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    Peabody Health Department

    Guidelines for Managing Life-Threatening Food Allergies

    Food allergies can be life-threatening.  The risk of accidental exposure to foods that can trigger a life-threatening allergic reaction can be reduced in the school setting if schools work with students, parents, and physicians to minimize risks and provide a safe educational environment for food-allergic students.  The most important aspect of the management of students with life-threatening allergies is avoidance.  This guide focuses on a team approach for addressing life-threatening food allergies and provides information on how to handle situations that may arise.  While this guideline focuses on food allergies, treatment of anaphylaxis (a life-threatening allergic reaction) is the same whether caused by insect sting; latex; medication; or exercise-induced.  This is a guideline that may be modified as future research dictates and in keeping with the individual school’s needs and plans.

    Responsibilities of the Parent/Guardian of Student with Food Allergies

    • Notify the school nurse and principal of the child’s allergies prior to the opening of school or as soon as possible after diagnosis.

    • Provide the school nurse with medical documentation of food allergy, instructions, treatment protocols, and medication orders as directed by a licensed medical provider.  Medication orders must be renewed at least annually, prior to start of new school year, and it is recommended that the order be from an asthma and allergy specialist.  

    • Provide the school with two-four epinephrine auto-injectors and all other prescribed medications.

    • Provide parent/guardian signed consent to administer all medications.

    • Provide parent/guardian signed consent to share information with other appropriate school staff.

    • Provide the school with properly labeled medications in the original pharmacy container and replace medications after use or upon expiration.

    • Provide the school with emergency contact information.

    • Participate in developing an Individual Health Care Plan (IHCP) that accommodates the child’s needs in school.

    • Parent/guardian will provide the school with a photo of the child and written permission to place photo on the Allergy Action Plan (AAP).

    • Provide a medical alert bracelet for the child.

    • Provide the school with the licensed provider’s statement if student no longer has allergies, or if there are changes in the medical orders or treatment protocols.

    • Provide a bag of “safe snacks” for the child to be left in classroom so there is always something the child can choose from during unplanned special events.

    • Provide a list of “safe snacks” which will be copied and sent home by the teacher to the parents/guardians of other students in the classroom.  

    • Educate the child in the self-management of his/her food allergy (if age appropriate) including:

    • safe and unsafe foods

    • strategies for avoiding exposure to unsafe foods

    • symptoms of allergic reaction

    • how and when to alert an adult if allergy-related problems occur

    • how to read food labels

    • importance of not trading or sharing of foods, food utensils, and food containers with others

    • how to use epinephrine auto-injector, if appropriate

    • Increase the child’s involvement in managing the food allergy as the child grows older and matures.

    Responsibilities of the student with food allergies

    • Be proactive in the care and management of his/her food allergies and recognize the first symptoms of an allergic/anaphylactic reaction. The student should assume more responsibility for his/her food allergies as he/she grows older and is more developmentally ready.

    • Do not trade or share food, food utensils, and food containers with others.

    • Do not eat anything with unknown ingredients or known to contain any allergen.

    • Practice good hygiene habits and wash hands before and after eating.

    • Promptly notify an adult if he/she eats something believed to contain the food to which they are allergic.

    • Promptly notify an adult when the first symptoms of an allergic reaction occur.

    • Self-administration of epinephrine by auto-injector, if appropriate

    Responsibilities of the Public Health/School Nurse

    • Obtain medical documents from parent/guardian detailing the diagnosis and treatment protocols for a life-threatening allergic condition.

    • Prior to entry or immediately after the diagnosis of a life-threatening allergic condition, meet with the student’s parent/guardian and develop an Individual Health Care Plan (IHCP) which includes an Allergy Action Plan (AAP) for the student.  

    • Assure that the Allergy Action Plan (AAP) includes the student’s name, photo, allergens, and warning signs of allergic reactions, emergency procedures, emergency contacts and required signatures.   Photo of student provided by parent/guardian will be attached to the Allergy Action Plan (AAP) with written consent.

    • Discuss with parent/guardian keeping an epinephrine auto-injector emergency kit containing necessary instructions in the classroom as well as in the nurse’s office.  The classroom epinephrine auto-injector can be taken on field trips.

    • Assess the student for his/her ability to self-administer epinephrine.  Criteria may include the student’s capabilities and safety of other students.

    • In conjunction with child’s parent/guardian and health care provider, determine the appropriateness for the student to carry his/her own epinephrine auto-injector

    • Arrange and convene a team meeting (preferably before the opening of school) to develop a plan with all staff who come in contact with the student with allergies.

    • Familiarize teachers with the Individual Health Care Plan (IHCP) and Allergy Action Plan (AAP) of the student by the opening of school, or as soon as the plan is written.  Other staff members (including bus drivers) who have contact with student with life-threatening allergic conditions should be familiar with his/her Individual Health Care Plan (IHCP) and Allergy Action Plan (AAP), if written consent has been given by parent/guardian, on a need-to-know basis.

