Setting The Standard: Managing Food Allergies in School

Setting the Standard
Managing Food Allergies in School

Laurel School District
August 2010
An Equal Rights and Opportunities School District

Table of Contents
Message ......................................................................................... 3
Terms to Understand ...................................................................... 4
Introduction ..................................................................................... 5
School Laws.................................................................................... 6
Understanding Food Allergies and Anaphylaxis.............................. 7
Signs and Symptoms/ Diagnosis/Prevention .................................. 9
Treatment...................................................................................... 10
Medications .................................................................................. 12
Management plan for the School
 Algorithm for Food Allergy Management ............................ 17
 The Role of the Student ..................................................... 18
 Parent/Guardian Support ................................................... 19
 Guidelines for School Administration Support .................... 20
 School Nurse Support ........................................................ 21
o Health History Planning ................................................ 23
o Health History Forms .................................................... 24
o Student Individualized Health Plan ............................... 28
o Food Allergy Action Plan ............................................... 30
o Transportation Student Food Allergy Form ................... 32
o Food Service Student Food Allergy Form ..................... 33
 Guidelines for Teaching Staff Support................................ 34
 Classroom and School Environment Concerns .................. 35
 Field Trip Issues ................................................................. 36
o Field Trip Parental Permission Form............................. 37
 Coaches/Athletic Director/Club Advisors/
After-School Employees/Volunteers ................................... 40
 Maintenance/Custodial Personnel Issues .......................... 41
 Food Service Personnel Issues .......................................... 42
 Cafeteria Accommodations ................................................ 43
o Food Allergy Substitution Form ................................... 44
 Transportation Personnel Issues ........................................ 46
 Educational Resources/Training ........................................ 48
 Steps to Take in the Event of a Food Allergy Reaction ...... 47
 Internet Resources ............................................................. 49
 References ......................................................................... 50
Managing Food Allergies Handbook -2-

Message
A dedicated group of individuals from the Laurel School District and Community
developed the “Setting the Standard: Managing Food Allergies in School” handbook.
The Laurel School District developed this handbook to have a consistent way of managing
food allergies and reactions in the school setting. The district’s goal is to provide a safe
environment and provide reasonable care for students with life-threatening food allergies.
This handbook is to provide guidance in the management of food allergies at school.
This handbook was developed in collaboration with the following group members:
Mrs. Lori Dado, High School Nurse

Mrs. Debra Garrett, Elementary School Nurse
Dr. Sandra Hennon, Superintendent of Schools
Dr. Harold Dunn, Principal of Academic Affairs
Mr. David Spalding, School Psychologist
Mr. Edward Novad, Custodial/Maintenance Supervisor
Ms. Carrie Bonyak, Cafeteria Supervisor
Mrs. Laurie Pollio, Cafeteria worker
Mr. Joseph Sager, Transportation Supervisor
Mrs. Patricia Miles, High School Teacher
Mrs. Lori Hites, High School Teacher
Mrs. Linda Barletto, Guidance Secretary
Mrs. Dianne Callahan, Special Education Secretary
Mrs. Michelle Patterson, Parent
Mrs. Elizabeth Wilson, Parent
Ms. Sarah Wilson, Student
Ms. Megan Patterson, Student
Ms. Ashley Mengel, Student

Terms to Understand
Action Plan - Steps used to care for a child who has been exposed to an allergen (food).
Anaphylaxis - A severe life-threatening reaction caused by an allergen (food).
Antihistamine – A medication given in orally, intramuscularly, or intravenously to block an
allergic histamine response.
Child - All students ages 4-21.
Epinephrine - Medication used to help with respiratory and cardiac symptoms of an
anaphylaxis reaction.
Food Allergy - Hypersensitivity to food.
Handbook - a written guide to performing specific tasks.
Management - To respond and control a situation.
Plan of Care- a written plan to address medical needs of a student.

Introduction
The development of this handbook is to provide a comprehensive guide for school
personnel to follow in the event of a student experiencing a food allergy reaction while at
school.
The school system is a unique setting that has the responsibility to educate students
in grades kindergarten through twelfth grade. Children come into this setting with a vast
number of medical conditions and issues which affect the educational process. The school
nurse is the only medically trained person within these walls. Schools often have only one
school nurse to cover thousands of students. This leaves educators and other untrained
personnel to handle medical situations that arise in the absence of the school nurse. It is the
school nurse’s obligation to help school personnel understand and identify behaviors in
students which require medical attention. One of those conditions is food allergies.
Food can often lead to a severe life-threatening reaction. The school nurse must
attempt to limit the potential of these types of reactions from occurring. To carry this out, the
school nurse must have a plan. Due to the complexity of food allergies, the plan needs to
have collaboration among parent(s)/guardian(s), and all school departments; including
school nursing personnel, teachers, administration, guidance, food service, transportation
services, custodial staff, and any other school personnel. A comprehensive science-based
plan is essential for providing a safe and successful school experience for students with
food allergies.
This document contains information specific to students with food allergies.
Nevertheless, all students with serious health issues should have a comprehensive plan in
place.

School Laws
Schools are required by law to protect the rights of students who have been
diagnosed with potentially life-threatening food allergies. The Individuals with Disabilities
Education Act (IDEA) and the Rehabilitation Act of 1973 ensure that children who have a
disability are provided with a free and appropriate public education. These laws permit
students with special physical and medical needs to attend school. Schools must make
reasonable accommodations for these individuals with disabilities to allow them full and
equal opportunities at school (Munoz-Furlong, 2004). Individuals with food allergies are
protected by these regulations.

Understanding Food Allergies and Anaphylaxis
Food allergies have increased over the past two decades (Mudd & Noone, 1995).
The Food and Allergy Anaphylaxis Network (FAAN) reports more than 12 million Americans
have food allergies; that is one in twenty-five or 4% of the population (FAAN, 2010). It is
estimated that food allergies affect up to eight percent of children under the age of three and
approximately two percent of the adult population with as many as forty to fifty percent of
those with a diagnosed food allergy are at high risk for anaphylaxis (Sheetz, Goldman,
Millet, McIntrye, Carroll, Gorak, Harrison, & Caricle, 2004). About ninety percent of food
allergies are caused by eight foods: peanuts, tree nuts, milk, eggs, fish, shellfish, soy, and
wheat. Most will be out-grown with age, but peanut and tree nut allergies are life-long (Mudd
& Noone, 1995). The alarming concern the Food and Allergy Network reports is that peanut
allergies have doubled in children over a five year period (1997-2002)(FAAN, 2010).
Children spend eight hours a day for a total of one hundred eighty days in school, and within
this time they can eat two meals each day plus snacks. Keeping this in mind, the chance of
having an allergic reaction related to a type of food is high. According to Mudd and Noone
(1995), in studies of fatal and near fatal anaphylaxis reaction to food, a majority of the
children who died from food- induced anaphylaxis ingested the food at school. Most school
nurses already institute the Food and Allergy Anaphylaxis Network Food Allergy Action plan
to follow in the case of a food reaction. However, treating the reaction is not enough.
Schools need to limit exposure to help prevent an attack from occurring.
An allergic reaction begins with a predisposed individual ingesting a food (by eating,
inhaling, or through contact with mucus membranes). This causes the body to produce an

