1. Allergy and Anaphylaxis in the School Setting
The Role of the
School Nurse

2. Allergy Prevention, Recognition, and Response
Careful planning and prevention can greatly reduce the risk of students experiencing anaphylaxis, or a life-threatening allergic reaction at school

3. What School Nurses Can Do
There is no cure for allergies or anaphylaxis.
But there are steps we can take:
To prevent exposure,
To recognize when an exposure has occurred, and
To respond quickly and effectively.

4. Prevention
Management of food allergies is based on a coordinated approach using effective partnerships among school nurse, food service personnel, other school staff, children and their parents and healthcare provider(s).
Implement a process to collect health related information from students on at LEAST a yearly basis (health intake/registration/history form). See HANDOUT.
A health history will provide health information to assist with providing medical care to the student during the school day, as well as an opportunity to anticipate a medical emergency based on the diagnoses of the student.

5. Prevention
Once a student has been identified to have a “food allergy”, a Family Food Allergy Health History form should be completed.
This provides an avenue to collect more specific information about the food allergen, past symptom history indicative of the allergic response, and medications or treatments prescribed by healthcare provider.

6. Prevention Student medical home is identified.
Student has health insurance.
Student has a “Medical Statement to Request School Meal Modification” form on file completed by a healthcare provider. (Original kept on file with Food Service Director, and copies kept in student health folder and with building food service kitchen manager).
If a student has a food allergy it is important that they have a healthcare provider who will assist them in diagnosing and treating as needed.
Our role as a school nurse includes “outreach, support and referral” to health systems, (programs and resources) including health insurance carriers.
The Medical Statement provides the school with written information from the healthcare provider to identify specific food allergens, sensitivities, or a disability that needs to be addressed at school.

7. Prevention
The school nurse will develop an Individualized Healthcare Plan (IHP) based on each child’s unique needs and treatment.
The school nurse will develop an Emergency Action Plan (EAP).
The IHP will provide specific prevention steps for the individual child and the EAP will provide student specific symptoms to observe.
Students with food allergies and anaphylaxis must not be excluded from school activities and the IHP and EAP will provide steps to keep the student safe.
After receipt of the “Medical Statement to Request School Meal Modification” form, the school nurse will develop an (IHP).
The school nurse will also develop an Emergency Action Plan.

8. Prevention
Communicate with ALL staff who interact with the students on a regular basis, ensuring they understand food allergy, can recognize symptoms, know what to do in an emergency and work collaboratively to eliminate or reduce the exposure to food allergens.
Ensure medications are appropriately stored, and allow student to “carry their own epinephrine” as much as possible.
Delegate school personnel to administer medications in accordance with Kansas Nurse Practice Act.
Work with district transportation staff to ensure their training includes “food allergy” symptoms awareness and what to do if a reaction occurs.
The individualized healthcare plan (IHP)

9. Prevention
Recommend that all buses have communication devices in case of emergency.
Enforce a “no eating” policy on school buses.
Discuss field trips with the parents and school staff to decide appropriate strategies for managing the food allergy (at least 2 weeks notice for in-state field trips and 2 months notice of out of state field trips). Take Emergency Action Plan and Medication on field trips.
Encourage classroom teachers to adopt a “no sharing” or “trading” food in their student population(s).

10. Prevention/Education
Consider art and science materials, including pet foods.
Promote hand washing before and after eating.
Read food labels every time food is served.
Consider talking with the parent of the child with an allergy to send home a letter to parents in the class.

11. Response to an Allergic Reaction
The Emergency Action Plan

12. Steps to Take
If a student displays signs and symptoms of an allergic reaction and/or reports an exposure to their allergen, school personnel should immediately:
Notify the school nurse (if available) and initiate the Emergency Action Plan
Locate the student’s epinephrine immediately; or administer via protocol, if “stock” epinephrine is available
Call 911 if epinephrine has been administered.

13. Act Quickly! Do Not Delay!
Epinephrine is the medication of choice for the treatment of acute anaphylaxis and delay of, or failure to administer Epinephrine, may contribute to a fatal outcome. When in doubt, use the EpiPen!
The side effects of the EpiPen could include fast heart beat, jittery feeling, and other cardiovascular symptoms. The life-saving benefit of Epinephrine outweighs the risks of side effects in an anaphylactic reaction.

14. Other Medication for use with Allergic Reactions
Antihistamine –
Diphenhydramine hydrochloride - Brand name includes: Benadryl
Cetirizine – Brand name includes: Zyrtec
May cause drowsiness, nausea, and dryness of the mouth.
NOTE: Antihistamines should not be the only medication given in anaphylaxis since epinephrine is the drug of choice. There is no contraindication to give epinephrine for anaphylaxis along with an oral antihistamine.

15. Online Resources
FAAN Back to School Tool Kit:
FAAN School Guidelines for Managing Students with Food Allergies:
FAAN Food Allergy Action Plan:
CDC National Center for Chronic Disease Prevention and Health Promotion:
American Academy of Allergy, Asthma and Immunology. (AAAAI).

16. References
School Tools: Allergy & Asthma Resources for Professionals.
The Food Allergy and Anaphylaxis Network (FAAN).,
National Association of School Nurses.
Asthma & Allergy Foundation of America.
Food Allergy Field Guide: