Supporting Students With Food Allergies

Students are often exposed to allergens in the classroom, cafeteria or playground.  An allergy is the body’s reaction to a substance like pollen, dust mites, mold, animal dander, latex, foods and insect stings that the body views as harmful. More than 50 million Americans (1 in 6) experience some form of allergy.¹

While exposure to dust mites and pollen are difficult to control in the school environment, schools can implement policies and procedures to reduce the risk of anaphylaxis due to exposure to food allergens. Anaphylaxis is a severe allergic reaction which occurs quickly after exposure to an allergic substance. Anaphylaxis symptoms include: skin reactions, including hives and itching and flushed or pale skin; swelling of the tongue and constriction of the airway causing difficulty breathing; nausea, vomiting or diarrhea, dizziness or fainting and a sudden drop in blood pressure.

With a large number of children living with allergies, it is important for schools to be prepared to help manage those allergies while the child is in the school. While not always able to prevent exposures, such as bee stings on the playground or dust mite exposure in the classroom, schools can reduce risk through monitoring the playground and removing beehives and routine cleaning of classrooms. The Allergy & Asthma Network offers guides for both schools and parents on managing allergies in school.

Food Allergies

A food allergy is an adverse immune response that occurs after exposure to a specific food.  Estimates show that as many as 8% of children may have a food allergy ², or an average of 2 students in each classroom. ³ Reactions to food allergies can range from mild symptoms to serious anaphylaxis and death.  There is no cure for food allergies; strict avoidance of exposure to the allergen is the best way to prevent a reaction.  There are eight foods or food groups that are responsible for the majority of serious allergic reactions in the United States: milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts and tree nuts.³

Policy to Support Students with Food Allergies 

In July 2009, Ohio law required the board of education of each city, local, exempted village and joint vocational school district, community school and the governing authority of each chartered nonpublic school to establish a written policy with respect to protecting students with food allergies. The policy must be developed in consultation with parents, school nurses and other school employees, school volunteers, students and community members.   

Further information on food allergy policy requirements can be found on the Department’s Food Allergy Policy Requirements and Guidance webpage.  

Training to Support Students with Food Allergies

In April 2021, Ohio law was amended to specify that each school district board of education may create training for all staff members and age-appropriate instruction for students in grades kindergarten through 12 on food allergies and ways in which to assist an individual experiencing an allergic reaction. If a district board chooses to provide training to staff and students, the training may include:  

• Instruction in food allergies;
• Signs and symptoms of anaphylaxis; 
• Prevention of allergic reactions;  
• Management and administration of epinephrine; and  
• Follow-up and reporting procedures.  

Completed training qualifies as a professional development activity for the renewal of educator licenses, in addition to activities approved by local professional development committees. 

The Ohio Revised Code and Food Allergy and Epinephrine Procurement

Ohio Revised Codes related to Food Allergy and Epinephrine Procurement	Public Schools	Chartered or nonchartered nonpublic school	Community School
Food Allergy Protection Policy	3313.719	3313.719	3314.03
Epinephrine Procurement	3313.7110	3313.7111	3314.143

Information on food allergy policy requirements and resources to train staff and students can be found on the Department's Food Allergy Policy Requirements and Guidance webpage.

Epinephrine Autoinjector Procurement

To support students with food allergies, guidelines are available on the procurement, distribution and training for the administration of epinephrine to support students with food allergies.

Ohio Law Related to Food Allergy and Epinephrine Procurement 

Schools and districts choosing to procure epinephrine autoinjectors must do one of the following:  

1. Have a licensed health professional authorized to prescribe drugs, personally furnish the epinephrine autoinjectors to the school or school district or issue a prescription for them in the name of the school or district.
2. Have the district's superintendent, chartered or non-chartered nonpublic governing authority obtain a prescriber-issued protocol that includes definitive orders for epinephrine autoinjectors and the dosages of epinephrine to be administered through them.
3. A district board or school that elects to procure epinephrine autoinjectors is encouraged to maintain, at all times, at least two epinephrine autoinjectors at each school.

A district board or school that elects to procure epinephrine autoinjectors shall require the district's superintendent or governing authority to adopt a policy governing their maintenance and use. Before adopting the policy, the superintendent or governing authority shall consult with a licensed health professional authorized to prescribe drugs and specify that assistance from an emergency medical service provider must be requested immediately after an epinephrine autoinjector is used.

