbetween
youandateamofkeyindividualsthatincludestheschoolnurse,teachers,administrators,cafeteriastaff,
maintenancestaff,transportationstaff,coaches,otherparents,andyourchild’’sclassmates.Allofthese
individualsplayaroleinfoodallergymanagement.TheFoodAllergy&AnaphylaxisNetwork(FAAN)has
createdthisguidancedocumenttohelpyouhelpyourchildjointhemillionsofchildrenwithfoodallergywho
attendschoolsafelyeveryday.
Thisguidanceaddressestheparents’’rolesinbecomingproactiveparticipantsinapartnershiptohelpmanage
foodallergiesintheschoolsetting.Thedocument,dividedinto10sections,focusesonachecklistofcritical
steps:
ChecklistforParents
1. BecomeInformedandEducated
2. PrepareandProvideInformationAboutYourChild’’sFoodAllergyandMedication
3. BuildaTeam
4. HelpEnsureAppropriateStorageandAdministrationofEpinephrine
5. HelpReduceFoodAllergensintheClassroom(s)
6. ConsiderSchoolMeals
7. AddressTransportationIssues
8. PrepareforFieldTripsandExtracurricularActivities
9. PreventandStopBullying
10. AssistYourChildwithSelfͲManagement
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ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
1) BecomeInformedandEducated
Therearevarioustopicsyoushouldknowandunderstandbeforeyouapproachyourchild’’sschool.
First,bewellversedonyourchild’’sfoodallergy.
Astheparentofachildwithfoodallergy,itiscriticalthatyouknowthefollowing:
x Thefoodsheorshemustavoid.
x Thesignsandsymptomsofanallergicreaction.
x Thewaysyourchildmightdescribeanallergicreaction.
x Theroleofepinephrineintreatment.
x ThecorrectwaytouseanepinephrineautoͲinjectabledevice,ifonehasbeenprescribed.
ThebestwaytolearnthisinformationistotalkwithaboardͲcertifiedallergist.Youcaneasilylocatean
allergistnearyouthroughtheAmericanAcademyofAllergy,Asthma&Immunology(AAAAI)website,
www.aaaai.org.
Second,learnhowschoolsgenerallymanagestudentswithfoodallergy.
ReadingAnaphylaxisinSchoolsandOtherChildͲCareSettings,apositionstatementfromAAAAI,isahelpful
initialstep.Youalsocanreviewstatewidefoodallergymanagementguidelinesthathavebeenpublishedbya
numberofstates,perhapsincludingyours.Appendix1citestheseandotherresourceswhereyoucanfind
informationtohelpyousetreasonableexpectationsformanagingyourchild’’sfoodallergiesatschool.
Third,findoutasmuchasyoucanaboutyourschool’’sapproachtofoodallergymanagement.
Becausefoodallergyhasbecomesuchanemerginghealthissue,especiallyamongchildren,manyschools
havealreadyadoptedandimplementedfoodallergymanagementstrategies.Agoodstartingpointforthe
inquiryisalocalfoodallergysupportgroup,whereyoucanconnectwithparentswhosechildrenattend
schoolsinyourlocalarea.FAANrecognizesmorethan170suchgroupsacrosstheUnitedStates(withdozens
morepending).Supportgroupsgenerallyholdregularmeetings,haveamedicaladvisor(usuallyalocal
allergist),andareknowledgeableaboutareaschoolsandtheirfoodallergymanagementpolicies.Support
groupsarealsoagreatwaytocomparenotesandsharetipswithotherparentsinyourarea.
Finally,understandthattheindividualneedsofstudentswithfoodallergymaydifferaccordingtoage.
Someofthemanagementstrategiesinthisdocumentmaybemoreappropriateattheelementaryschoollevel
asopposedtothehighschoollevel,whenstudentsbecomemoreindependent.Forexample,studentsinhigh
schoolmaynotneedtositatadesignatedtableinthecafeteria,andmaynotneedtoberemindedaboutthe
potentialdangerofsharingortradingfood.
