“School days, school days, good old golden rule days” are the lyrics of an old song that beckoned kids back to school.

These days, kids are going back to school prepared with portable electronic notebooks, iPods, and almost every other technical gadget possible. If a child has a food allergy, especially a severe one, he or she must have access to an EpiPen® (an auto-injector that administers epinephrine, which is the definitive emergency treatment for severe allergic reactions). For one of the 5 to 8 percent of school-aged children with food allergies, it is important to understand the potential life and death situations that may occur in a classroom, lunchroom, and even during after-school activities. The entire school community, including the school food service staff, needs to be aware of the seriousness of food allergies and how to help students manage their allergies while they are at school. School food service staff and others may need a little help and guidance on how to effectively manage and educate others about food allergies.

In June 2006, The International Food Information Council (IFIC) and the School Nutrition Association (SNA) partnered to conduct a survey called the Questionnaire on Food Allergy. Notable in the 2006 survey was a more than 1,000 percent increase in participation by SNA directors and managers from the previous survey, which was conducted in 2004. Interest in food allergies has increased due to the need for information about the subject, especially at the school food service level. Much of this interest is the result of increased media attention and the implementation of the U.S. Food Allergen Labeling and Consumer Protection Act (FALCPA), which took effect on January 1, 2006, and mandates that foods containing milk, eggs, fish, crustacean shellfish, peanuts, tree nuts, wheat, and soy must declare the presence of that ingredient or food in plain language on the label or ingredient list.

A Primer on Food Allergies

The most common food allergens for most individuals, also referred to as the “Big 8,” are peanuts, dairy products, eggs, soy, wheat, fish, shellfish and tree nuts. FDA has defined tree nuts as chestnuts, Brazil nuts, walnuts, hazelnuts, pecans, pine nuts, and cashews. Many individuals outgrow certain allergies, but unfortunately, for some children, peanuts, tree nuts, dairy, soy, and egg allergies can remain with them throughout their entire lives.

Although it is important to realize that other allergy-causing foods, especially among children, can be just as prevalent and dangerous, recent reports indicate that the rate of allergies to peanuts, in particular, is significant among children. According to the Food Allergy and Anaphylaxis Network (FAAN), milk and egg allergies actually affect more children in the United States.

Speak Up! About a Child’s Food Allergy

Communicating about a child’s food allergy to the school staff is extremely important to help prevent a reaction from occurring while the child is at school. This is especially important if the child has been newly diagnosed with a food allergy, as the child will not have a documented history of food allergy from which the school food service staff, school nurse, or even teachers can draw.

A food allergy action plan, or food allergy emergency response plan, developed with the school staff, is helpful in providing effective food allergy management at the school food service level. The 2006 IFIC/SNA food allergy survey found that approximately 45 percent of participants had a food allergy emergency response plan, whereas the remaining 55 percent did not have or did not know if their school had one.

The following groups at any school should be involved in developing an effective and workable food allergy action plan:

Food Service Manager

Aside from teachers, most people focus on the lunchroom staff when communicating food allergy information. The school’s food service staff is part of the food allergy management team and should be invited to any meetings about a child’s allergy. SNA provides school nutrition professionals with information and resources on managing food allergies through conference education sessions, its website, and its member publications. However, “policies and approaches for managing food-allergic students are set at the local school and district level, and they can vary widely,” explains SNA spokesperson Erik Peterson. “We encourage parents to contact their local food service director to discuss these policies one on one.”

In addition, the “School Food Service and Food Allergies” information sheet is specifically designed with school food service professionals in mind. It includes general information on food allergies as well as tips on how to develop an effective food allergy action plan.

School Nurse

The 2006 survey indicated that the school nurse is increasingly becoming more and more the ‘go to’ person for food allergy management. Approximately 85 percent of survey participants, a slight increase from the 2004 survey findings, indicated that the school nurse is involved in the food allergy management team.

