Allergy and Anaphylaxis Management in Schools

Steps for schools

• Identify students with life-threatening allergies through a review of health history and/or medication forms, and collect additional needed information  
  • Food Allergies and Anaphylaxis, National Association of School Nurses 
    Includes a food allergy health history form 

• Flag students with life-threatening allergies within the health section of the school’s records or identify another method to easily track students (eg, spreadsheet, registry) 
• Notify teachers and other appropriate school personnel of students with life-threatening allergies and provide training on how to recognize and respond to allergic reactions and signs of anaphylaxis (for resources, see education/training section) 
• Record and monitor key data for students with allergies, such as completion of needed forms and medication administration 
• When storing records and communicating regarding student health conditions, follow confidentiality guidelines 
  • HIPAA and FERPA, National Association of School Nurses  (login required) 
    NASN resources on HIPAA and FERPA, including a webinar and 2 radio broadcasts 
  • Data Privacy in School Nursing: Part 1 and Part 2, The Network for Public Health Law 
    Overview of HIPAA and FERPA with FAQs from school nurses 
  • Data Sharing Guidance for School Nurses, The Network for Public Health Law 
    Overview of laws with questions and examples for setting up data sharing agreements 
  • Joint Guidance on the Application of the Family Educational Rights and Privacy Act and the Health Insurance Portability and Accountability Act of 1996 to Student Health Records, US Dept. of Health and Human Services and US Department of Education 
    Guidance with FAQs to clarify implementation of HIPAA and FERPA in relation to school health services 

How primary care providers can help

• Explain to families the importance of informing the school about the child’s allergies, turning in all school health forms, and providing the school with medications 
• Maintain blank paper and electronic versions of school district health forms for families to complete 
• Assist families that may need help with completing health forms and fax them directly to the school nurse/school health office 
• Ask families to sign a consent form to allow communication with the school about the child’s allergies 
  
  • Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education 
    Consent form for schools and providers to share information 

• Notify the school of patients whose allergies are severe or require special monitoring

Steps for schools

• Ensure that students with life-threatening allergies have a current emergency plan on file. Start with students at highest risk for anaphylaxis 
  
  • Guidance on Completing a Written Allergy and Anaphylaxis Emergency Plan, American Academy of Pediatrics 
    Guidance and sample emergency plan 
  • School Nursing and Health- Health Conditions, Colorado Department of Education 
    Includes emergency plan form 
  • Guidelines for Managing Life-threatening Food Allergies in Connecticut Schools, Connecticut State Department of Education 
    Guidebook with emergency plan template 

• As needed, develop an Individualized Healthcare Plan (IHP) for students with allergies 
  • Food Allergies and Anaphylaxis, National Association of School Nurses 
    Includes a checklist for developing student healthcare plans and sample plan 

• When developing emergency plans, IHPs and/or IEP/504 plans, consider school-sponsored activities, field trips, before- and after-school care, and times when a school nurse is not present 
  • Food Allergy Management and Education, Children's Hospital St Louis 
    Includes field trip risk assessment form for schools 
  • Field Trips: Guidance for School Nurses, Connecticut State Department of Education 
    Information on considerations related to field trips for students with special health care needs 

• Periodically evaluate students’ plans to ensure they contain current information (eg, medications, contact information) and that their needs are being met 

How primary care providers can help

• Provide patients with risk of anaphylaxis with an emergency plan for use at school. If possible, send the plan directly to the school nurse/school health office in addition to giving a copy to the family. If the school does not use a specific template, the AAP offers one 
• Include your office contact information on the emergency plan 
• Respond promptly to questions from the school regarding the emergency plan and provide any information needed for the development of an IHP or other management plans 
• Keep in mind that not all schools have a school nurse present at all times. Ensure that the emergency plan and any other orders are written in a way that can be understood by trained school staff 

Steps for schools

• Maintain written emergency protocols with clear communication procedures and responsibilities  
  • Recognize and Respond to Anaphylaxis, Food Allergy Research and Education 
    Protocol for recognizing and responding to anaphylaxis 
  • Code Ana, The Teal Schoolhouse 
    Online program to prepare schools to respond to medical emergencies 

• Train all staff on how to recognize and respond to signs of anaphylaxis ​(see educate/train staff), including in students with no prior history 
  • Allergy and Anaphylaxis: A Practical Guide for Schools and Families, Allergy and Asthma Network 
    Guidebook with school safety guidance including tabletop drills 

• Assure immediate access to epinephrine, including during field trips and school-sponsored activities (see Manage medications) 
• Plan for access to epinephrine during lockdowns, evacuations, and other disaster procedures 
• Consider maintaining stock epinephrine if allowed within your state 
  • Epinephrine in Schools, Asthma and Allergy Foundation of America 
    Map that shows which states allow stock epinephrine and which require it 

How primary care providers can help

• Assist patients with obtaining epinephrine to keep at school 
• Volunteer to review school emergency protocols 
• Assist schools in training staff on recognizing and responding to anaphylaxis 
• Secure caregiver permission to communicate with the school to facilitate communication during urgent situations  
  
  • Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education 
    Consent form for schools and providers to share information 

• Work with the state or local school health services program lead to provide standing orders and other assistance to schools in maintaining stock epinephrine (if needed within your community) 

Steps for schools

• Develop and maintain written policies and protocols for anaphylactic reactions within your district. Policies and protocols provide guidance for staff and communicate expectations for all stakeholders 
  • School Nursing and Health- Health Conditions, Colorado Department of Education 
    Includes sample board policy 
  • Guidelines for Managing Life-threatening Food Allergies in Connecticut Schools, Connecticut State Department of Education 
    Guidebook with protocols to prevent exposure to allergens and steps for developing district policies 
  • Food Allergies and Anaphylaxis, National Association of School Nurses 
    Includes a checklist for developing policies and protocols and a sample policy 
  • Anaphylaxis, Wisconsin Department of Public Instruction 
    Includes sample policy and procedure 

• Ensure that policies and protocols adhere to national and state laws and regulations, including state nurse practice acts 
  • Epinephrine in Schools, Asthma and Allergy Foundation of America 
    Map that shows which states allow stock epinephrine and which require it 

• Policies and protocols should address:
  • Routine and emergency management
  • Medication administration and nursing delegation or administrative assignment, including provisions for self-carry and self-administration, standing orders, and stock medications
  • Procedures for field trips, the bus, and before- and after-school activities
  • Documentation 
  • Procedures for errors
  • Use of written care plans
  • Maintenance of a safe environment 

How primary care providers can help

• Educate school leadership about the importance of written policies and protocols 
• Volunteer to help develop or review district policies and procedures to ensure that they are comprehensive, aligned with best practice, and practical given available staffing and resources (see examples above) 

Steps for schools

• Support self-carry of epinephrine auto-injectors for students who are able to self-administer 
  • School Nursing and Health- Health Conditions, Colorado Department of Education 
    Includes self-carry contract 

• Ensure that epinephrine is stored in secure yet easily accessible locations during the school day, during school-sponsored activities, and during field trips 
• Work with families, providers, and insurers to obtain epinephrine for school use 
  • What to Do If You Can’t Afford Epinephrine Auto-Injectors, Kids with Food Allergies 
    Options for reducing the cost of auto-injectors 

• Maintain documentation of medications stored, medications administered, medication errors, and medication authorizations 
  • School Nursing and Health- Health Conditions, Colorado Department of Education 
    Includes epinephrine reporting form 
  • Sample Policies and Forms, Mass.gov 
    Sample medication orders, authorizations, logs, and policies 

How primary care providers can help 

• Assess patient readiness to self-carry and provide recommendation to the school 
• Provide ongoing self-management education to patients 
• Respond to questions from the school regarding medications 
• Assist families in securing epinephrine to keep at school 
  • What to Do If You Can’t Afford Epinephrine Auto-Injectors, Kids with Food Allergies 
    Options for reducing the cost of auto-injectors 

• Advocate for insurers to cover extra epinephrine for at school 

Steps for schools

Staff

• Define staff roles. At a minimum, all staff should receive basic information about anaphylaxis and how to identify and respond to emergencies 
• Identify training needs for nurses, Unlicensed Assistive Personnel, food service workers, and other staff through knowledge and skills assessments 
• Provide regular training and assessment on relevant skills and information, keeping in mind the prior knowledge and health literacy level of the audience 
  • School Staff Training Module, AllergyHome.org 
    Online, evidence-based module and handouts to train school staff on allergies and anaphylaxis. Aligned with CDC Voluntary Guidelines 
  • School Staff Module, Allergy Safe Kids 
    Colorado school staff training 
  • Epinephrine Administration Training Program, Connecticut Department of Education 
    Training for unlicensed personnel on epinephrine administration with accompanying trainer guide 
  • Guidelines for Managing Life-threatening Food Allergies in Connecticut Schools, Connecticut State Department of Education 
    Guidebook with information on training school staff 
  • Keeping Students Safe and Included, Food Allergy Research and Education 
    Online course for educators on preventing and managing anaphylaxis. 
  • Get Trained- Epinephrine Administration, National Association of School Nurses 
    Program for school nurses to use in training unlicensed personnel to administer epinephrine auto-injectors. 
  • A Shot to Live, University of Utah School of Medicine  
    Training for unlicensed personnel on epinephrine administration 
  • Medication Training, Wisconsin Department of Public Instruction 
    Training videos, tests, and skills check-off on epinephrine administration 