antibody that initially attaches to the surface of cells. This initial process yields no
symptoms and will go unnoticed. However, the next time the food is ingested, the proteins
in the food attached to these antibodies cause the body to release a histamine response
that causes an allergic reaction (Formanek, 2001). A reaction can occur within minutes to
hours after ingestion. Symptoms can be mild to life threatening. The specific symptoms that
a student experiences depends on the location in the body in which the histamine is
released. If the allergic reaction becomes severe, it is then known as anaphylaxis, a life-
threatening event (Smith, 2005). Food allergies are the leading cause for anaphylaxis
outside of the hospital setting. Other common causes of anaphylaxis include allergies to
latex, medications, and insect stings.
This handbook will focus on food allergies although some of the information provided
is appropriate for other causes of allergic reactions that can cause anaphylaxis.

Signs and Symptoms
Allergies can affect almost any part of the body and display a vast number of
symptoms. Anaphylaxis includes the most dangerous symptoms, including, but not limited
to: breathing difficulties, a drop in blood pressure, or shock, which are potentially fatal.
Common signs and symptoms of allergic/anaphylactic reactions may include:
Hives Coughing
Itching (of any part of the body) Wheezing
Swelling (of any body parts) Throat tightness or closing
Red, watery eyes Difficulty swallowing
Runny nose Difficulty breathing
Vomiting Sense of doom
Diarrhea Dizziness
Stomach Cramps Fainting or loss of consciousness
Change in voice Change of skin color
(Source: Position statement- American Academy of Asthma Allergy and Immunology)

Accessed from http://aaaai.org/medicaesources/academy_statements/position_statements/ps34.asp on 3/5/2010.
Diagnosis
The diagnosis of allergy with a risk of anaphylactic reactions is made based on the
patient’s history and confirmed with appropriate skin and/or blood tests done by
appropriately trained allergy specialists.
Prevention
Avoidance of a specific allergen is the basis of management in preventing
anaphylaxis. Avoiding the food that produces the allergic problems is tricky. Many of the
common food allergens (peanuts, nuts, fish, shellfish, milk, soy, egg, wheat) are hidden or
accidentally introduced into everyday items that are not obvious to the untrained person.
However, it is definitely possible to reduce a student’s exposure to allergenic food within the
school setting.

Treatment
There is no cure for food allergies. Strict avoidance of food allergens and early
recognition management of allergic reactions to food are important measures to prevent
serious health consequences (FAAN, 2010). Accidental food ingestion can occur despite
avoidance measures. Treatment should be immediately available for these emergencies.
The school nurse is responsible for obtaining and keeping all treatment protocols for
students with food allergies. According to school policy, all medications must be
accompanied with a written physician order for treatments and medications prescribed. The
students’ parent/guardian must also sign these orders. The school nurse will initiate the
Food Allergy Action Plan (See page 31). This action plan will provide easy to follow steps
for recognizing and treating a reaction and provide key actions to perform for managing the
allergic reaction.
Epinephrine and antihistamine medications are the drugs of choice and should be
administered immediately in an emergent situation of a child having a potentially life-
threatening allergic reaction. Epinephrine injection is available in a number of self-
administration delivery devices (See pages 13-15). There are no contraindications to the
use of epinephrine for a life-threatening allergic reaction. After the administration of these
medications, the student should be transported via ambulance to be evaluated. No one can
predict the events of neither anaphylaxis nor how a student will respond to treatment.
Emergency room personnel MUST evaluate all students after having an allergic reaction.
Epinephrine should be put in locations that are easily accessible to school personnel and
students. These locations must be known by everyone. Students that are old enough to
Managing Food Allergies Handbook - 10 -

self-administer epinephrine should carry their own. For younger children, the epinephrine
device should be kept in the classroom and passed from teacher to teacher as the child
moves through the school (e.g., from classroom to music to PE to lunch), or kept in areas
that are easily accessible to everyone.
All students, regardless of whether they are capable of epinephrine self-
administration, will still require the help of others because the severity of the reaction may
hinder their attempts to inject themselves. Adult supervision is ALWAYS recommended.
All school personnel need to be familiar with basic first-aid and resuscitative
techniques. This training should include how to use Epinephrine devices. School
employees need to be familiar with these techniques. This will ensure that everyone will
know what to do if a reaction occurs. Quick response and treatment will save lives.

Medications
Epinephrine kits are available by prescription only either as a spring-loaded self-
injectable device (Epi-Pen, Epi-Pen Jr; Dey Laboratories, Napa Valley, Calif) or as a
preloaded syringe (Ana-Kit; Bayer Laboratories, Spokane, Wash). The syringe has a
locking notched plunger, which is rotated to enable each of the 2 doses (0.3mg each)
contained in the barrel for self-injection. The spring-loaded auto-injector devices has 1 dose
but may be preferred because of its simplicity of use.
Epi-Pen is available in 2 forms, Epi-Pen Jr and Epi-Pen. The Epi-Pen Jr is used for
children weighing 10 to 20 kg (22 to 45 lb). The Epi-Pen is used for those weighing greater
than 20 kg (45 lb). All those responsible for using epinephrine kits should be familiar with
these kits and the instructions for their use. Training devices and brochures outlining most
aspects of handling and administering epinephrine are available from the manufacturers.
Source: American Academy of allergy Asthma & Immunology 1996-2010 retrieved on March 5, 2010 at
www.aaaai.org/members/academy_statements/position_statements/ps34.asp

Epi-Pen (old)
(Source: Dey Pharmacueticals - Accessed from http://www.epipen.com on

3/5/2010.

Epi-Pen (new)
(Source: Position statement- American Academy of Asthma Allergy and

Immunology)
Accessed from
http://aaaai.org/medicaesources/academy_statements/position_statements/p
s34.asp on 3/5/2010.
Twinject
(Source: Shionogi Pharma, Inc. - Accessed from http://twinject.com on March

3, 2010.

Adrenaclick
(Source: Dey Pharmacueticals - Accessed from http://www.adrenaclick.com on

3/5/2010.