    • Conduct in-service training and education for appropriate staff regarding a student’s life-threatening allergens, symptoms, risk reduction procedures, emergency procedures, and how to administer epinephrine by auto-injector.

    • Track in-service attendance of all involved parties to ensure that they have been trained.

    • Educate new personnel as necessary.

    • Periodically check medications for expiration dates and arrange for them to be current.

    • Arrange periodic follow-up as often as necessary to review the effectiveness of the Individual Health Care Plan (IHCP).

    • Make sure there is a contingency plan in place in the case of a substitute nurse.

    Responsibilities of the School Administration (or delegate)

    • Develop policy to ensure that the school environment is as safe as reasonably achievable for students with diagnosed food allergies. Such decisions must comply with federal, state, and district law, and incorporate physician’s orders. The Peabody Health Department recommends that schools establish allergen-free zones, rather than an allergen-free campus, whenever possible.

    • Identify a core team including, but not limited to, school nurse, teacher, principal, school food service manager, and counselor to work with parent and the student to establish a prevention plan.  Changes to the prevention plan to promote food allergy management should be made with core team participation whenever possible.

    • Assure that all staff that interact with the student on a regular basis understand food allergy, can recognize symptoms, know what to do in an emergency, and will work with other school staff to eliminate the use of food allergens in the allergic student’s meals, educational tools, and arts and crafts projects.

    • Principal or delegate will send a letter home to inform and educate parents/guardians and students on allergen restrictions and school policies.  Parent/guardian of student with diagnosed life-threatening food allergy must agree to this notification being sent home to families, as food allergies are a confidential health condition.  This written notification will be signed by school administrator and school nurse.

    • Principal or delegate will establish procedures for handling students, parents, staff, volunteers, and others who repeatedly are non-compliant with adherence to offending allergen restrictions and school policies.

    • Principal or delegate will make sure a contingency plan is in place in case of a substitute teacher or substitute food service personnel.

    • Principal or delegate will have a plan in place when there is no school nurse available.

    • Practice the Allergy Action Plan (AAP) before an allergic reaction occurs to assure the efficiency/effectiveness of the plans.

    • Students with a diagnosed allergy should be allowed to carry their own epinephrine, if age appropriate, after approval from student’s physician, parent, school nurse, principal, and as allowed by local or state regulations.

    • Discuss field trips with the family of the food-allergic child to determine the appropriate strategies for managing the food allergy.  

    • Work with the district transportation administrators to assure that school bus driver training includes symptom awareness and what to do if an allergic reaction occurs.  Enforce a “no eating” policy on school buses with exceptions made only to accommodate students with special needs/disabilities as mandated under federal, state, and district laws.

    • Follow federal, state, and district laws and regulations regarding sharing medical information about the student.

    • Take threats or harassment against an allergic child seriously and report to the appropriate authorities.

    • Notify food service director/staff of students with life-threatening food allergies.

    • Ensure cleaning and sanitation protocols are strictly followed to avoid cross-contamination.

    • Ensure that after-school activities sponsored or approved by the Peabody Public School District are consistent with school policies and procedures regarding management of life-threatening allergies.

    • Coordinate with the school nurse to identify locations where medications are stored, and be sure that an emergency kit is available that contains a physician’s standing order for epinephrine (for students without diagnosed allergies).  

    Responsibility of the Classroom Teacher/Specialist


    Procedure for Allergen-Free Classrooms

    • Teachers will be familiar with the Individual Health Care Plan (IHCP) and the Allergy Action Plan (AAP) of students in their classes and respond to emergencies as per emergency protocol in the Allergy Action Plan (AAP).

    • Teacher will notify parents/guardians of students, classroom volunteers, and classroom aides that the classroom will be allergen-free.  This notification will be in written form and will be distributed prior to the opening of the school year or as soon as possible after diagnosis.  This notification will request parents/guardians to not send any products containing the allergen of concern for their child to eat during snack or lunch time in the classroom.  Parents/guardians of students receiving notification will complete and return the bottom portion of notification to the classroom teacher so that staff is aware that parents/guardians have received the notification.  Parent/guardian of student with diagnosed life-threatening food allergy must agree to this notification being sent home to families, as food allergies are a confidential health condition.  This written notification will be signed by school administrator and school nurse.

    • Teacher must provide a substitute teacher with written information that there are students with life-threatening allergies in the class, information about the classroom being allergen-free, and information about an allergen-free table in the cafeteria, restricted snacks, and procedures if a student has an allergic reaction.

    • The classroom should have functioning emergency communication device (telephone, cell phone, two-way radio, walkie-talkie or similar).

    • Information should be kept about students’ food allergies in the classroom.  These foods should not be used for class projects, parties, holidays and celebrations, crafts, science experiments, cooking, snacks, rewards, or other purposes.

    • Restricted foods will not be allowed in the classroom.  All food items could be placed in a separate container in order to keep possible allergens away.  The teacher will then make sure that the unopened container is transported to the cafeteria.