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ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
2) PrepareandProvideInformationAboutYourChild’’sFoodAllergyandMedication
FoodAllergyActionPlan
Providinginformationaboutyourchild’’sfoodallergyandmedicationstotheschooliscritical.Withthehelpof
yourchild’’sallergist(orotherlicensedhealthcareprovider),completeaoneͲpageFoodAllergyActionPlan.
Yourchild’’sschoolmayhaveitsownform,anditmayhaveaslightlydifferentname(i.e.,EmergencyCare
Plan);ifnot,youcandownloadonefromtheFAANwebsiteatwww.foodallergy.org/page/foodͲallergyͲactionͲ
plan1.
Theformshouldinclude
x Acompletelistoffoodstowhichyourchildisallergic.
x Thepossiblesymptomsofyourchild’’sallergicreaction.
x Thetreatmentthatshouldbeadministeredtoyourchild,andunderwhatcircumstances.
x Contactinformationforemergencymedicalservices(i.e.,911),yourchild’’sallergist,andyou.
x Acurrentpictureofyourchild.
x Thesignatureofyourchild’’sallergist(orotherlicensedhealthcareprovider).
BesidestheFoodAllergyActionPlan,theschoolmayaskyoutoprovideinformationsuchasallergytest
resultsandanyhistoryofyourchild’’sallergicreactions.Theschoolalsomayrequireyoutocomplete
additionalmedicalformsnotnecessarilyrelatedtofoodallergy.
EpinephrineAutoͲInjector
YoualsomustprovidetheschoolwithatleastoneepinephrineautoͲinjector,ifprescribed.Infact,many
parentsprovideatleasttwoautoͲinjectors,incaseaseconddoseisneeded.EpinephrineautoͲinjectorsshould
haveashelflifeof1year,sobesuretochecktheexpirationdateontheautoͲinjectorbeforegivingittothe
school.Youmaywanttoensurethattheexpirationdateisatleast12monthsaway,sothatyouwillnotneed
toreplacethedeviceduringtheschoolyear.
AdditionalMedications
Dependingonyourchild’’scircumstances,youmayneedtoprovidetheschoolwithadditionalmedications
suchasantihistamineand/orasthmainhalers.Remember,however,thatepinephrineisthefirstlineof
defensefortreatingapotentiallylifeͲthreateningallergicreaction,andthatalleffortsshouldbedirected
towarditsimmediateuse.Researchclearlyshowsthatfoodallergyfatalitiesaremostcommonlyassociated
eitherwithnotusingepinephrineorwithdelayingepinephrinetreatment.1,2,3,4
1
TheUseofEpinephrineintheTreatmentofAnaphylaxis.PositionStatementfromtheAmericanAcademyofAllergy,Asthma&
Immunology.Availableonlineat:www.aaaai.org/members/academy_statements/position_statements/ps26.asp.
2
BockSA,MuñozͲFurlongA,SampsonHA.Fatalitiesduetoanaphylacticreactionstofoods.JournalofAllergyandClinical
Immunology2001;107:191Ͳ193.
3
BockSA,MuñozͲFurlongA,SampsonHA.Furtherfatalitiesduetoanaphylacticreactionstofood:2001to2006.JournalofAllergy
andClinicalImmunology2007;119:1016Ͳ1018.
4
SampsonHA,MendelsonL,RosenJP.FatalandnearͲfatalanaphylacticreactionstofoodinchildrenandadolescents.NewEngland
JournalofMedicine1992;327:380Ͳ384.
5
ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
3) BuildaTeam
Managingfoodallergyatschoolinvolvesateamofindividuals,includingtheschoolnurse,teachers,
administrators,cafeteriastaff,maintenancestaff,transportationstaff,coaches,otherparents,andyourchild’’s
classmates.
Inworkingwithyourteam,recognizeupfrontthatsomeofthemembersmightneedadditionaltimetolearn
aboutfoodallergyandthestepsneededtoavoidfoodallergensintheschoolsetting.ActionsthataresecondͲ
naturetoyou,suchasreadingingredientlabels,maynotbeintuitiveactionsforothers.Maintainanopen
dialoguewithyourteam,characterizedbycalm,confidentcommunication.Also,makeyourselfavailableto
yourteam,andprovidethemwithyourcontactinformationsotheycancallyouwithquestions,suggestions,
orconcerns.Considersharingwiththemacopyoftheinformationsheet,““10FactsAboutFoodAllergy””(see
Appendix2).
Beforethefirstdayofschool,trytomeetwithmembersofyourteamto
x Introduceyourselfandshareinformationaboutyourchild.
x Findoutwhattheyalreadyknowaboutfoodallergy.
x Provideinformationonthebasics(ifnecessary),clearupanymisconceptions,anddiscusstherole
teammembershaveinmanagingyourchild’’sfoodallergy.
Provideacopyofyourchild’’sFoodAllergyActionPlantotheteammemberswhoaremostlikelytocomeinto
contactwithyourchildduringtheschoolday,andaskthemtokeepitinaneasilyaccessiblelocation.
Becauseofschedules,youmaynotbeabletomeetwithalltheschoolteammembersasagroup.However,as
soonaspossiblebeforethebeginningoftheschoolyear(orpriortoaschoolenrollmenttransfer),youshould
meetatleastwithyourchild’’steacher(s),whowillhavethemostcontactwithyourchildthroughoutthe
schoolday.
Youalsoshouldmeetwiththeschoolnurseinordertodiscussyourchild’’sFoodAllergyActionPlan,andany
needforanadditionaltypeofwrittenmanagementplan.Morecommontypesofplansinclude:
x AnIndividualizedHealthcarePlan(IHP),whichisrecommendedbytheNationalAssociationofSchool
Nurses(NASN)forstudentswhosehealthcareneedsmayaffecttheirabilitytoattendschoolsafely
andperformacademically.5
x A504Plan6,whichappliestostudentswhohaveadisabilitythataffectstheirabilitytoparticipatefully,
alongsidetheirpeers,inallregularfacetsoftheschoolday.Childrenwhosefoodallergymayresultin
severe,lifeͲthreateningreactions(intheopinionofthechild’’slicensedhealthcareprovider)meetthe
definitionofdisabilityunderSection504.7Eachschoolshouldhavea504Coordinatorwhocanhelp
youdevelopa504Plan.
x AnIndividualEducationProgram(IEP),basedontheIndividualswithDisabilitiesEducationAct(IDEA).
IDEAaddressesservicesforchildreninneedofspecialeducation(i.e.,childrenwithconditionsthat
impacttheireducationalperformance,suchashearing,visionorspeechimpairments,behavioral
conditions,orautism).ChildrenwithfoodallergyalonegenerallydonotqualifyforanIEP;however,a
5
NASNPositionStatementonIndividualizedHealthcarePlans,availableonlineatwww.nasn.org/Default.aspx?tabid=226.
Section504oftheRehabilitationActof1973,asamended,29U.S.C.s.794isafederallawdesignedtoprotecttherightsof
individualswithdisabilitiesinprogramsandactivitiesthatreceivefederalfundsfromtheU.S.DepartmentofEducation.Recipients
ofthesefundsincludepublicschooldistricts,alongwithotherstateandlocaleducationalagencies.
7
AccommodatingChildrenwithSpecialDietaryNeedsintheSchoolNutritionPrograms.UnitedStatesDepartmentofAgriculture
FoodandNutritionService,Fall2001.Availableonlineat:www.fns.usda.gov/CND/Guidance/special_dietary_needs.pdf.
6
6
ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
childwithfoodallergyalsomayhaveacoͲexistingconditionthatmaywarrantprotectionunderIDEA.
Inthiscase,thefoodallergyandthecoͲexistingconditionaregenerallyaddressedthroughoneIEP.
