School Peanut Allergy Safety

Q. How can my peanut-allergic child be kept safe at school?

A. Consider the following facts: Food allergies affect 8 percent of children under 3, and 6 to 8 percent of school-age children. Eighty-five percent of children outgrow milk and egg allergies by age 5, but only 20 percent outgrow peanut allergy by age 6. The prevalence of peanut and tree nut allergies in children has doubled in the past five years. Peanut-allergic patients have accidental exposures and reactions every three years. Seventy-five percent of peanut-allergic reactions occur on the first known exposure. Twenty-five percent of epinephrine administrations in schools are for people who have never had food allergy or anaphylaxis. In the U.S., fatal food anaphylaxis occurs in 150 people each year, 90 percent from peanut and nut allergies. Fatal anaphylaxis occurs most often outside the home, in schools and restaurants. Given these statistics, every school needs to be prepared to deal with the problem of food anaphylaxis, especially from peanut allergy.

In 2001, following the death of a peanut-allergic student in Massachusetts, the Massachusetts Department of Education convened a Food Anaphylaxis Task Force, of which I was privileged to be a part. We discussed the growing problem of life-threatening food allergies in schools, the importance of making all schools aware of this problem, and the importance of having ways to prevent and manage anaphylaxis in schools. After meeting over the course of a year, in 2002 the task force published "Managing Life Threatening Food Allergies in Schools," a 76-page set of guidelines for all schools in Massachusetts. This detailed document addresses all aspects of managing food allergies in schools, including the action plan and recommendations for the classroom, cafeteria, school sports, playgrounds, extracurricular activities, school trips, and school buses. You can adapt sections from these guidelines for your child's action plan for school. You can view or download this document from the Web site of the Massachusetts Department of Education at www.doe.mass.edu/cnp. Many states and even schools from other countries have used these guidelines as a template for their own school policies.

The key points of the guidelines are to:

1. Identify the student with the food allergy to the school;
2. Have a written emergency action plan in place for managing an anaphylactic reaction;
3. Have a written individual healthcare plan in place for the prevention and proactive management for the student in all the different school environments he or she may be in, from the classroom to the cafeteria to the bus to field trips.

The emergency action plan is formulated by your physician with your input, based on your child's history, and specifies what symptoms to look for and what treatments are to be given, as well as contact information and directions for disposition following the reaction. The school nurse usually is responsible for implementing this plan in the event of an actual emergency. This is discussed in greater detail in the section on the school's responsibility to you.

The general principles of the preventive plan usually include the following:

1. The general principles of avoidance followed at home should be applied to the classroom, cafeteria, and all areas where the student may be. Nineteen percent of anaphylactic reactions in Massachusetts schoolchildren occurred outside the school building, on the playground, on the school bus to and from school, and on field trips.
2. For areas where food is consumed, hand washing, no food sharing, and the routine cleaning of surfaces where food is prepared and consumed to avoid cross contamination are practices that students and school staff need to learn and use.
3. For the classroom, students and staff need to become familiar with the concept of "hidden" peanut ingredients, not only in foods and but also in nonfood items that may be used in classroom projects in arts and crafts, math, and science. Reading the ingredient labels of foods, as well as other items such as bird feeders and pet feed, becomes an additional responsibility of the school teacher and staff.
4. There should ideally be a full-time nurse in any school where there are students with life-threatening allergies. If the school nurse is unable to be on site, she should be able to train a designated staff member in the management of anaphylaxis and the use of epinephrine.
5. Every student with life-threatening allergies needs to have an epinephrine autoinjector in the school. The epinephrine autoinjector needs to be accessible for quick access within several minutes of a reaction and kept in a secure but unlocked location.
6. Emergency communications between all the student's locations (classroom, cafeteria, gym, playground, etc.) and the school nurse and/or principal's office should be available. Students, families, teachers, and school staff should all be educated on food allergies, anaphylaxis, and general avoidance principles. The Food Allergy & Anaphylaxis Network is an excellent resource for educational programs for schools and provides many age-specific materials, including videos for children and a very useful kit for school staff and personnel.