Algorithm for Food Allergy Management
Source: New York School Health Service Center, retrieved on March 16, 2010 at
www.schoolhealthservicesny.com

The Role of the Student
The students play a vital role in managing their food allergy reactions. A student
must be responsible for identifying and notifying staff of potentially life-threatening
symptoms at the onset. This could be a difference between getting prompt treatment or a
delay in response that can be fatal.
The student will:
 Be trained to use and expected to carry Epi-pen and Benadryl (Antihistamine) at all
times while participating in school and school-related activities (The school nurse or
the student’s health care provider will train the student. The training will be
documented and return demonstration will be witnessed).
 Be responsible to eat ”safe” foods, not to share foods/utensils with/from other
students. NO SHARE PLAN.
 Sit in designated areas in cafeteria as indicated in Student’s Individual Health Plan.
 Be an advocate for self.
 Seek assistance whenever needed.
 Be responsible to report signs and symptoms at first onset to responsible person
(The Nurse will be notified immediately by that person).
 Administer Epinephrine at first onset of symptoms under adult supervision (A trained
adult may assist if needed).
 Be responsible for own care during after school activities.
 Be responsible for being observant and careful not to be around others eating,
example snack area, concession stands, etc.
 Know signs and symptoms of anaphylaxis.
 Follow plan as written.

Parent/Guardian Support
Parent/Guardian(s) are an integral part of the entire process for managing food
allergies. The parent/guardian(s) must be involved in all aspects of the planning phases in
order for the school district to provide the safest possible care to their child while attending
school.
The Parent/Guardian(s) will:
 Provide information to school nurse on food allergies when a child enters school.
 Notify the school nurse of any changes in medical care associated with food allergies
once a child is an active student in school.
 Provide all required documentation per school policy for medications and treatment
protocols related to food allergy management.
 Will assist in writing the Food Allergy Management Plan.
 Will comply with the Food Allergy Management Plan as written.
 Provide medications and documentation as required by school medication policy for
student.
 Support the schools efforts to reduce chances of anaphylaxis.
 Communicate openly with school personnel.
 Communicate directly with school nurse, cafeteria supervisor, and transportation
supervisor related to concerns for their child’s food allergy.
 Provide snack alternatives and food item choices for their child.
 Communicate with child to discuss care/plan for “After School Activities” because
there are no medical personnel on site.
o Parent and child will be responsible for any or all arrangements for after school
activities. Student is responsible for carrying Epinephrine.
o Staff on site will be educated about food allergy management plan but will be
instructed to call 9-1-1. Should an emergent situation arise (Food Allergy
Action Plans will be easily accessible in designated areas).

Guidelines for School Administration Support
The Laurel School Administrators are the foundation to the school buildings operating
efficiently. Managing students with food allergies will require administrator support and
guidance for the management plan to run smoothly. The administration will:
 Support the Food Allergy Management Plan as written.

 Will guide staff as necessary, to implement and follow the plan.
 Responsible for all enforcement and disciplinary actions associated with not following
the Food Allergy Management Plan as written.
 Enforce current school procedures (Student Handbook) regarding no food or drinks in
halls, at lockers, anywhere except cafeteria.

School Nurse Support
The school nurse is the only medical personnel on site; therefore, this position is the
coordinator and provider of all care associated with student medical needs. Managing food
allergies is potentially a life-threatening event and must be dealt with by a proactive
approach: thus the Food Allergy Management Plan. The school nurse will:
 Be responsible for all coordination of Food Allergy Management Plan for students in
the district.
 Will obtain all required documentation for each student with known food allergies.
 Will initiate and write the Food Allergy Action Plan (see page 30), The Individual
Health Plan (see page 28),the Transportation Student Emergency Information
card(see page 32), and Food Service Student Emergency Information(see page 33).
 Be the liaison between home and school.
 Be a student advocate.
 Hold annual district-wide in-service for all employees which will include the following
information:
o How the plan will work.
o What is involved in following the plan.
o How to address issues of food allergies in the classroom and the use food for
classroom projects.
o Food Science classroom will be a NUT-FREE area (See Classroom and
School Environmental Management).
o The ingestion of food in the classrooms.
o Educate the teachers on procedures about the identification of potential
dangers.
o The emergency procedure for handling food allergies.
o Epinephrine training/use.
o The classroom procedures to help eliminate potential food reactions,
 Seek volunteers for epinephrine administration training

 Develop a procedure to notify all employees of those food-allergic students in the

buildings.
 Review all cafeteria procedures related to food handling and cross-contamination
and special menu alternatives.
 Work with the transportation supervisor to set up procedures to handle emergencies
and to prevent students from bringing food items on the bus.
 Notify Transportation, Cafeteria, and Maintenance/Custodial Supervisors of all
identified students with food allergies. The supervisors will notify their staff.
 Will provide Transportation Department with identification cards and the procedure
for handling a food allergy reaction on school bus.
 Work with the administration and the maintenance department with the development
of procedures concerning proper and routine cleaning of classroom areas.
 Notify all district employees of the location of the emergency action plan and
emergency medications.
RED binder will contain Food Allergy Action Plan for each identified student.
These binders will be located in Nurses’ Offices(2), Gymnasiums(3), the Athletic Trainer
Office(1), Cafeterias(2), and Front Offices(2), and Transportation Office(1). Copies will
also be in room 402 on second floor of the high school building (1).
.

Health History and Planning
The school nurse is responsible to seek out information pertaining to any student with
identified food allergies.
When a student enrolls in school, information is gathered regarding medical
conditions and health history (See pages 24-27). When a parent/guardian identifies a child
has having a food allergy the school nurse makes contact with the parent/guardian
regarding the extent of the allergy and treatment as prescribed.
Once a food allergy is identified, the school nurse will implement the process and
obtain necessary documentation required under school policy. The school nurse will:
 Acquire written medical documentation accompanied with parent signature.
 Initiate the Individual Health Plan which can be part of a IEP or 504 plan or stand
alone(See page 28).
 Initiate the Food Allergy Action Plan on the student (see page30).
 Epinephrine will be available as needed.
 Notify all necessary school staff of medical condition and protocol.

