Food Allergy Guidelines

Procedures for Students with Severe Food Allergies

Updated 8/20/2012

An estimated eight percent (approximately two million) of children in the United States are affected by one or more food allergies. With a true food allergy, an individual's immune system overreacts to a food that is usually harmless. This response by the immune system can be life-threatening within a matter of minutes.

The most common food allergens are peanuts, tree nuts, fish and shellfish, milk, eggs, soy, and wheat. These ingredients are not always obvious on package products.

The goal for students with food allergies is complete avoidance of the offending agent but in spite of everyone's best efforts, accidental exposure sometimes occurs. Allergic reactions can result from ingesting or inhaling the allergen and from skin contact with the allergen. The onset of the reaction can occur rapidly or it may be delayed.

Proper planning and implementation can minimize and often eliminate the risk of an allergic student's exposure to a food allergen. The students' parents and the student, the school nurse, classroom teachers, campus administrators, cafeteria staff, custodians, and classmates can all contribute to minimizing the chances of an exposure and a potentially serious reaction.


  1. Any student with a parent reported or physician documented severe food allergy must have a current written physician's order/severe allergy action plan on file with the school nurse. The physician's documentation must be on file in the clinic within five business days of the first day of the child's attendance.
  2. The school nurse will meet with parents/guardians of students with severe food allergies to review the nature of the allergy; obtain a history of the child's reactions to the allergen; review physician's written documentation and current orders; and develop an appropriate school management plan and emergency care plan. New forms will be required for each school year.
  3. Students who have proper authorization to carry and self-administer emergency medications for severe allergic reactions are required to keep a second set of properly labeled emergency medications in the clinic. This is to ensure that the student will have medication available in the event they are unable to locate their personal supply.


  1. The school nurse will notify key faculty and staff on each campus of any students with food allergies. This notification will include campus administrators, appropriate faculty and instructional aides, the cafeteria manager, the head custodian and bus drivers.
  2. The school nurse will prepare a Severe Allergy Alert notification for teachers who have students with severe food allergies. It will include the child's name and brief instructions for initial management of an exposure. The classroom teacher will keep one copy and a copy will be available for substitute teachers. A copy will also be given to the cafeteria manager.
  3. If parents/guardians wish to write a letter regarding their child's allergies to be sent home with other students, it must first be approved by the principal, school nurse and the Director of Personnel and Legal Affairs.


  1. The school nurse, with the parents'/guardians' assistance, will assess the child's level of understanding regarding foods to avoid. The school nurse will reinforce the child's self-management of the food allergy with emphasis on the following:The school nurse will share information with faculty and staff on potentially life threatening food allergies. Methods to avoid the offending allergen, recognition of signs and symptoms of allergic reactions, and the importance of timely treatment will be discussed.
    • safe and unsafe foods
    • strategies for avoiding exposure to unsafe foods
    • symptoms of an allergic reaction
    • reading food labels for ingredients (age appropriate).
  2. Principal designated staff will be trained on Epi-Pen administration.
  3. The school nurse will assist the teacher in discussing the following with the student's classmates: no sharing or trading of food, beverages, or utensils; no touching of each other; and the importance of handwashing before and after snacks and meals.
  4. If a student with severe food allergies has a physician's order to carry their prescribed emergency medication and self-medicate and meets established district policies to do so, the school nurse will meet with the parent and student to discuss proper management of an allergic reaction. The student must understand and agree to comply with the following:
  5. The Epi-Pen or other prescribed medications for a severe allergic reaction is to be kept in the student's or a trained adult's immediate possession (for early morning or late afternoon activities) while the student is on campus or at a school-related activity.
  • In the event the student self-administers an emergency medication (oral or injection) or a trained adult administers the same, the school nurse will be notified immediately as well as the first response team. The school nurse/school will notify EMS (911), the student's parents/guardians, the student's physician (if requested by the parents/guardians), and a campus administrator.
  • The student must be escorted to the clinic by an adult after self-administration of the Epi Pen® or prescribed emergency medication.
  • If the allergic reaction occurs during an extracurricular activity or after school hours and the nurse is not on campus, a designated adult will notify EMS (911), the student's parents/guardians, and a campus administrator.

Work with the District Transportation Administrator to assure that school bus driver training includes symptom awareness and what to do if a reaction occurs.