    • Sharing or trading food should be prohibited.

    • If a student, classroom aide, classroom volunteer, or substitute inadvertently brings a restricted food to the classroom he/she will not be allowed to eat that food in the classroom.

    • Students and adults should wash their hands before and after the handling/consumption of food. Hand wipes may be used if needed.

    • Consider restricting classroom animals. Special attention must be paid to the ingredients in animal food, as many animal feeds contain peanuts.

    • Consider a once-a-month celebration for birthday parties, with a non-food treat.

    • A sign or universal symbol indicating that the classroom is allergen-free will be posted outside the classroom at all times.  The school community and all visitors to the classroom should be informed and educated about the risk of food allergies.

    • All surfaces must be cleaned with soap (allergen-free) and water after the consumption of food in order to prevent cross-contamination.

    • A parent/guardian of a student with food allergies is responsible for providing classroom snacks for his/her own child.  These snacks should be kept in a separate snack box.

    • Teacher will discuss field trips with the parent/guardian of the food-allergic child to decide the appropriate strategies for managing the food allergy.  

    • If for safety reasons a medical alert bracelet needs to be removed during specific activities, the student should be reminded by the staff, coach, or other onsite person in charge of conducting school or after school activities, to replace the medical alert bracelet immediately after the activity is completed.

    School Field Trips

    • Field trips need to be chosen carefully by teachers and administrators; no student should be excluded from field trips due to risk of allergen exposure.

    • Teacher will notify school nurse of field trips in a timely manner so that consideration of safety of the student with life-threatening allergies may be determined.

    • Medications including epinephrine auto-injector, copy of medication orders, copy of parent consent for medication administration, and a copy of the student’s Allergy Action Plan must accompany the student on all field trips.

    • Parent/guardian of student with diagnosed life-threatening allergies and who are at risk for anaphylaxis should be invited to accompany their child on school trips, in addition to chaperones. Alternately, a parent may delegate another trained individual (such as another parent of a student with a food allergy) to monitor the student.

    • In the absence of accompanying parent/guardian, the school nurse may identify unlicensed staff trained to administer epinephrine by auto-injector the task of watching out for the student’s welfare and for handling any emergency.  The adult carrying the epinephrine should be identified and introduced to the student as well as the other chaperones.

    • Eating food should be prohibited on school buses.

    • Students and adults will be required to wash their hands before and after the handling/consumption of food.  Hand wipes may be used if needed.

    • A cell phone or other communication device must be available on the field trip for emergency calls.

    • School nurse and school administrator should be notified in a timely manner of any emergency situation which arises while on school trips.

    Responsibilities of the Food Services/Cafeteria

    • Train all food service staff and their substitutes to read product food labels and recognize food allergens.

    • Read all food labels and recheck routinely for potential food allergens.  Contact The Food Allergy Network for current lists on how to read a food label. As food manufacturers continuously refine and improve food products, food labels must be read for every product purchased.

    • Maintain contact information for manufacturers of food products (Consumer Hotline).  

    • Strictly follow cleaning and sanitation protocols to avoid cross-contamination.

    • Set up policies/procedures for the cafeteria regarding food allergic students.

    • Train cafeteria monitors to take note of the situation surrounding a child with allergies and intervene quickly to help prevent trading of food or bullying.

    • All students eating meals in the cafeteria should be encouraged to wash their hands before and after eating so that traces of allergens will not be left on their hands. Hand wipes may be used if needed.

    • Create specific areas in the cafeteria that will be allergen-free.  A “peanut free” table should be established and maintained, as reasonably appropriate, as an option for students with peanut/nut allergies.  These tables should be designated by a universal symbol and it will be the responsibility of the school administrator or designee to take reasonable steps so that these areas are not contaminated.

    • Provide substitutions in snacks and lunches for students with medical or other special dietary needs.  Substitutions must be made on a case by case basis only when supported by a statement of the need for substitutions and if possible, recommended alternate foods.  Such statement must be signed by a licensed medical provider.

    • Provide alternative foods for a student who brings a restricted food product to school.

    Responsibilities of School Bus Company

    • Provide functioning emergency communication device (cell phone, two-way radio, walkie-talkie or similar).

    • Know local Emergency Medical Services procedures.

    • Maintain policy of no food eating allowed on school buses.

    • School bus drivers should be trained by appropriate personnel in risk reduction procedures, recognition of allergic reaction, and implementation of bus emergency plan procedures.

    • With parental permission, school bus drivers will be provided with the Allergy Action Plan of all students with life-threatening allergies.

    This proposal of guidelines was prepared by Deborah A. Compiano, RN, Peabody Public Health/School Nurse with the Peabody Health Department.  This document was adapted from materials produced by the Massachusetts Department of Education, Massachusetts Department of Public Health, The Food Allergy and Anaphylaxis Network, Beverly Public Schools, Salem Public Schools, and the Danvers Public Schools.