7
ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
4) HelpEnsureAppropriateStorageandAdministrationofEpinephrine
Knowinga)whereyourchild’’sprescribedepinephrineislocated,b)whohasaccesstoit,andc)whowill
administerthemedicationintheeventofanemergencyiscriticaltosupportingyourchild’’shealthandwellͲ
beingatschool.
Whendeterminingthelocationoftheepinephrine,considerthefollowing:
x Dependingontheirageandmaturitylevel,manychildrencarrytheirepinephrine(inawaistpackorin
abookbag).Thispracticeisgenerallyallowedbystatelawand/orlocalschoolboardpolicyandis
basedonparentalandphysicianconsent.Evenintheeventthatthechilddoescarryhisorher
prescribedepinephrine,aresponsibleadultshouldalwaysbeavailableincaseanemergencyarises.
x Localschoolpolicymayrequirethatprescribedepinephrinebekeptunderlockandkey.Ifso,discuss
whohasaccesstoepinephrineandhowconvenientlyitcanbeaccessedinanemergencyorafter
normalschoolhours.
x Localpolicymayallowepinephrinetobekeptintheclassroom(inacontainermountedtoawall,out
ofthereachoftheotherstudents,orintheteacher’’sdesk),orpassedfromteachertoteacherasyour
childchangeslocationsduringtheschoolday.
Makesurethattheepinephrineyouprovidetheschoolhasnotexpired,andisclearlylabeledwithyourchild’’s
nameandclassroominformation.
Epinephrineisgenerallyadministeredbytheschoolnurse.However,becauseaschoolnursemaynotbe
availableduringanallergicreaction,otherschoolpersonnel(oftencalleddelegates)canbetrainedto
administerthemedication.Thisprocessofdelegationisgenerallydeterminedbylocalschoolboardpolicyand
bythejudgmentoftheschoolnurse.8Trainingofdelegatesisdonebyaschoolnurse,adistrictnurse,orother
licensedhealthcareprovider.
Wheneverepinephrineisadministered,thefollowingproceduresshouldbefollowed:
x Emergencymedicalservices(i.e.,911)mustbecontactedimmediately,andtherespondingemergency
personnelmustbeauthorizedtocarryandadministerepinephrine.Inmanylocations,onlycertain
typesofemergencypersonnelareallowedaccesstoepinephrine.Checkwithyourlocalambulance
provider(s)tolearnabouttheirpolicies.
x IntheeventthatyourchildselfͲadministersepinephrine,heorshemustnotifyanadultstaffmember
asquicklyaspossible,andtheadultshouldcallemergencymedicalservices(i.e.,911)immediately.
ChildrenshouldneverselfͲadministerepinephrinewhenalone,althoughthiscircumstancemightbe
beyondthechild’’scontrol.
x Yourchildshouldbetransportedtoahospitalandobservedfor4hours.Insomeallergicreactions,the
symptomsgoaway,onlytoreturn2to3hourslater.Thisiscalledabiphasicreactionandmaybe
moreseverethanthefirstͲphasesymptoms.
Ifyourchildhasanallergicreactionatschool,discusstheeventwithappropriateschoolpersonnel.Review
howthereactionoccurredandhowitcouldhavebeenprevented.Inaddition,notethesuccessesand
challengesthatwereevidentintheresponsetotheemergency.
8
Delegation.PositionStatementfromtheNationalAssociationofSchoolNurses.Availableonlineat:
www.nasn.org/Default.aspx?tabid=349. 8
ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
5)HelpReduceFoodAllergensintheClassroom(s)
Speakwithyourchild’’steacher(s)abouttheroleoffoodintheclassroom.Determinewhetherstrategiescan
beimplementedtohelpavoidexposuretofoodallergensandtheriskofyourchildhavinganallergicreaction.