  1. Students may not trade or share food, beverages, or utensils.
  2. Students with food allergies should not eat or drink anything with unknown ingredients or known to contain allergens
  3. Students with food allergies will notify an adult immediately if they consume something they believe may contain an allergen.
  4. The school nurse and teacher will discuss field trips and special class activities with the allergic student's parents/guardians to determine appropriate strategies for managing the allergy during these events. This could include parents/guardians attending the field trip or activity to offer the highest level of protection for the child.
  5. During field trips, any student with physician documented severe food allergies will be placed in the student group led by the child's classroom teacher.
  6. Students with severe food allergies (such as peanut allergies) may be allowed to sit at a designated table where the allergen is not present (a peanut-free table). These students may invite a friend to sit with them at that table provided their lunch does not pose a risk to the student with severe food-specific allergies. If the food allergy is less severe, as documented by written orders from the student's attending physician, and the student does not need separate seating, arrangements will be made for the student to sit at or near the end of the table with others whose lunches do not pose a risk.
  7. A food service staff member will clean the student's table before the student is seated.
  8. If snacks are eaten in the classroom, the same seating and cleaning procedures outlined for the cafeteria will be followed by the teacher. All students must wash their hands after snack.
  9. Discuss field trips with the family of the food allergic child to decide appropriate strategies for managing the food allergy.


  1. An Emergency Health Care Plan (EHCP) will be provided by the student's physician and an Individualized Health Plan (IHP) will be developed by the school nurse and parent for each student with physician documented severe food allergies.
  2. An emergency kit for each student with prescribed medications for severe food allergies will be kept in a locked cabinet in the Clinic. The cabinet is to be clearly labeled "Meds". The emergency kit must contain the student's prescribed emergency medications and a copy of the student's EHCP.
  3. The expiration dates of all emergency medications will be clearly marked in red on the student's EHCP.
  4. If an allergic reaction occurs, the nurse will be notified immediately and will implement the student's Emergency Health Care Plan. If the nurse is not available for some reason, the First Response Team or the staff trained member will assume this responsibility. A student with a severe allergic reaction MUST NOT be sent to the clinic alone or with another student. If a student experiences a severe allergic reaction during a field trip, a trained school staff member will implement the student's Emergency Health Care Plan. In order to offer maximum support to the student, the student's parent/guardian may implement the EHCP if they are in attendance.
  5. The school nurse or trained staff volunteer will administer the prescribed emergency medications according to the physician's directions at the first sign of an allergic reaction or known exposure to the allergen.
  6. Students who have proper authorization to carry and self-administer their medications for treatment of severe food allergies MUST come to the clinic immediately after self-administration. They must notify an adult immediately after self-administration and be accompanied to the clinic by an adult.
  7. After the emergency medications are administered, EMS (8-911) will be summoned.
  8. After EMS is notified, contact the student's parents/guardians and, if requested by the parents/guardians, the student's physician. Notify a campus administrator that EMS has been summoned.
  9. If EMS arrives to transport the student before the parents/guardians arrive, an administrator or their designee will accompany the student to the hospital and will remain with them until a parent/guardian arrives. If the child's parent/guardian is attending a special activity or field trip and the child must be transported by EMS, the parent/guardian will accompany the child to the hospital. If necessary, a designated employee from the student's school will be dispatched to meet the ambulance at the hospital.
  10. Campus staff involved in responding to a severe allergic reaction will meet within five school days following the reaction to review and evaluate their response. Any changes made as a result of the review will be noted on the student's Emergency Health Care Plan and also on the IHP. Changes may include encouraging parents'/guardians' attendance during special activities and field trips.
  11. The student's parents/guardians will be contacted to replace any used medication/supplies. Immediately upon receipt of replacement medications, the nurse will check the expiration dates and physician's orders.
  12. Pursuant to standing orders from a physician supporting the Boerne ISD, all campus nurses may keep on hand epinephrine pens as prescribed by the physician. Nurses shall follow the protocols established by the physician for their use. They shall be used only in emergency situations and may not be distributed to staff or students. After the epinephrine pen is administered, EMS will be contacted. In the case of students, the nurse shall make immediate contact with the parents and then follow-up with the student as soon as practical thereafter.