Health History Forms Grade K-6
Health History Form
Today's Date__________________________
Child's Name_____________________________Birthdate_____________Male__________
Female________
Parents are: ___Married ___Single ___Divorced ___Separated ___Widowed
Child is living with:___Mother___Father ___Both ___Guardian (Name please):
__________________
If leaving with guardian, what is the relationship to the child?_______________________________________
Have any members of the immediate family died? _____Yes _____No
How many people live in the same household as the child?__________________________________________
Who looks after this child during the day?_______________________________________________________
Are there any problems such as housing, employment, food, etc…?___________________________________
Has this child attended: _____Head Start _____Pre-school (where)___________________________
Does your child fall, stumble or bump into things frequently? _____Yes _____No
How do you feel your child's development compares with other children as brothers or sisters?
_____Same _____Slower _____Faster
Child Health History:
Did the mother have any illness during pregnancy? _____Yes _____No
Did the baby come on time? _____Yes _____No
Did the baby have any special problems in the first six months? _____Yes _____No
At what age did the child sit alone without support?_______________________________________________
At what age did the child walk alone?__________________________________________________________
At what age did the child begin to say two or three words together?___________________________________
Does your child have complete bowel and bladder control? _____Yes _____No (if no explain)
Does your child have complete bowel and bladder control? _____Yes _____No (if no explain)
_________________________________________________________________________________________
Can the child use the toilet without help? _____Yes _____No
Does the child wet the bed? _____Yes _____Occasionally _____Frequently _____No
Has your child been under a physician's care during the last 12 months?
_____Routine Care _____No _____Other (specify)________________________________
Is there anything about your child's health that concerns you?
_____Yes _____No
Has your child been under a dentist's care during the last 12 months?
_____routine care _____No _____Other (specify)____________________________________
Does your child have any allergies?

Medication _____Yes _____No Food _____Yes _____No Insect Stings _____Yes _____No
Pollens/molds/spores ____Yes ____No Plants _____Yes _____No Other (specify)
If answered “Yes,” tells us the kind type
of reaction your child has.
Child has:
Contacts ____Yes _____No Glasses _____Yes _____No Hearing aid _____Yes _____No
Orthodontic _____Yes _____No Braces/appliances _____Yes _____No Other
(specify)___________

List medications that your child is currently taking. Include the reason for the medication
Medication Dose Reason
Has your child ever been hospitalized or had an operation? _____Yes _____No
Has your child had any other illness, accident, or broken bones? _____Yes _____No
When Name of hospital What for
Has your child had any of the following? Give details.

Speech problems
Vision problems
Hearing problems
Emotional problems
Physical disability or other limitations
Family Health History: (Place an "X" in the box to any problems the child's parents, grandparents, brothers
or sisters have had and indicate the relationship in the space provided).
Allergies Eye disease Learning problems
Anemia Hearing problems Multiple sclerosis
Asthma Heart Disease Muscular dystrophy
Cancer Nervous breakdown High blood pressure
Diabetes Kidney problems Sickle cell
Epilepsy/seizures Lead poisoning Tuberculosis
Drug/Alcohol Addition Mental retardation
List Family Members:

Relationship Age Name Any Medical Occupation or Educational
Problems School Level
Mother
Father
Brother(s)
Sister(s)
Is there anything else you would like us to know about your child?_______________________
______________________________________________________________________

Health History Form Grade 7-12 (front)
Health History Form
Today's Date__________________________
Child's Name_____________________________Birthdate_____________Male__________
Female________
Parents are: ___Married ___Single ___Divorced ___Separated ___Widowed

Child is living with:___Mother___Father ___Both ___Guardian (Name please):
__________________
If living with guardian, what is the relationship to the child?________________________________________
Have any members of the immediate family died? _____Yes _____No
How many people live in the same household as the
child?___________________________________________
Who looks after this child during the
day?________________________________________________________
Are there any problems such as housing, employment, food,
etc…?____________________________________
Child Health History:

Has your child been under a physician's care during the last 12 months?
_____Routine Care _____No _____Other
(specify)____________________________________
Is there anything about your child's health that concerns you?
_____Yes _____No
Has your child been under a dentist's care during the last 12 months?
_____routine care _____No _____Other
(specify)____________________________________
Has your child had any new immunizations? _____Yes _____No

Please list names and dates
received:_________________________________________________________________________________
_________________________________________________________________________________________
Does your child have any allergies?

Medication _____Yes _____No Food _____Yes _____No Insect Stings _____Yes _____No
Pollens/molds/spores ____Yes ____No Plants _____Yes _____No Other (specify)
If answered “Yes,” tells us the kind type
of reaction your child has.
Child has:
Contacts ____Yes _____No Glasses _____Yes _____No Hearing aid _____Yes _____No
Orthodontic _____Yes _____No Braces/appliances _____Yes _____No Other
(specify)___________

List medications that your child is currently taking. Include the reason for the medication.
Medication Dose Reason
Has your child ever been hospitalized or had an operation? _____Yes _____No
Has your child had any other illness, accident, or broken bones? _____Yes _____No
When Name of hospital What for
Has your child had any of the following? Give details.

Speech problems
Vision problems
Hearing problems
Emotional problems
Physical disability or other limitations
Family Health History: (Place an "X" in the box to any problems the child's parents, grandparents, brothers
or sisters have had and indicate the relationship in the space provided).
Allergies Eye disease Learning problems
Anemia Hearing problems Multiple sclerosis
Asthma Heart Disease Muscular dystrophy
Cancer Nervous breakdown High blood pressure
Diabetes Kidney problems Sickle cell
Epilepsy/seizures Lead poisoning Tuberculosis
Drug/Alcohol Addition Mental retardation
List Family Members:

Relationship Age Name Any Medical Occupation or Educational
Problems School Level
Mother
Father
Brother(s)
Sister(s)
Is there anything else you would like us to know about your child?___________________________________
______________________________________________________________________

Sample Individual Health Care Plan
SPECIAL NEEDS HEALTH CARE PLAN
Student Name Date of Birth

Parents/Guardians Name Phone (H)
Address Phone (W)
Phone (C)
Alternate Contact Names Phone (H)
Address Phone (W)
Phone (C)
Primary Health Care Phone
Provider
Specialty Provider Phone
MEDICAL DIAGNOSIS
ALLERGIES (Medication, Food, Bees, Environment)-
Special Recommendations for care___________________________________________________

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
SPECIAL PROCEDURES / SPECIAL DESIGNED INSTRUCTION

PROCEDURE PHYSICIAN ORDER FREQUENCY

SPECIAL PROCEDURES / SPECIAL DESIGNED INSTRUCTION
MEDICATIONS GIVEN AT SCHOOL

MEDICATION DOSE ROUTE FREQUENCY
MEDICATIONS GIVEN AT HOME

MEDICATION DOSE ROUTE FREQUENCY
SPECIAL CONSIDERATIONS / NEEDS

Diet or Toileting / Diapers
Feeding
Positioning Naptime/Sleeping
Outdoor Activities / Transportation
Sunscreen
Additional
Needs
Follow Food Allergy Action Plan for Food allergy reaction…

Attached to this form
___________________________________________
School Nurse Date
____________________________________________
Student/Parent Date

Food Allergy Action Plan (front side)
Source: www.foodallergy.com retrieved on March 10, 2010.