Suchstrategiesmayinclude
x Havinga““nofoodsharing””or““nofoodtrading””rule.
x Encouraginghandwashingafterfoodhandlingandeating.Liquidsoap,barsoap,andsanitizingwipes
effectivelycleanhandsofpotentialallergens,butantibacterialsanitizinggelsdonot.9
x Washingsurfacesafterfoodiseatenorused.Commercialwipesandspraycleanersaremosteffective
atremovingpeanutproteinfromtablesandothersurfaces.9
x Usingnonfooditemsforclassroomprojects,academicrewards,andclassroomcelebrations.
x Encouragingpackagedfooditemswithingredientlabels,asopposedtohomeͲbakedgoods.
x Avoidingmodelingclay,papermâché,crayons,soaps,andothermaterialsthatmaycontainallergens.
x Keeping““safesnacks””intheclassroomforunplannedevents,alongwithsafe,nonperishablemealsin
caselunchiscompromisedorintheeventofashelterͲinͲplaceemergencyorevacuationtoanother
location.
x Providingtheclassroomteacherwithsafesnacksfortheentireclasssothatyourchildcaneatwhat
everyoneelsedoes.
x Havingstudentsstoretheirlunchesinaspecificlocation.
x Allowingyoutobecomea““classroomparent””sothatyoucanhaveadvancenoticeofplanned
activitiesthatmightinvolvefood.Someclassroomparentsarechosenoverthesummerbythelocal
PTA.Ifyoucannotbeaclassroomparent,asktobeinvitedtoclasseventssuchasfieldtripssothatyou
canhelptheteachermonitoryourchild’’sexposuretofoodallergens.
x Makingsurethatacopyofyourchild’’sFoodAllergyActionPlanisavailableforsubstituteteachers.
Inordertoraiseawarenessoffoodallergyandhelpreduceallergensintheclassroom,someschoolssenda
letterhometoclassroomparents,informingthemthatthereisachildintheclasswithfoodallergy.Sucha
lettercanhelppromoteparentalsupportofthefoodallergymanagementteaminitswork.
Youalsomaywanttoasktheschooladministrationtodesignateyourchild’’sclassroomasonethatisnotused
foroutsideactivitiesandevents(duringnonschoolhours)thatinvolvefood.Takingthisprecautionwillhelp
reducecontaminationofdesksandothersurfaceswithfoodallergenswhenschoolisnotinsession.
9
PerryTT,ConoverͲWalkerMK,PomésA,ChapmanMD,WoodRA.Distributionofpeanutallergenintheenvironment.Journalof
AllergyandClinicalImmunology2004;113:973Ͳ6.
9
ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
6)ConsiderSchoolMeals
Someparentspreferthattheirchildeatonlyfoodpreparedathome,whileothersprefertotakeadvantageof
federalschoolmealprograms.
AccordingtoguidelinessetforthbytheU.S.DepartmentofAgriculture(USDA),thefederalagencyoverseeing
theSchoolBreakfastProgramandtheNationalSchoolLunchProgram,schoolsmustoffersafesubstitute
mealstostudentswithlifeͲthreateningfoodallergies.Inordertodoso,however,theschoolneedswritten
instructionsfromthechild’’slicensedhealthcareprovider,aswellastheidentificationofappropriate
substitutions.TheUSDAprovidessampleformsinitsAccommodatingStudentswithSpecialDietaryNeedsin
theSchoolNutritionPrograms(seeAppendix1).Theinstructionsandformscanbeintegratedintotheteam’’s
approachtomanagingyourchild’’sfoodallergiesatschool.
Talkwiththeschool’’sfoodservicedirector,preferablybeforethestartoftheschoolyear,tofindouthowthe
schoolcafeteriamanagesstudentswithlifeͲthreateningfoodallergies,andwhethertheapproachis
appropriateforyourchild.Commonapproachesinclude
x Postingmenusinadvancetoallowparentstoidentifypotentiallyunsafemealofferings.
x TrainingfoodservicepersonnelonfoodallergyissuessuchasavoidingcrossͲcontactduringfood
preparationandserving,andreadingfoodlabels.
x Postingpicturesofchildrenwithfoodallergiesbehindthecounterorregister.
x Usingseatingarrangementstominimizeexposuretofoodallergens,whileensuringthatchildrenwith
foodallergydonotsitalone.
x Encouraginghandwashingaftereatingandfoodhandling.
x Washingsurfacesafterfoodiseatenorserved.
