Food allergies in schools have become an increasingly serious concern for students, teachers, and school personnel.
As an educator, you likely didn’t plan on providing medical care for students, but the reality is that almost half of severe allergic reactions, called anaphylaxis, that happen at school occur in the classroom on your watch (Hogue, 2017).
It isn’t enough to just have a plan for students in your class that are known to have an allergy because one out of every four food allergy reactions that happen at school happen to students with no known history of a food allergy (McIntyre et al., 2005; Sicherer et al., 2001). While rare, students have died from the effects of suffering an allergic reaction and not receiving the life-saving medication called epinephrine soon enough (Schoessler & White, 2013; Robinson & Ficca, 2011; Sicherer & Simons, 2007).
What can you do to prepare for the possibility of a food allergy reaction happening in your class? You can become allergy-aware by learning the signs and symptoms of a reaction, responding to a potential allergic reaction, and preventing allergic reactions from happening.
Signs and symptoms of an allergic reaction
The early symptoms may be mild but can quickly become life threatening. The following chart from the Epinephrine Policies and Protocols Workgroup of the National Association of School Nurses (2014) provides guidance for educators.
|Are any of these signs and symptoms present and severe?||Or is there a COMBINATION of symptoms from different body areas?|
|LUNG: Short of breath, wheeze, repetitive cough||SKIN: Hives, itchy rashes, swelling (eyes, lips)|
|HEART: Pale, blue, faint, weak pulse, dizzy, confused||GUT: Vomiting, cramping pain, diarrhea|
|THROAT: Tight, hoarse, trouble breathing/swallowing||HEENT*: Runny nose, sneezing, swollen eyes, phlegmy throat|
|MOUTH: Obstructive swelling (tongue and/or lips)||OTHER: Confusion, agitation, feeling of imp
|SKIN: Hives all over body [OR Hives visible on body]||If YES, quickly follow the student’s emergency action plan or your school’s policies and procedures.|
*Head, eyes, ears, nose, and throat.
How to respond to an allergic reaction
Once it is clear that an allergic reaction may be occurring (or even if you think, “I wonder if this might be an allergic reaction.”), take action quickly.
For a student with a known allergy, refer to the student’s emergency action plan. For a student with no known allergy, contact the school nurse if your school has one and take action according to your school’s policies and procedures.
Students experiencing anaphylaxis need emergency epinephrine. Every state and every school district has different rules and regulations about which school personnel can administer this life-saving medication. If you are not allowed to use an epinephrine auto-injector, get someone who can quickly.
If you are allowed to use an epinephrine auto-injector, take heart because epinephrine auto-injectors are very easy to use. Demonstration videos are available online:
- AuviQ: https://www.youtube.com/watch?v=DNej6KfHb5c
- EpiPen: https://www.youtube.com/watch?v=FXlqSuzzrws
- Generic auto-injector/Adrenaclick: https://www.youtube.com/watch?v=J0cSlufZpNI
If an epinephrine auto-injection is required, immediately dial 911 or call your emergency services. Contact your school nurse if he or she is not already on the scene, as well as a parent or guardian.
Preventing food allergy reactions
No plan is fool-proof. Even the most meticulous person cannot avoid all potential exposures to allergens, especially food allergens. However, some simple steps can decrease the likelihood of a student’s exposure to his or her allergen.
- Work with the school nurse to understand your students’ allergy care needs and learn how to respond to allergic reactions for students with no known allergies.
- Understand food labeling. Online resources include: http://allergyhome.wpengine.netdna-cdn.com/wp-content/uploads/2014/12/Label-Reading-Two-Pager-FAMILY-EDITIONv1.1.pdf and https://www.foodallergy.org/file/tips-avoid-allergen.pdf
- Avoid common allergens in classroom projects. Stop and think before offering snacks to students. The most common food allergens are:
- Milk, Eggs, Fish, Crustacean Shellfish, Peanuts, Tree Nuts, Wheat, and Soy
- Keep communications open with students and their parents. Work with your principal and school nurse to develop a powerful, compelling message about allergen awareness so that school can be a safe space for student learning.
About the Author
Andrea Tanner, MSN, RN, NCSN, is a National Association of School Nurses (NASN) Epinephrine Resource School Nurse, Anaphylaxis Community Expert, National Certified School Nurse, selected as one of the 2015 Robert Wood Johnson Foundation’s Breakthrough Leaders in Nursing, and Coordinator of Health Services in southern Indiana. Mrs. Tanner served on a committee with the American Academy of Pediatrics to develop national guidance for school allergy policies and procedures. She has presented on food allergy policies, procedures, and staff training at state and national conferences, and has published articles on the topic in Principal Leadership and NASN School Nurse.
Epinephrine Policies and Protocols Workgroup of the National Association of School Nurses. (2014). Sample protocol for treatment of symptoms of anaphylaxis – Epinephrine autoinjector administration by school health professionals and trained personnel. Retrieved from https://www.nasn.org/portals/0/resources/Sample_Anaphylaxis_Epinephrine_Administration_Protocol.pdf
Hogue, S, et al. Abstract 696. Presented at: American Academy of Allergy, Asthma & Immunology Annual Meeting; March 3-6, 2017; Atlanta.
McIntyre, C., Sheetz, A., Carroll, C., & Young, M. (2005). Administration of epinephrine for life-threatening allergic reactions in school settings. Pediatrics, 116(5), 1134-1140.
Robinson, J. & Ficca, M. (2011). Managing the student with severe food allergies. Journal of School Nursing, 28(3), 187-194. doi: 10.1177/1059840511429686.
Schoessler, S. & White, M. (2013) Recognition and treatment of anaphylaxis in the school setting: The essential role of the school nurse. NASN School Nurse, 29: 407-415. doi: 10.1177/1059840513506014
Sicherer, S., Furlong, T., DeSimone, J., & Sampson, H. (2001). The US Peanut and Tree Nut Allergy Registry: Characteristics of reactions in schools and day care. Journal of Pediatrics, 138(4), 560-565.
Sicherer, S. & Simons, F.E. (2007). Self-injectable epinephrine for first aid management of anaphylaxis. Pediatrics, 119(3), 638-646. doi: 10.1542/peds.2006-3689.