Food Allergy Action Plan (back side)
Source: Food Allergy and Anaphylaxis Network, retrieved on March 16, 2010 at www.foodallergy.org

Transportation Student Food Allergy Emergency Card
Student: _____________________________Date of Birth: ___________
MEDICAL ISSUE______________________________
TREATMENT ______________________________
Parents: __________________________________ STUDENT
PHOTO
Address: __________________________________
Home Phone: ________________
FIRST CONTACT Mother’s NAME:_____________________
CELL: ____________________________
SECOND CONTACT Father’s NAME____________________

PHONE:________________________
CELL: _________________________
OTHER CONTACT:
NAME:___________________PHONE:_________________
NAME:___________________PHONE:_________________
PHYSICIAN:
NAME:_______________________PHONE______________
- ------------------------------------------------------------------
Emergency Checklist for Bus Transportation
Allergy Symptoms:
________________________________________________________________________________
________________________________________________________________________________
__________________________________________________________________________
Treatment: Benadryl 2 tsp by mouth. Epi-pen IM

________________________________________________________________________
Students Response:
 If has Epinephrine and/or Benadryl with them they are to administer immediately
Driver Reponse:
1. STOP BUS IMMEDIATELY (in a safe area).
2. Call Mr. Sager or Mrs. Polivka immediately provide bus location
 They will call 9-1-1 and parents.
3. Stay with bus and students. Never Leave.
4. If trained assist with student’s Epinephrine administration if warranted
5. Begin CPR if warranted.
This form is for students with life-threatening food allergies and other issues such as food
intolerances to be completed by your Health Care Provider regarding your child’s medical
condition.

Food Service Student Food Allergy Emergency Card
Student: _____________________________Date of Birth: ___________
MEDICAL ISSUE______________________________
TREATMENT ______________________________
Parents:__________________________________ STUDENT
PHOTO
Address: __________________________________
Home Phone: ________________
FIRST CONTACT Mother’s NAME:_____________________
CELL: ____________________________
SECOND CONTACT Father’s NAME____________________

PHONE:________________________
CELL: _________________________
OTHER CONTACT:
NAME:___________________PHONE:_________________
NAME:___________________PHONE:_________________
PHYSICIAN:
NAME:_______________________PHONE______________
- ------------------------------------------------------------------
Emergency Checklist for Cafeteria Workers
Allergy Symptoms:
________________________________________________________________________________
________________________________________________________________________________
__________________________________________________________________________
Treatment: Benadryl 2 tsp by mouth. Epi-pen IM

________________________________________________________________________
Students Response:
 If has Epinephrine and/or Benadryl with them they are to administer immediately
Cafeteria Response:
1. Clear area surrounding the student. Allow privacy.
2. Follow Food Allergy Action Plan for student.
3. CONTACT SCHOOL NURSE IMMEDIATELY.
4. Call Supervisor immediately. They will call 9-1-1 and parents.
5. Stay with students. Never Leave.
6. If trained assist with student’s Epinephrine administration if warranted
7. Begin CPR if warranted.
This form is for students with life-threatening food allergies and other issues such as food
intolerances to be completed by your Health Care Provider regarding your child’s medical condition.

Guidelines for Teaching Staff Support
The teaching staff is an important component for managing student medical
conditions. They are the eyes and ears inside the classroom. The teaching staff routinely
observes students and are able to pick out unusual mannerisms for a particular student.
This provides valuable information and prompts actions when necessary. These skills will
prove life saving in the event of an anaphylactic reaction. In order to be consistent with all
aspects of care in managing food allergies at school, the teaching staff will:
 Utilized a Standardized Substitute notification folder. This MUST be used and

kept in standard location ________________by all staff to notify a substitute
teacher of students with food allergies (and all medical needs)
 Be familiar and comply with Food Allergy Management Plan Handbook.
 Follow Individual Health Plan and Food Allergy Action Plan as written.
 NEVER use food items of any sort in classroom activities.
 Only use permitted food items at elementary parties. (May allow fruits and
vegetables, no dips, food provided by cafeteria? If Pizza is furnished by
cafeteria – sauce may contain NUT particles and may need glueten free crust)
 Ensure a safe classroom environment by not eating at desk or supplying any food
items.
 Immediately wash desk with soap and water and dry with separate disposable towel
if area becomes contaminated with any food item.
 Know the location of the Food Allergy Action Plans.

Classroom and School Environment Management
It is essential to manage the school environment in order to limit the exposure of food
allergens in the school. Everyone must work together to keep the school environment safe
for all students. Since it is important to maintain a safe environment the following will occur
within the school buildings:
 Family Consumer Science classroom- check name for consistency

 The food science classroom will be NUT-FREE at all times. No nuts or any
products containing or products processed in nut factories will be used (this
will limit cross-contamination and air-borne exposure of food allergens).
 Procedures for using Family Consumer Science classroom for any after
school activities must follow NUT-FREE requirement to prevent cross-
contamination.
 Tables must be properly cleaned using soapy water clean, using individual
disposable cloths (one per table) and dried with using individual clean
disposable cloth (one per table).
 Snack areas
o These areas will remain behind closed doors.

o These items are not available during the school day.
o Students with food allergies will be instructed that this is an off limits area unless
no one else is in the area.
 Nuts from outside venues
The Laurel School District has no way to enforce nuts coming from an outside source.
We can only discourage others from bringing in foods that contain nuts.

Field Trip Issues
Field trips are part of the entire educational experience at Laurel. Students with food
allergies are not discriminated against because of their medical condition. All students must
have the opportunity to attend both class-related and after school educational trips.
In the event of a field trip, the self-directed student’s Food Allergy Action Plan and
medications can be given to a designated individual (parent/guardian or an employee
designated by the school district) who is familiar with the student’s medical needs and will
be directly available to the student. In the case of a non-self-directed student, only the
parent , school nurse or substitute nurse hired by the school district may administer
medications to the student.
An Epinephrine trained personnel MUST attend field trip when a

Student with food allergies is going.
 The field trip advisor is responsible for obtaining the proper field trip permission form
from each student per the field trip procedure (see page 37--39) for all trips or
anytime a student is leaving the assigned building (Information on these slips are
considered to be confidential).
 The field trip advisor is responsible for contacting parent with any issues or concerns
prior to the departure of the trip.
 Field Trip advisor is responsible for acquiring all medically necessary
equipment/medications for students with food allergies to bring on the trip.
 The Field Trip advisor is to notify school nurse if there has been an emergency.
 The Field Trip advisor must consider all eating situations and plan for prevention of
exposure to life threatening foods.
 No food items are permitted on buses at all times.
 Field Trip advisor is responsible for notifying school nurse of any outgoing trip one
week prior to departure. NO EXCEPTIONS!

