Allergy and Anaphylaxis Management in Schools

This page outlines the key components of effective school-based allergy and anaphylaxis management and provides practical tips and resources to help schools and primary care providers improve care for students with severe and life-threatening allergies.

• Food allergy affects approximately 1 in 20 school-aged children.
• Reactions at school are fairly common. One survey of school nurses found that 32% reported that a student had experienced an allergic reaction at school in the past year. 1
• Up to one quarter of anaphylactic reactions at school are among students with previously undiagnosed allergy.
• Food is the most frequent trigger, accounting for approximately 60% of reactions in schools.
• One large study found that symptoms of anaphylaxis are most likely to develop in the classroom (47%), cafeteria (20%) and playground (10%).
• Almost a quarter of food allergic students report food allergy-related bullying, including from teachers and staff.
• Several studies have found important gaps in school nurse knowledge about allergy/anaphylaxis management, including lack of awareness that hand sanitizer does not remove residues that can triggerallergic reaction, lack of knowledge about when to use an additional epinephrine autoinjector, and use of antihistamine instead of epinephrine as first-line treatment.

Best Practice and Clinical Guidelines for School-Based Management of Allergy and Anaphylaxis

• Management of Food Allergy in the School Setting, American Academy of Pediatrics
  AAP policy statement on food allergy management

• Clinical Conversations for Food Allergy Management, National Association of School Nurses
  Selection of articles and literature on food allergy management
• Stock Inhaler Toolkit for Schools, American Academy of Allergy Asthma & Immunology
  Toolkit that can be used by school personnel to set up and initiate a stock inhaler program in your school or district.
• Stock Epinephrine Toolkit for Schools, American Academy of Allergy Asthma & Immunology
  Toolkit that can be used by school personnel to set up and initiate a stock epinephrine program in a school or district.

Policy Statement

School-based health centers can be an excellent resource for diagnosis, education, treatment, and care coordination. See the American Academy of Pediatrics’ policy statement on this topic for more information about coordination between school-based health centers, primary care, and school health services.