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ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
7)AddressTransportationIssues
Manyschoolshaveproceduresformanagingfoodallergiesonschooltransportationvehicles.Ifso,findout
whattheseproceduresare,anddeterminewhethertheyareappropriateforyourchild.Keepinmindthat
childrenridetransportationvehiclesnotonlytoandfromschoolbutalsoduringfieldtripsandforafterͲschool
activities.
Commonschoolbus/vanproceduresinclude
x A““nofood””policy(unlessmedicallynecessary).
x Specialseatingarrangements.
x Equippingthebusdriverwithacellphoneoremergencyradiodevice.
x Allowingchildrenoranaccompanyingadulttocarrytheirprescribedepinephrineonthebus.
x TrainingdriverstorecognizethesymptomsofapotentiallylifeͲthreateningallergicreaction,andto
respondappropriately.
Atmanyschools,parentsdrivegroupsofchildrenbyprivateautomobile.Insuchcases,thepoliciesand
proceduresforschoolbus/vantransportationshouldapply.
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ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
8)PrepareforFieldTripsandExtracurricularActivities
Yourchild’’sfoodallergyshouldnotpreventhimorherfromattendingfieldtripsandparticipatingin
extracurricularactivities.
Askthatyoubegivenadvancenoticeabouttheseevents,sothatyoucanaddressanyfoodallergyconcerns.
Issuestoconsiderincludethefollowing:
x Whowillberesponsibleforcarryingyourchild’’sFoodAllergyActionPlanandmedications?
x Whowillberesponsibleforrecognizingthesymptomsofanallergicreaction,administering
medications,andcallingemergencymedicalservices(i.e.,911)ifnecessary?
x Willyourchildbeabletobringhisorherownfood?
x Ifyourchildistoreceiveaspecialmeal,suchasasacklunchnotsuppliedbythechild,whowillensure
thatthemealgiventoyourchildissafeforhimorher?
x Willthechildreneatatarestaurantorothertypeoffoodserviceestablishment?Ifso,special
arrangementsmaybenecessary.
x Whattypeoftransportationwillbeinvolved(bus,van,privateautomobile)?
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ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
9)PreventandStopBullying
Anychildcanbebulliedatschool,oftenwithdevastatingresults.Thebullyingofchildrenwithfoodallergies
takesongreaterurgencybecauseofthelifeͲthreateningnatureofthecondition.Childrenwithfoodallergies
havehadsevereallergicreactionsafterbeingharassedwithanactualfoodallergen(i.e.,smearingpeanut
butteronthefaceofachildwhoisallergictopeanuts).
Schoolsshouldhavestrong,proactiveantiͲbullyingpreventionprogramsthatincludeasystemwherebyall
studentslearnhowtorecognizeandreportbullyingrelatedtolifeͲthreateningfoodallergy.Ahelpful
educationalawarenessresourceisFAAN’’sBeaPAL(ProtectALife™™fromFoodAllergies)program,designedto
assistparentsandeducatorsinteachingstudentswhatfoodallergiesareandhowtohelptheirfriendswho
havefoodallergies(seeAppendix1).
Theschool’’sresponsetoreportedbullyingshouldbemadeclearattheoutset,shouldbefullyimplementedas
planned,andshouldbeboththerapeuticandpunitive.
Alwaysbeonthelookoutforsignsthatyourchildmightbeexperiencingbullyingorteasingbecauseofhisor
herfoodallergy.Potentialsignsofbullyingorteasingincludedepression,socialanxiety,resistancetogoingto
school,andpooracademicperformance.
Ifyoususpectthatyourchildisbeingbullied,contacttheteacherortheprincipal.TheU.S.Departmentof
HealthandHumanServiceshasfurtherresourcesonbullying,whicharelistedinAppendix1.