Field Trip Parental Permission Form
The _________________is planning a field trip. Please review the following trip details and
complete, sign; and return the bottom portion of this form to the club advisor(s) no later than
______________________(due date).
Field trip to_______________________________________________________________

Date of trip ______________Time and place of departure___________________________
Mode of transportation ______________________________________________________
Advisor in charge________________________________Phone______________________
Cost of trip_________Members should bring_____________________________________
_________________________________________________________________________
Detach bottom and return to club advisor(s)

--------------------------------------------------------------------------------------------------------------------------
__________________________has my permission to participate in the field trip

to_________________________ on ___________________________________________
During the activity I may be reached at:
Address__________________________________________________________________
Phone___________________________ Alternative Phone__________________________
If I cannot be reached in the event of an emergency, the following person is authorized to
act in my behalf:
Name_________________________Phone____________________________________
Relationship to participant__________________________________________________
Physician’s name________________________________Phone____________________
Ambulance Preference_____________________________________________________
Other comments__________________________________________________________
Signature of parent/legal guardian____________________________Date____/____/____

Field Trip - Medical Information
Name__________________________Date of Birth________________________________
Home Address_________________________Home Phone_________________________
_________________________
IN CASE OF EMERGENCY CONTACT:

(1) Name____________________________Phone________________Phone___________
Address__________________________________________________________________
(2) Name____________________________Phone________________Phone___________
Address__________________________________________________________________
HEALTH INFORMATION: (Please state the facts in connection with the following)
Describe any condition requiring medication as a treatment:_________________________
_________________________________________________________________________
_________________________________________________________________________
List any allergies and tells us what happens if exposed_____________________________

_________________________________________________________________________
_________________________________________________________________________
Any surgery in the past year?____ If yes, please state nature:________________________
Name of Primary Care Provider:_______________________Phone___________________

Indicate health history information below: A check means “yes.” Please explain any checks
in the space provided.
Respiratory problems- Asthma, Emotional or mental disorders

Tuberculosis, persistent cough, etc.
Heart problems- high or low blood Recent exposure to a contagious
pressure, Rheumatic Fever, etc. disease
Stomach or intestinal problems- Currently under medical care
ulcers, jaundice, hernia, colitis,
indigestion, etc.
Eye, Ear, Nose, Throat-Hayfever, ear Physical limitations
infections, impaired sight or hearing
Nervous disorder-convulsions, Kidney, gall bladder or liver disease
epilepsy (seizures), dizziness, etc.
Skin diseases Diabetes or hypoglycemia
Muscular/Skeletal- arthritis, recent
fractures
Please explain any checks:__________________________________________________

Laurel Field Trip Form- Medical Information Continued…
RECOMMENDATIONS AND RESTRICTIONS:

Any treatment to be continued_________________________________________________
Any medication to be administered (specific dosages). All medications must be brought to

event in their original containers according to school medication policy._________________
_________________________________________________________________________
_________________________________________________________________________
Any medically prescribed meal plan or dietary restrictions___________________________

_________________________________________________________________________
Is there any other information that staff need to know about your child?_________________
_________________________________________________________________________
_________________________________________________________________________
List any special accommodations that are needed in order to participate in the program:___
_________________________________________________________________________
_________________________________________________________________________
Parental Authorization for Emergency Medical Care

Must be signed by parent/guardian
If medical information changes I agree to notify the school district. I herby authorize you, in
the event of an emergency, that is, when you are unable to reach me for authorization or
when circumstances require immediate action, to proceed according to good medical
practice with treatment of my daughter/son. Also, I authorized the hospital attending
physician, or other health care specialist administering the treatment to release pertinent
information to the insurance company assuming coverage for the same.
_______________________________ ______________________
Parent/Guardian Signature Date
Insurance Company Name_________________________Policy Number_____________________

Insurance Company Address________________________________________________________
Insurance Company Phone Number__________________Subscriber Name__________________
Laurel encourages persons with disabilities to participate in its programs and activities. If you anticipate
needing any type of accommodation or have questions about the physical access provided, please contact the
school in advance of your participation or visit.

Coaches/Athletic Director/Athletic Trainer/
After School Employees/Volunteers Issues
Students are involved in a variety of activities. As a staff person who interacts with
students, one is expected to be aware of any medical issues that may arise. The following
guidelines will help limit a student with food allergies exposure to allergens:
 All after school personnel and volunteers are required to attend/complete a

mandatory Food Allergy Educational program offered by the school district.
 Keep a copy of the Food Allergy Action Plan on students with known food allergies.
 Follow the direction of the supervisor regarding any food allergy issues as necessary.
 Knowing the signs and symptoms of anaphylaxis.
 Being familiar with the Food Management Plan.
 Knowing the location of Food Allergy Action Plan.
 Contact school nurse/parent of student with food allergies regarding any issues you
are unsure of prior to student supervision after school.
 Do not allow any food items on the bus as written in the Student Handbook.
 Do not give students any food items for any reason.
 Know how to call 9-1-1 and activated the Emergency Medical System.
 Implement Food Allergy Action Plan as necessary.
 Consider the presence of food allergens involved in after school activities and modify
as needed.
 If using either the school cafeterias or Food Science classroom No nut products are
permitted in these areas.

Maintenance/Custodial Issues
The maintenance/custodial staff can help keep the school safe and minimize exposure
to harmful allergens simply with routine cleaning of classrooms. In order to maintain a clean
healthy environment the custodial staff will:
 Perform weekly cleaning of all student desks by rotating hallways daily on a six-day
school day schedule in order to reach all classrooms every six days.
Elementary Sample Schedule: High School Sample Schedule:
Day 1 – Kindergarten Day 1 – 100 Hall
Day 2 – Grade 1 & 2 Day 2 – 200 Hall
Day 3 – Grade 3 & 4 Day 3 - 300 Hall
Day 4 – Grade 5 & 6 Day 4 - 400 Hall
Day 5 – Library/ Gym Day 5 – Library/ Gyms
Day 6 - Special Ed. Offices/Band/Choir Day 6 – Special Ed. Offices/Band/Choir
 The desks need cleaned using soap and water and a separate disposable clean cloth
(one per desk) and dried using a separate disposable clean towel (one per desk to
prevent cross- contamination
 Perform weekly wiping off doorknobs, boards and ledges, countertops, etc.
 General cleaning as directed by supervisor.
 Know Food Management Plan and follow Food Allergy Action Plan as necessary.