Students

• Provide coaching and education when interacting with students in order to support increased independence in self-management  
  • Food Allergy Management and Education, Children's Hospital St Louis 
    Includes educational materials for students 

Families

• Provide educational resources for families 
  • Planning for School with Food Allergies, Allergy and Asthma Network 
    Provides information for families on preparing for and managing food allergies at school
  • Food Allergy Management and Education, Children's Hospital St Louis
    Includes educational materials for families 
  • Children with Food Allergies, Food Allergy Research and Education 
    Includes information for families 

How primary care providers can help

• Volunteer to assist with developing, reviewing, or delivering trainings (see resources above) 
• Recommend or provide patient education materials 
• Communicate with school nurses about children and families that may need additional education, such as newly diagnosed patients 
• Advocate for adequate numbers of licensed school nurses in schools 

Steps for schools

• Assist families without a primary care provider and/or insurance with accessing health care 
  • Does Your Child Have Health Insurance? AASA 
    Toolkit to assist schools in identifying uninsured children and connecting them to coverage 
  • Health Insurance for Children: How Schools Can Help, CDC 
    Guidance for schools on connecting students with health insurance 

• Obtain consent from caregivers to communicate with students’ primary care providers (consider including in annual consent form) 
  • Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education 
    Consent form for schools and providers to share information 

• Notify caregivers (and primary care provider, if appropriate) of allergic reactions at school 
• Communicate with students’ providers and caregivers regarding any concerns 
• Identify local resources that can support students with allergies 
  • Parents for Healthy Schools, CDC 
    Collection of resources, including guidebook, presentation, e-learning module, and idea sheets for engaging parents in school health, including chronic condition management 
  • Partner Build Grow, The Center for Health and Health Care in Schools 
    Action Guide for sustaining school-based approaches to support cognitive, social, emotional, and physical health 
  • Food Allergies and Anaphylaxis, National Association of School Nurses 
    Includes checklist for fostering stakeholder collaboration 
  • Partnership Building to Support Students Managing Chronic Health Conditions, National Association of School Nurses 
    Webinar on how to create, strengthen, and sustain partnerships to support students with chronic health conditions to be safe, healthy and ready to learn 

• Consider partnering with a local hospital, public health department, nursing school, or community provider to provide education to staff, families, and/or students 

How primary care providers can help

• Obtain consent from caregivers to communicate with the school 
  
  • Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education
    Consent form for schools and providers to share information 

• Recommend community resources and partners that can support students with life-threatening allergies 
• Consider serving as a consultant to the school district or participating on a school health or wellness committee 

Steps for schools 

• Ensure adequate school nurse staffing 
  • Role of the School Nurse in Providing School Health Services, American Academy of Pediatrics  
    Policy statement outlining the importance of a school nurse in every school 
  • School Nurse Workload: Staffing for Safe Care, National Association of School Nurses 
    Position statement on appropriate school nurse staffing 

• Assure quick access to epinephrine​ (see manage medications and plan for emergencies) 
• Implement needed accommodations​ as outlined in IEP and/or 504 plans 
• Manage potential triggers in the school environment​ and minimize risk of exposure 
  
  • Keeping Students with Food Allergies Safe at School, Asthma and Allergy Foundation of America 
    Includes information on allergens in crafts and activities 
  • Guidelines for Managing Life-threatening Food Allergies in Connecticut Schools, Connecticut State Department of Education 
    Guidebook with protocols to prevent exposure to allergens 

• Create a positive social climate that fosters acceptance, inclusion, and full participation for all students 
  • Keeping Students with Food Allergies Safe at School, Asthma and Allergy Foundation of America 
    Includes information on bullying 

How primary care providers can help

• Educate school leadership on the importance of policies to protect students from allergy triggers 
• Work with families and schools to support full participation by students with food allergies 
• Advocate for adequate school nurse staffing