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ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
10)AssistYourChildwithSelfͲManagement
Forchildrenwithfoodallergies,preventionofallergicreactionsinvolvesmakinggoodchoices,advocatingfor
themselves,andrecognizingpotentiallydangeroussituations.Asyourchildgrowsolderandmatures
developmentally,learninghowtomanagehisorherfoodallergyisvitallyimportantinindividualand
collectiveeffortstoavoidlifethreateningfoodallergens.Yourroleinyourchild’’slearningprocessisessential.
Whenappropriate,teachyourchildto
x Carryhisorherprescribedepinephrineatalltimes.Remember:promptadministrationofepinephrine
iskeytosurvivingapotentiallylifeͲthreateningreaction.
x Knowwherehisorherprescribedepinephrineislocatedatschool(ifheorsheisnotoldenoughor
permittedtocarryit)andwhichschoolpersonnelcanaccessthemedication.
x Raiseawarenessoffoodallergyamongothers(classmates,friends,etc.).
x Avoideatinganyfoodwhoseingredientsareunknown,suchashomeͲbakedgoods.
x Avoidsharingortradingfoodwithclassmates.
x Washhandsregularlytohelppreventexposuretofoodallergens.
x Readfoodlabelstoidentifypotentialfoodallergens.
x Learnhowtorecognizethesymptomsofareactionandtotellanadultimmediatelyifheorshe
suspectsanallergicreaction.
x Wearmedicalidentificationjewelrythatcanhelpconveyfoodallergyinformationtoemergency
medicalpersonnel.
x Reportbullyingorteasingsothatappropriateactioncanbetaken.
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ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
Appendix1:SelectedResources
TheFoodAllergy&AnaphylaxisNetwork(FAAN)
¾ FoodAllergyActionPlan(EmergencyCarePlan):www.foodallergy.org/page/foodͲallergyͲactionͲplan1
¾ ManagingFoodAllergiesintheSchoolSetting(video):www.foodallergy.org/section/videoͲgallery
¾ BackͲtoͲSchoolToolKit:www.foodallergy.org/section/backͲtoͲschoolͲtoolͲkit͸containsdownloadable
posters,brochures,presentations,certificates,andothereducationalmaterials,includingtheBeaPAL
(ProtectALife™™fromFoodAllergies)program
¾ Foodallergywebsiteforkids:www.faankids.org
¾ Foodallergywebsiteforteens:www.faanteen.org
¾ TalkingtoYourTeenAboutFoodAllergy(brochure):
www.foodallergy.org/downloads/TeenBrochure.pdf
¾ Linkstostatewideguidelinesformanagingfoodallergyinschools:
www.foodallergy.org/page/statewideͲguidelinesͲforͲschools
CentersforDiseaseControlandPrevention(CDC)andOtherFederalAgencies
CDC
¾ CDCDatabrief––FoodAllergyAmongU.S.Children:www.cdc.gov/nchs/data/databriefs/db10.htm
¾ CDC/DivisionofAdolescentandSchoolHealth:FoodAllergies
www.cdc.gov/healthyyouth/foodallergies/index.htm
HealthResourcesandServicesAdministration
¾ TakeaStand!LendaHand!StopBullyingNow!(gamesandcartoonwebisodes):
www.stopbullyingnow.hrsa.gov/index.asp?area=main
U.S.DepartmentofAgriculture
¾ AccommodatingChildrenwithSpecialDietaryNeedsintheSchoolNutritionPrograms:
www.fns.usda.gov/CND/Guidance/special_dietary_needs.pdf U.S.DepartmentofEducation
¾ DearColleagueLetteronDisabilityHarassment:www.ed.gov/PressReleases/07Ͳ2000/0726_2.html
ProfessionalOrganizations
AmericanAcademyofAllergy,Asthma&Immunology(AAAAI):www.aaaai.org
¾ AnaphylaxisinSchoolsandOtherChildͲCareSettings.PositionStatement:
www.aaaai.org/members/academy_statements/position_statements/ps34.asp
¾ TheUseofEpinephrineintheTreatmentofAnaphylaxis.PositionStatement:
www.aaaai.org/members/academy_statements/position_statements/ps26.asp
AmericanCollegeofAllergy,Asthma&Immunology(ACAAI):www.acaai.org
NationalAssociationofSchoolNurses
¾ IndividualizedHealthcarePlans.PositionStatement:www.nasn.org/Default.aspx?tabid=226
¾ Delegation.PositionStatement:www.nasn.org/Default.aspx?tabid=349
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ManagingFoodAllergiesintheSchoolSetting:GuidanceforParents
Appendix2:10FactsAboutFoodAllergy
1) Thereisnocureforfoodallergy.Strictavoidanceoftheoffendingallergenistheonlywaytopreventa
reaction.