Food Service Personnel Issues
The food service personnel have an extremely difficult position in maintaining a safe
food preparation area and a safe eating area for all students. This is particularly difficult if
there are air borne food allergies. Therefore, the cafeteria will not prepare, purchase, or
serve any foods containing or processed with NUTS. This will prevent cross-contamination
and will provide a potentially less dangerous area for students with food allergies. The food
service personnel will help ensure a safe area by:
 Any student with known food allergies will be provided by the school nurse a
Standard Food Allergy Substitution Form (See pages 44-45) to be completed and
returned to the school nurse and then forwarded to the cafeteria supervisor.
 Cleaning tables using soap and water and a separate disposable clean cloth (one per
table) and dried using a separate disposable clean towel (one per table to prevent
cross- contamination).
 Perform routine cleaning as directed by supervisor of food preparation areas.
 Following the Food Allergy Action Plan.

Cafeteria Accommodations
The cafeteria area is one of many potential dangers for a student with food allergies.
Therefore, this area must become a safer place for students to eat and socialize. Because
of the potential risks both the elementary and high school cafeterias will not purchase,
prepare, or serve food items containing NUTS. The following recommendations have been
decided upon by the committee members:
 All students with food allergies are required to sit in designated areas in the cafeteria
for exposure issues. This is MANDATORY at the elementary level, but is voluntary at
high school level. It is available to all students with food allergies.
 The designated food allergy tables will be put up after use and no one is permitted to
use them for any reasons once they are cleaned and set aside.
 Any function that uses and occurs in the cafeteria MUST hire a Laurel Cafeteria
worker on-site (paid for by the group requesting use of cafeteria). This will ensure
proper equipment cleaning and limit cross-contamination from use.

Standard Food Allergy Substitutions
This form is good for one school year
Return this form to school nurse
Directions: Check the box next to the appropriate category heading. By signing
below, the standard food substitutions are accepted unless the “No Substitutions
Needed” box is checked.
School___________________________Stude________________________________
Date____________________Licensed Medical provider________________________
(Signature)
[] No Substitution Needed
Peanuts/Nuts
Common School Items School Substitutions Could Include
[] Peanut Butter/Uncrustable Sandwich [] Cheese Sandwich
[] Trail Mix [] Cheese Stick
[] Granola Bar [] Turkey, Ham or Beef Sandwich
[] Peanut Butter Cookie [] Chicken Nuggets
[] Some Quick Desserts [] Peanut-Free/Nut-Free Cookie or Crackers
[] Purchased Bread Products, Brownies Cookies, and Breakfast Muffins may be processed in a
facility that contains peanuts or tree nuts.
Dairy
[] Pizza [] Turkey, Ham or Beef Sandwich
[] Ice Cream [] Hamburger on Bun
[] Burrito [] Soft/Hard Taco (No Cheese)
[] Cheese Sandwich
[] Bread Entrée Items
[] Ravioli/Spaghetti
[] Most School-Prepared Breads
Wheat
[] Sandwich Bread [] Rice
[] Bread Items [] Hard Taco Shell
[] Cookies/Cakes [] Tortilla Chips
[] Many Desserts [] Potato (Mashed)
[] Pizza Crust [] French Fries
[] Hamburger/Hot Dog Bun [] Oatmeal
[] Pastas (Ravioli/Spaghetti) [] Rice Cereal
[] Bread Entrée Items
[] Breakfast Cereals and Entrees

Milk
[] Milk [] No substitutes for milk
Soy (Note: Most of our food items contain soy or soy oil.)
[] All Bread Items (Soy Oil) [] Yogurt
[] Purchased Entrees (burrito, nuggets [] String Cheese
[] Corndog, hamburger, ravioli, etc.) [] Sun Chips
[] Salad Dressings/Dips [] Potato (Fresh)
[] Most Purchased Snack/Dessert Items [] Hot Dog (no Bun)
[] Fresh Fruits and Vegetables
Egg
[] Eggs [] Hamburger on Bun
[] Breaded Entrée Items [] Hot Dog on Bun
[] Tuna Sandwich [] Peanut Butter/Uncrustable Sandwich
[] Mayo Products [] Cheese Sandwich
[] Waffle/French Toast
[] Cakes
[] Muffins/Quick Breads
[] Most of School-Prepared Breads
Fish
[] Fish Nuggets (Fun Fish) [] Hamburger on Bun
[] Fishwich on Bun [] Cheese Sandwich
[] Breaded Fish Entrees [] Turkey, Ham or Beef Sandwich
[] Tuna Sandwich [] Chicken Nuggets
FOODS TO OMIT
_______________________ _______________________ _______________________
_______________________ _______________________ _______________________
_______________________ _______________________ _______________________
FOODS TO SUBSTITUTE*
_______________________ _______________________ _______________________
_______________________ _______________________ _______________________
*Some substitutions may not be available or allowed.
Substitutions must be products commonly available in the district warehouse.
Nutrition Services 724 658 9056 ext. 1945
Lori Dado, High School Nurse 724 598 9932
Debra Garrett, Elementary School Nurse 724 658 9056 ext 2941

Transportation Personnel Issues
Riding a school bus to school is a milestone in every child’s life. Parents put their
children lives in the hands of responsible drivers every day. Student’s with food allergies
place their lives at risk everyday despite being transported to school. Bus drivers can help
reduce the potential dangers for students with food allergies by following the suggestions:
 When/If a seat on the bus becomes contaminated proper cleaning of the bus seats is
necessary. Use soap and water and a separate disposable clean cloth (one per seat)
and dried using a separate disposable clean towel (one per seat to prevent cross-
contamination) when a seat becomes soiled or contaminated by food.
 Perform routine cleaning as directed by Transportation supervisor.
 Following the Transportation Student Emergency Information Sheet for students with
food allergies (See page 32).
 Do not allow any food items on the bus as written in the Student Handbook.
 Do not give students any food items for any reason.

Steps to Take in the Event of a Reaction
The best approach to reacting to an anaphylactic reaction caused by food is to be
educated and prepared. This handbook is designed to help with both. In the event of an
anaphylactic emergency the following steps should be followed:
 Food Allergy Action Plans are located in a RED binder and will be accompanied by
epinephrine and antihistamine for easy access. The locations of these binders will
be: (11)
o Nurse’s Offices (elementary & high school).

o Cafeteria Offices (elementary & high school).
o Transportation Office.
o Front Offices (elementary & high school).
o Gyms (elementary & high school).
o Athletic Trainer Office
o Room 402 of the high school.
 Individual Food Allergy Action Plans will be included on every student with a known
food allergy.
 A step by step procedures are outlined by the plan.
 Follow the plan as written
 Never hesitate to administer Epinephrine- It is always better to give than NOT. There
are no harmful effects for not giving epinephrine but if delayed it may be fatal.
 Always call for help.
 Always call 9-1-1.