“It’s very important for parents to call the school early and make an appointment for a meeting,” advises the FAAN chief executive officer, Ann Muñoz-Furlong. Even if the school staff is familiar with the problem and has had the student in class before, parents should ask for a meeting anyway. It will help the staff brush up on the child’s symptoms and treatment plan and any changes in the child’s medical condition. At a minimum, the child’s primary teacher and the school nurse should be present at the meeting, where the allergy, its symptoms, and treatments should be discussed. It is important to determine whether the school system allows children to carry their own allergy medications, and if not, who is in charge of the prescribed medication while the children are at school. If the child is older and moves from class to class, all the child’s teachers should attend the meeting.

Adjunct Staff

Food allergies are an issue that the entire school staff—not just the child’s primary teacher—should know about. “Reactions in school frequently occur when children are working with food for projects—in math class, art, home economics, and during school celebrations,” explains Muñoz-Furlong. After-school activity supervisors, such as coaches, tutors, and advisors should also be included in the communication chain. Food allergy action plan forms should be handy for all supervisory staff with whom the child will come into contact during the school day and during after-school activities.

Handle Teens with Care

Most teens are not too willing to let their parents proclaim the dangers of their adolescent’s food allergy to everyone at school. In fact, they often do not want anyone to know they suffer from food allergies at all. Teens with food allergies are considered a high-risk group because they have more unsupervised opportunities to consume food and they don’t tell others that they have food allergies. Teens have been known to just walk away from the group during the throes of an allergic reaction, because they do not want to draw attention to themselves.

Issues of fitting in and privacy concerns can make food allergy management more difficult, but not impossible. “The basic difference between informing a young child’s school staff and informing a teen’s school is that the teen should be included in all aspects of the communication, whereas a younger child should not,” explains Muñoz-Furlong. For instance, the teen should be included in the meeting with the school staff so that he or she can discuss his or her allergy experiences and specific symptoms. He or she should also be involved in any school plans for handling a food allergy emergency, such as who will be informed or contacted and under what conditions.

Food Allergy Action Plan

Parents should be advised to create their child’s food allergy action plan from the FAAN website (www.foodallergy.org). The form lists the symptoms and step-by-step instructions on how the child’s allergy should be treated and the form should be signed by the child’s doctor. It also has a place to attach a picture of the child. Multiple color copies of the form should be provided to school staff.

For School Food Service Personnel

It is important for the school food service professional to be an integral part of the student’s food allergy emergency response plan. Here are a few suggestions on how to get involved.

• School food service staff should participate in meetings with parents of food allergic children, school nurse, teachers, principals, counselors, and health care provider.
• Be able to recognize the student and become familiar with his or her emergency medical information and specific food allergy.
• Ask parents to provide a copy of the signed medical statement from the physician outlining appropriate meal substitutions.
• Know where emergency medications such as epinephrine (EpiPen®) are stored and how they should be administered in case a student has an allergic reaction in the school cafeteria.
• Keep food allergy information in a handy place in case there are questions about any special diet.
• Learn how to read labels and review menus with parents of students who have food allergies to determine what, if any, menu items need to be substituted.
• Avoid cross-contact of foods (which occurs when two or more foods come into contact with each other, causing their proteins to mix). Use separate utensils for jams, jellies, and peanut butter; and wash them thoroughly with warm, soapy water.
• Work with a registered dietitian or other qualified nutrition specialist to manage dietary substitutions.

The International Food Information Council (IFIC) Foundation, in partnership with several leading food allergy, dietetic, and nutrition institutions, offers a variety of resource materials suitable for health professionals, dietitians, and consumers. Resource materials include “Understanding Food Allergy” brochure, “School Food Service and Food Allergies” information sheet, and the “Food Allergy” poster, which is printed in both English and Spanish, specifically designed for restaurant staff. These food allergy materials and others are available at www.ific.org/publications/other/foodallergyresources.cfm.