2) Afoodallergyoccurswhentheimmunesystemmistakenlyattacksafoodprotein.Ingestionofthe
offendingfoodcantriggerthesuddenreleaseofchemicals,includinghistamine,resultinginsymptomsof
anallergicreaction.Thesymptomscanbemild(rashes,hives,itching,and/orswelling)orsevere(trouble
breathing,wheezing,and/orlossofconsciousness).AfoodallergycanbelifeͲthreatening.
3) Theseverityofaperson’’sallergicreactionstofoodcannotbepredictedfrompreviousreactions.Someone
whosereactionshavebeenmildinthepastmightreactmoreseverelyduringanextepisode.
4) Anaphylaxisisaseriousallergicreactionthatisrapidinonsetandcanresultindeath.Itismostoften
causedbyallergicreactionstofood,insectstings,medications,andlatex.Foodallergyistheleadingcause
ofanaphylaxisoutsideofthehospitalsetting.
5) Earlyadministrationofepinephrine(adrenaline)iscrucialtosuccessfullytreatinganaphylacticreactions.
EpinephrineisavailablebyprescriptionasanautoͲinjectabledevice.
6)Foodintolerance,unlikeafoodallergy,doesnotinvolvetheimmunesystemandisnotlifeͲthreatening.
Lactoseintolerance,inwhichindividualshavetroubledigestingmilksugarlactose,isacommonexample.
Symptomsoffoodintolerancecanincludeabdominalcramps,bloating,anddiarrhea.
7)Fouroutofevery100childrenhaveafoodallergy,andstudiesshowthattheprevalenceisincreasing
amongchildren.10,11,12Thereasonsfortheapparentincreaseinfoodallergyarenotclearlyunderstoodby
scientists.
8)Althoughanindividualcanbeallergictoanyfood,eightfoodsaccountfor90%ofallfoodͲallergicreactions
intheUnitedStates:milk,eggs,peanuts,treenuts(almonds,Brazilnuts,cashews,hazelnuts,macadamia
nuts,pecans,pistachios,andwalnuts),wheat,soy,fish,andshellfish.
9)Childrentypicallyoutgrowallergiestomilk,egg,wheat,andsoy.However,peanut,treenut,fish,and
shellfishallergiesareusuallylifelong.
10)Casualexposuretopeanutbutter(suchasthroughskincontactandinhalation)isunlikelytocause
anaphylaxis.13However,allergicreactionscanoccurfromairborneexposuretodustorcookingfumes.
10
BranumAM,LukacsS.FoodAllergyAmongU.S.Children:TrendsinPrevalenceandHospitalizations.NationalCenterforHealth
StatisticsDataBrief,No.10,October,2008.
11
SichererSH,MuñozͲFurlongA,GodboldJH,andSampsonHA.USprevalenceofselfͲreportedpeanut,treenut,andsesameallergy:
11ͲyearfollowͲup.JournalofAllergyandClinicalImmunology2010;125:1322Ͳ6.
12
Branum,AM,Lukacs,SL.FoodAllergyAmongChildrenintheUnitedStates.Pediatrics2009;124:1549Ͳ55.
13
SimonteSJ,MaS,MofidiS,SichererSH.Relevanceofcasualcontactwithpeanutbutterinchildrenwithpeanutallergy.Journalof
AllergyandClinicalImmunology2003;112:180Ͳ2.
16