Guidelines for Food Allergies


A food allergy is an abnormal response to a food, triggered by the body’s immune system (NIAID, 2010). Symptoms of a food induced allergic reaction may range from mild to severe and may become life-threatening. Reactions vary with each person and each exposure to a food allergen and the severity of an allergic reaction is not predictable. The Centers for Disease Control and Prevention recently reported an 18 percent increase in food allergies among school-aged children from 1997 to 2007. Current estimates state that between 1 in 13 (Gupta, 2011)) and 1 in 25 children are now affected with 40 percent reporting a history of severe reaction (CDC, 2012). There is no cure for food allergies. Strict avoidance of food allergens and early recognition and management of allergic reactions are important measures to prevent serious health consequences (U. S. Food and Drug Current research shows that between 1 in 13 and 1 in 25 children are now affected with food allergies. Administration, 2008). Children spend up to 50 percent of their waking hours in school, and foods containing allergens are commonly found in schools. Thus, the likelihood of allergic reactions occurring in schools is high (Sheetz, 2004). Studies show that 16-18 percent of children with food allergies have had allergic reactions to accidental ingestion of food allergens while in school. Moreover, food-induced anaphylaxis data reveals that 25 percent of anaphylactic reactions in schools occur among students without a previous food allergy diagnosis (Sicherer, 2010 & Nowak-Wegrzyn, 2001).

A food allergy is a potentially serious immune-mediated response that develops after ingesting or coming into contact with specific foods or food additives. A life-threatening allergic reaction to food usually takes place within a few minutes to several hours after exposure to the allergen. Eight foods account for over 90 percent of allergic reactions in affected individuals: milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat (Sampson, 2004 & Sicherer S., 2002). Although most allergic reactions are attributed to these eight foods, any food has the potential of causing a reaction. In addition, school settings may contain non-food items such as arts and crafts materials that contain trace amounts of food allergens. Many products used in the school setting may contain food proteins. Cross contamination can occur when an allergen is transferred from one item (utensils, pots, pans, countertops, surfaces, etc.) to another. When preparing, handling and serving food, it is critical to make sure that food preparation and serving utensils are not exposed to allergens for the safety of children with food allergies. Allergic reactions can occur with trace exposure to food allergens. There is no cure for food allergy. Strict avoidance of allergens and early recognition and management of allergic reactions are important to the safety of children with food allergies at risk for anaphylaxis.

Anaphylaxis is defined as “a serious allergic reaction that is rapid in onset and may cause death” (Simons, 2008). Anaphylaxis includes a wide range of symptoms that can occur in many combinations and is highly unpredictable. It is estimated that four out of every 50 children have a food allergy (Gupta, R, 2011) and children with food allergies are more likely to experience other allergies. Children with the diagnosis of asthma may be more likely to experience an anaphylactic reaction to foods and be at higher risk of death. In case studies of fatalities from food allergy among pre-school and school-aged children in the United States, nine of 32 fatalites occurred in school and were associated primarily with significant delays in administering epinephrine, the only lifesaving treatment for anaphylaxis (Sicherer S. & Mahr, T. 2010). Epinephrine is available through a physician’s prescription in an auto-injectable device. The severity of one reaction does not predict the severity of subsequent reactions and any exposure to an allergen should be treated based on the child’s Food Allergy Action Plan (FAAP)/Emergency Action Plan (EAP) and Individualized Healthcare Plan (IHP).

Food allergy can have a wide-ranging, negative effect on children and their families, affecting not only life at home but also school, work, vacation, and entertainment. Virtually no life activity remains unaffected by the presence of a potentially fatal allergy (Greenhawt, M., 2011). Currently, management of food allergies consists of educating children, parents and care providers, including school personnel, about strict avoidance of the food allergen, recognizing the signs and symptoms of an allergic reaction, and initiating emergency treatment in case of an unintended ingestion or exposure. In order to address the complexities of food allergy management in schools, it is important that students, parents/ caregivers, and school personnel work cooperatively to create a safe and supportive learning environment (National School Boards Association, 2011).

With the increasing prevalence of food allergies in the past two decades, care of students with life-threatening allergies has become a major issue for school personnel (Sheetz, 2004). Caring for children with diagnosed food allergies at-risk for anaphylaxis in the school setting requires a collaborative partnership with the students, parents, healthcare providers and school staff.

Signs and Symptoms of an Allergic Reaction
In the case of life-threatening food allergy reactions, more than one system of the body is involved. The mouth, throat, nose, eyes, ears, lung, stomach, skin, heart, and brain can all be affected. The most dangerous symptoms include breathing difficulties and a drop in blood pressure or shock, which is potentially fatal.