A district board or school that elects to procure epinephrine autoinjectors must:

• Identify the one or more locations in each school operated by the district in which an epinephrine autoinjector must be stored.
• Specify the conditions under which an epinephrine autoinjector must be stored, replaced and disposed.
• Specify the individuals employed by or under contract with the district board, in addition to a school nurse or an athletic trainer, who may access and use an epinephrine autoinjector to provide a dosage of epinephrine to an individual in an emergency situation.
• Specify any training that employees or contractors, other than a school nurse or athletic trainer, must complete before being authorized to access and use an epinephrine autoinjector.
• Identify the emergency situations, including when an individual exhibits signs and symptoms of anaphylaxis, in which a school nurse, athletic trainer or other employees or contractors may access and use an epinephrine autoinjector.
• Specify the individuals, in addition to students, school employees or contractors, and school visitors, to whom a dosage of epinephrine may be administered through an epinephrine autoinjector in an emergency situation.

A school district board of education chartered, or non-chartered nonpublic school may accept donations of epinephrine autoinjectors from a wholesale distributor or a manufacturer and may accept donations of money from any person to purchase epinephrine autoinjectors.

Free or Reduced-Cost Epinephrine Autoinjectors: 

Ohio law requires a school or district that elects to procure epinephrine autoinjectors to report to the Department each procurement and each occurrence in which a dose of the drug is used from a school's supply.

• Public and Community schools should report in Education Management Information System (EMIS). For more information on how to report in the system, contact the district's EMIS Coordinator or see section 5.3 of EMIS manual.
• Non-Public schools should report in the Non-Public Schools Data System (NPDS). See Instructions for Reporting in NPDS for further information.

Schools

• Epipen4Schools (free) 
• Auvi-Q (reduced-cost)

Families

• EPIPEN and EPIPEN JR (savings card);
•  Many drug manufacturers have patient assistance programs;
• Asthma and Allergy Foundation of American list of drug manufacturer assistance programs;
• Compare prices at other pharmacies or check prices at:
  • GoodRx;
  • Medical Assistance Tool;
  • SCBN Prescription Advocacy;
  • Needymeds;
  • RxAssist;
  • Familywise prescription discount card.
  • RXless
  • HelpRX
  • SingleCare

Reporting Epinephrine Autoinjector Procurement and Usage 

A district board of education or a chartered or non-chartered nonpublic school or community school that elects to procure epinephrine autoinjectors must report to the department of education each procurement and occurrence in which an epinephrine autoinjector is used from a school’s supply of epinephrine autoinjectors.

•  2022 - 2023 school year- Reporting of procurement of Epinephrine Autoinjectors will be included in the year end reporting in EMIS.

Allergy Resources for Schools

The following resources can assist school staff with food allergy policy development, implementation and evaluation to support students with food-based allergies.

• Centers for Disease Control and Prevention Food Allergies in Schools Toolkit;
• Food Allergy Research and Education (FARE); 
• Food Allergy & Anaphylaxis Emergency Care Plan;
• Food Allergy 101; 
• National Association for School Nurses: Allergy Forms, Policies & Checklists; 
• Section 504, Title II and Ensuring Protection of K-12 Students with Severe Allergies; 
• US Department of Education Section 504 Protections for Students with Food Allergies 
• Ohio Department of Health Resources
  • Policy Template for: Non-Individualized Specific Epinephrine Autoinjector Policy from Ohio Association of School Nurses and the Ohio Department of Health;
  • Sample Anaphylaxis Action Plan;
  • Sample Epinephrine Autoinjector Policy;
  • Authorization for Student Possession and Use of an Epinephrine Autoinjector;
  • Epinephrine Autoinjector Administration Form and Roadmap;
  • “Epinephrine Autoinjectors in Ohio Schools: A Train-the-Trainer Course for School Nurses”- on Ohio Train course number ID 1051726.

References

1. Cleveland Clinic. Allergies: Types, Symptoms, Causes & Treatments (clevelandclinic.org) https://my.clevelandclinic.org/health/diseases/8610-allergy-overview
2. Gupta RS, Warren CM, Smith BM, Blumenstock JA, Jiang J, Davis MM, Nadeau KC. The public health impact of parent-reported childhood food allergies in the united states. Pediatrics. 2018;142(6):e20181235.
3. Boyce JA, Assa’ad A, Burks AW, et al; NIAID-Sponsored Expert Panel. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(suppl 6):S1–S58.

Last Modified: 4/25/2024 2:18:18 PM

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