Educational Resources- Training
Education is one of the key components to managing food allergy emergencies.
Everyone in a school setting must be trained to be able to recognize and react in order to
help a student who is suffering from a food allergy reaction. All educational programs will be
conducted by the school nurse. Education will include but not limited to:
 All parent volunteers will be required to attend an annual Mandatory food allergy
training prior to volunteering in the school district (This will be done at the first PTO
meeting at the elementary school and will be done during the first month of school for
the high school parent(s)/guardian(s) and again in the spring.
 Food allergy awareness program will be conducted to all students annually at grade
orientations.
 Food allergy awareness programs will occur at the Kindergarten and seventh grade
parent orientation programs.
 A mandatory in-service for all school personnel will be provided for all district
employees (teaching staff, clerical staff, cafeteria personnel, transportation
personnel, custodial/maintenance staff.
 Food allergy training program and epinephrine administration training will be
available on the school website at all times.
 The school nurse will notify key personnel through department supervisors of known
students with food allergies and appropriate information sheets will be provided.

Internet Resources
Adrenaclick- www.adrenaclick.com
American Academy of Allergies and Immunology – www.aaaai.org
Asthma & Allergy Foundation/NE – www.aafa.org
Epi-pen- www.epipen.com
Food Allergy and Anaphalaxis Network- www.foodallergy.com
Twinject- www.twinject.com

References
Adrenaclick Drug information. Retrieved on March 2, 2010 at www.adrenaclick.com.
American Academy of Asthma Allergy and Immunology Accessed from
http://aaaai.org/medicaesources/academy_statements/position_statements/ps34.asp
on 3/5/2010.
Asthma & Allergy Foundation /NE. (1999) [Electronic version] Anaphlylaxis. Preventing life-
threatening food allergy emergencies in schools. A resource packet for school
nurses and administrators. Accessed at www.aafa.org on February 1, 2009.
Epipen Drug Information. Retrieved on March 2, 2010 at www.epipen.com.
Food Allergy Management Algorithm (2009). New York Health Services Center. Retrieved
on March 1, 2010 at www.schoolhealthservicesny.com
Food Allergy & Anaphylaxis Network (2005). School food allergy program. Retrieved
February 2, 2009 from www.foodallergy.org/school/html.
Formanek, R. (2001). Food Allergies: When food becomes the enemy. US Food and Drug
Administration, accessed on March 5, 2010 from
http://fda.gov/fdac/features/2001/401_food.html.
Gaudreau, J. (2000). The challenge of making the school environment safe for children with
food allergies. Journal of School Nursing, 16(2), 5-10.
Mudd, K. & Noone, S. (1995) Management of severe food allergy in the school setting.
Journal of School Nursing, 11(3), 30-32.
Munoz-Furlong, A. (2004). Food allergy in schools: concerns for allergists, pediatricians,
parents, and school staff. Annuals of Allergy, Asthma & Immunology, 93(5), 47-50.
Sheetz, A., Goldman, P., Millett, K., Franks, J., McIntyre, L.,Carroll, C., Gorak, D., Harrison,
C., & Carrick, M. (2004). Guideline for management life-threatening food allergies in
Massachusetts schools. Journal of School Health, 74 (5), 155-160.
Smith, M., Anaphylaxis: Severe allergic reaction. Individualized healthcare plans for the
School Nurse, SunRise Press, MN, 2005.
Twinject Drug Information. Retrieved on March 2, 2010 at www.twinject.com.

Setting The Standard: Managing Food Allergies in School

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Setting The Standard: Managing Food Allergies in School

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Setting the Standard

Managing Food Allergies in School

An Equal Rights and Opportunities School District

Managing Food Allergies Handbook -2-

This handbook is to provide guidance in the management of food allergies at school.

Mrs. Lori Dado, High School Nurse

Managing Food Allergies Handbook -3-

Anaphylaxis - A severe life-threatening reaction caused by an allergen (food).

Antihistamine – A medication given in orally, intramuscularly, or intravenously to block an

allergic histamine response.

Child - All students ages 4-21.

Epinephrine - Medication used to help with respiratory and cardiac symptoms of an

Food Allergy - Hypersensitivity to food.

Handbook - a written guide to performing specific tasks.

Management - To respond and control a situation.

Plan of Care- a written plan to address medical needs of a student.

Managing Food Allergies Handbook -4-

have collaboration among parent(s)/guardian(s), and all school departments; including

school nursing personnel, teachers, administration, guidance, food service, transportation

This document contains information specific to students with food allergies.

Managing Food Allergies Handbook -5-

Managing Food Allergies Handbook -6-

Schools need to limit exposure to help prevent an attack from occurring.

Managing Food Allergies Handbook -7-

latex, medications, and insect stings.

Managing Food Allergies Handbook -8-

Common signs and symptoms of allergic/anaphylactic reactions may include:

(Source: Position statement- American Academy of Asthma Allergy and Immunology)

appropriately trained allergy specialists.

Managing Food Allergies Handbook -9-

recognition management of allergic reactions to food are important measures to prevent

avoidance measures. Treatment should be immediately available for these emergencies.

administered immediately in an emergent situation of a child having a potentially life-

threatening allergic reaction. Epinephrine injection is available in a number of self-

Managing Food Allergies Handbook - 10 -

that are easily accessible to everyone.

All students, regardless of whether they are capable of epinephrine self-

hinder their attempts to inject themselves. Adult supervision is ALWAYS recommended.

Managing Food Allergies Handbook - 11 -

but may be preferred because of its simplicity of use.

Managing Food Allergies Handbook - 12 -

(Source: Dey Pharmacueticals - Accessed from http://www.epipen.com on

Managing Food Allergies Handbook - 13 -

(Source: Position statement- American Academy of Asthma Allergy and

(Source: Shionogi Pharma, Inc. - Accessed from http://twinject.com on March

Managing Food Allergies Handbook - 15 -

(Source: Dey Pharmacueticals - Accessed from http://www.adrenaclick.com on

Managing Food Allergies Handbook - 16 -

Managing Food Allergies Handbook - 17 -

must be responsible for identifying and notifying staff of potentially life-threatening

delay in response that can be fatal.

The student will:

Managing Food Allergies Handbook - 18 -

The Parent/Guardian(s) will:

Managing Food Allergies Handbook - 19 -

 Support the Food Allergy Management Plan as written.

Managing Food Allergies Handbook - 20 -

allergies is potentially a life-threatening event and must be dealt with by a proactive

Managing Food Allergies Handbook - 21 -

 Develop a procedure to notify all employees of those food-allergic students in the

Managing Food Allergies Handbook - 22 -

identified food allergies.

When a student enrolls in school, information is gathered regarding medical

Parents are: _Married _Single _Divorced _Separated ___Widowed

Has your child had any new immunizations? _Yes _No