Mouth Tingling, itching, swelling of the tongue, lips or mouth; blue/grey color of the lips
Throat Tightening of throat; tickling feeling in back of throat; hoarseness or change in voice
Nose/Eyes/Ears Runny, itchy nose; redness and/or swelling of eyes; throbbing in ears
Lung Shortness of breath; repetitive shallow cough; wheezing
Stomach Nausea; vomiting; diarrhea; abdominal cramps
Skin Itchy rash; hives; swelling of face or extremities; facial flushing
Heart Thin weak pulse; rapid pulse; palpitations; fainting; blueness of lips, face or nail beds; paleness

Treatment of Anaphylaxis
Epinephrine is the first-line treatment in cases of anaphylaxis. Other medications have a delayed onset of action. Epinephrine is generally prescribed as an auto-injector device that is relatively simple to use.

Anaphylaxis can occur immediately or up to two hours following exposure to an allergen. In approximately one third of anaphylactic reactions, the initial symptoms are followed by a delayed wave of symptoms two to four hours later. This combination of an early phase of symptoms followed by a late phase of symptoms is defined as a biphasic reaction. While initial symptoms respond to epinephrine, the delayed biphasic response may not respond to epinephrine and may not be prevented by steroids.

Therefore, it is imperative that following the administration of epineprhine, the student be transported by emergency medical services (EMS) to the nearest hospital emergency department even if the symptoms appear to have resolved. Because the risk of death or serious disability from anaphylaxis itself usually outweighs other concerns, existing studies clearly favor the benefit of epinephrine administration in most situations. There are no medical conditions which absolutely prohibit the use of epinephrine when anaphylaxis occurs (Boyce, 2010).

Identification of Students With Food Allergy At-Risk for Anaphylaxism
Due to an increase in prevalence of food allergies and the potential for a food allergic reaction to become more life-threatening, information needs to be shared with the school in order to promote safety for children with food allergies that are at-risk for anaphylaxis. It is important for parents to provide accurate and current health information when requested, in order to assist schools in obtaining information necessary to:

  1. identify the child’s food allergens;
  2. specify the nature of the child’s allergic reaction;
  3. reduce risk of exposure to food allergens;
  4. provide emergency treatment to the student during the school day and at school-sponsored activities in the event there is an unintended exposure to a food allergen; and
  5. facilitate communication between the school and the student’s healthcare provider.

Texas Education Code Chapter 25, Section 25.0022 states that upon enrollment of a child in a public school, a school district shall request, by providing a form or otherwise, that a parent or other person with legal control of the child under court order:

  1. disclose whether the child has a food allergy or a severe food allergy that, in the judgement of the parent or other person with legal control, should be disclosed to the district to enable the district to take necessary precautions regarding the child’s safety, and
  2. specify the food to which the child is allergic and the nature of the allergic reaction.

Positive Solutions Charter High School is not responsible for and cannot guarantee the accuracy of any of the nutritional information contained on this site. It is not a guarantee of ingredients in all foods. Products stocked by Positive Solutions Charter High School change due to supplier changes or substitutions. Manufacturers may also change formulation and ingredient profiles without the knowledge of Positive Solutions Charter High School. Parents are welcome to look at any ingredient label on food products. Positive Solutions Charter High School is not responsible for and cannot guarantee the contents of food products prepared by manufacturers. The information contained on this site is not intended as a substitute for advice from your physician or other healthcare professional. For students that have severe allergies it is strongly suggested that parents have a menu marked by a healthcare professional for school staff to follow or parents are encouraged to provide meals to their child/children prior to sending them to school.

Documentation from a medical authority will be required for accommodations to be made for a
student’s menu. Parents are encouraged to use the attached Physician Order Form for special dietary
requests. This form should be completed by the student’s physician and returned to the school office. Other physician forms may be accepted during special circumstances.

  • Each special dietary request must be supported by a statement that explains the food substitution that is requested.
  • It must be signed by a recognized medical authority (physicians, physician assistants or nurse
  • The physician statement must identify:
    • The child’s disability
    • An explanation of why the disability restricts the child’s diet
    • The major life activity affected by the disability
    • The food or foods to be omitted from the child’s diet and the food or choice of foods that must be substituted.
  • The medical statement will be kept on file at the school during the time the student is in school.
  • Please contact the school office or student coordinator if you would like assistance with special dietary needs. An effort will be made to provide a substitution for the items containing the allergen(s). Please note that depending on the circumstances, the requested substitution may not be available in which case the parent may want to provide breakfast or snacks at home prior to the child being dropped off for school.

Milk Substitutions
Please notify the school office of any milk substitution requirements.

Peanut/Nut Allergies
Positive Solutions Charter High School does not contact food manufacturers to determine if food items are manufactured in a plant where peanuts, nuts or any other allergens may be present in trace amounts. Positive Solutions Charter High School makes an effort to avoid products known to contain peanuts as an ingredient; therefore, cannot guarantee that foods purchased have not been in contact with peanuts or other nuts during manufacturing.


For further information, resources, and references visit TEA’s Guidelines: