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Food Allergies: Guidance for Schools

Food allergies are some of the most common medical emergencies school staff sees. According to Food Allergy Research & Education (FARE), 1 in 13 children has a food allergy and 1 in 5 has experienced a severe allergic reaction, many while at school. By having a detailed written program to handle a severe allergic reaction, schools can help parents and children safely transition from home to school.

The symptoms of this disease can range from mild to severe. In rare cases, food allergies can lead to anaphylaxis—a severe and potentially life-threatening allergic reaction. No therapies are available to prevent or treat food allergies. The only preventative option for the patient is to avoid the food allergen. Treatment involves the management of symptoms as they appear.

The most common food allergens with the most serious allergic reactions—eggs, milk, peanuts, tree nuts, soy, wheat, shellfish and fish—are highly prevalent in the American diet, so students and their families must be vigilant. Schools can reduce the risk of accidental exposure to foods if they work with students, parents and physicians to minimize risks and provide a safe environment for students with food allergies.

Family's Responsibility

  • Notify the school of the child's allergies.
  • Work with the school to develop a plan that accommodates the child's needs throughout the school day, including: when in the classroom and cafeteria; at after-care programs and school-sponsored activities; and when on the school bus.
  • Work with the school to develop a Food Allergy Management and Prevention Plan (FAMPP). Refer to the Centers for Disease Control and Prevention’s (CDC) published guidelines for managing food allergies in schools and early care and education programs.
  • Provide written medical documentation, instructions and medications (as directed by a physician), using the Food Allergy Management and Prevention Plan as a guide. Include a photo of the child on the written form.
  • Provide properly labeled medications and dispose of expired medications.
  • Educate the child in the self-management of their food allergy, including:
    • Safe and unsafe foods
    • Strategies for avoiding exposure to unsafe foods
    • Symptoms of allergic reactions
    • How and when to tell an adult that they may be having an allergy-related problem
    • How to read food labels (if age appropriate)
  • Review policies and procedures with the school staff, the child's physician and the child (if age appropriate) after a reaction has occurred.
  • Provide emergency contact information.

School's Responsibility

  • Be knowledgeable about and follow applicable federal laws, including:
    • Americans with Disabilities Act (ADA)
    • Individuals with Disabilities Education Act (IDEA), Section 504
    • Family Educational Rights and Privacy Act (FERPA)
    • Any state laws or district policies that apply
  • Review the health records submitted by parents and physicians.
  • Include students with food allergies in school activities. Students should not be excluded from activities solely based on their food allergy.
  • Identify a core team of a school nurse, teacher, principal, school food service and nutrition manager/director and counselor (if available) to work with parents and the student (if age appropriate) to establish a prevention plan and emergency care plan (ECP). Changes to the prevention plan to promote food allergy management should be made with core team participation.
  • Ensure that all staff who interact with the student on a regular basis understand the food allergy, can recognize symptoms, know what to do in an emergency and work with other school staff to eliminate the use of food allergens in the student's meals, educational tools, arts and crafts projects or incentives.
  • Practice the Food Allergy Management and Prevention Plans before an allergic reaction occurs to make sure it is efficient and effective.
  • Coordinate with the school nurse to ensure medications are appropriately stored and be sure an emergency kit is available that contains a physician's standing order for epinephrine. In states where regulations permit, medications should be kept in an easily accessible secure location central to designated school personnel. It should not be locked in cupboards or drawers. Students should be allowed to carry their own epinephrine (if age appropriate) after approval from the student's physician, parent or school nurse, permitting it is allowed by state or local regulations.
  • Designate school personnel who are properly trained in administering medications in accordance with the State Nursing and Good Samaritan Laws governing the administration of emergency medications.
  • Be prepared to handle a reaction and ensure that there is a staff member available who is properly trained to administer medications during the school day, regardless of time or location.
  • After a reaction occurs, review policies and the prevention plan with core team members, parents or guardians, student (if age appropriate) and physician.
  • Work with the district transportation administrator to ensure school bus driver training includes symptom awareness and what to do if a reaction occurs.
  • Recommend that all buses have communication devices in case of an emergency.
  • Enforce a "no eating" policy on school buses, with exceptions made only to accommodate special needs under federal or similar laws, or school district policy.
  • Discuss field trips with the family to decide appropriate strategies for managing the food allergy.
  • Follow federal, state and district laws and regulations regarding sharing medical information about the student.
  • Take threats or harassment against a child with allergies seriously.

Student's Responsibility

  • Must not trade food with others
  • Do not eat anything with unknown ingredients or known to contain any allergen
  • Be proactive in the care and management of their food allergies and reactions, based on their developmental level
  • Notify an adult immediately if they eat something they believe may contain the food to which they are allergic

Signs of an Allergic Reaction

Symptoms of a food allergy can develop within minutes or up to an hour after exposure to the allergen. Each person reacts differently but common symptoms of a reaction include:

  • Hives, itching or eczema
  • Swelling of the lips, face, tongue or throat
  • Wheezing, nasal congestion or trouble breathing
  • Tingling in the mouth, hoarse voice or trouble swallowing
  • Abdominal pain, diarrhea, nausea or vomiting
  • Dizziness, lightheadedness or fainting
  • Mood change or confusion

Not all allergic reactions will progress to anaphylaxis, but it's smart to be prepared. Even children without life-threatening symptoms can progress into anaphylaxis without warning.

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