New School Food Allergy Guidance Hailed as 'Clear, Actionable'

New U.S. school guidance has been unveiled to help teachers and school staff provide a safe, inclusive environment for students with food allergies.

The nonprofit FARE has released the expert guidance, called the Food Allergy Management in Schools (FAMS) report. The document includes recommendations on yearly staff food allergy training, stock epinephrine availability, preventing allergen exposures, preparing for emergencies, and communication.

FARE (Food Allergy Research & Education) collaborated on the report with other food allergy nonprofit leaders, medical professionals, school experts and disability rights experts.

“Schools are responsible for the safety of all students, including those with food allergies,” stresses FARE CEO Sung Poblete, PhD, RN. “This resource is a vital companion to the guidelines introduced more than 10 years ago.”

The resource includes 34 recommendations that enhance the Centers for Disease Control and Prevention (CDC) voluntary guidelines for managing allergies at school. Those date back to 2013.

“With about two children in every U.S. classroom on average with food allergy, this resource fills a critical need,” Poblete tells Allergic Living. The downloadable FAMS report, released on November 21, 2024, was funded by the CDC, in partnership with the American Academy of Pediatrics (AAP).

The 15-member advisory council worked together on the yearlong project with a few key goals, Poblete says. They are:

Reduce accidental exposure to food allergens.
Improve recognition and treatment of allergic reactions.
Ensure that food-allergic students can participate safely in school activities.

School Guidance: Simplifying Advice

Advisory council member attorney Amelia Smith says the FAMS school guidance provides direct, simplified advice. This includes how it addresses the disability rights of students with food allergies.

“I’m proud of the fact that we focus on not only general policy, but also on making sure individual needs are met,” she says. Smith is general counsel and vice president of civil rights advocacy for the nonprofit Food Allergy & Anaphylaxis Connection Team (FAACT).

The experts’ task also included creating user-friendly, concise and more manageable recommendations than the lengthy 2013 CDC guidelines.

Poblete hopes the new 33-page resource, which provides practical guidance in plain language, will make it more likely that schools will implement the voluntary K-12 recommendations.

“More teachers, school administrators, school nurses, teachers’ aides and others who a student may encounter would be aware of food allergy,” she says. That will mean “they are ready to meet the needs of these students.”

‘Clear, Actionable’ Recommendations

The tangible, practical advice in FAMS is something Christine Creter wishes she had when her son was younger. After her son, now almost 14, experienced anaphylaxis at school, she had to ensure his multiple food allergies would be accommodated. She took it upon herself to use resources available on FARE’s website to educate school staff.

A longtime professional learning strategist and founder of the Creter Group, Creter was the project manager for FAMS. She guided the process and offered up pertinent questions for the expert advisors.

She credits the advisory council’s commitment to “keeping kids safe and included” for the success of the new resource. The result is a “succinct, clear, actionable set of recommendations” that can help parents like her, Creter says.

School staff and parents will find the recommendations grouped under four topic areas:

Personnel training and education.
Prevention of allergy exposure.
Preparing for emergencies.
Communication and collaboration.

Each topic area includes an overview, summary and questions with specific answers that provide guidance. For example, in the training section, a question is posed: “What information should schools include in food allergy training?” Five recommendations follow, including an explainer on the types of food allergies, tips, charts, and links.

School Guidance: Staff Training

The experts recommend that all school staff receive food allergy training at least once a year. Poblete says the training forms the basis for other goals, such as reducing accidental allergen exposure, identifying reactions and improving the staff’s ability to respond to emergencies.

The FAMS report provides advice for training content, such as prevalence of food allergies, cleaning protocols, and the importance of treating anaphylaxis quickly.

The recommendations also address training based on the staff member’s role. For example, ensuring cafeteria monitors learn the strategies to prepare allergy-safe meals. As well, providing school volunteers with information on recognizing and treating allergic reactions.

Administrators and school leaders also should be trained on legal requirements for food allergy management in schools, the experts advise. Under the Rehabilitation Act of 1973 and further clarified by the Americans with Disabilities Act (ADA), the 504 plan ensures students with disabilities equal access to education in publicly funded schools. Training should cover specifics about 504 plans as they pertain to students with food allergies, state and federal laws, district policies, and USDA meal substitution policies.

FAACT’s Smith says the details about the school’s legal requirements are especially helpful. “There’s a nice breakdown of the different types of accommodation plans.”

Prevention of Allergy Exposure

The advisory council emphasizes to schools that avoidance is key in preventing accidental reactions. The FAMS report says this starts with the task of documenting which students have food allergies.

The resource also stresses the importance of each student with food allergies having an Allergy and Anaphylaxis Emergency Plan (AAEP) on file. This accompanies other standardized documents, such as a 504 plan or an individualized health plan (IHP).

The school nutrition department also carries responsibility in this area, by maintaining medical statements about a child’s dietary needs. The experts recommend publishing school menusd that include labeling for the top 9 allergens. This “allows caregivers and students to review upcoming meals and plan ahead,” FAMS states.

The report addresses encountering allergens beyond the cafeteria. “Making the environment safer includes understanding all the places where a student with food allergy might encounter their allergen both in and outside of the cafeteria,” Poblete says.

The recommendations explain where allergens can turn up. Examples are offered, such as play dough that contains wheat in arts class, or an egg drop experiment in science. Recommendations are listed to avoid such situations.

Providing a safe environment “includes improving awareness of food allergy as a disease to help reduce instances of bullying,” Poblete also notes.

While the FAMS report discourages having food in the classroom, that might not always be possible. So, there are recommendations on how to manage such situations with food allergies in mind, such as handwashing and cleaning surfaces.

Many of the recommendations to prevent allergen exposure are issues that FAACT’s Smith has discussed frequently with families. Those families have often received pushback in 504 meetings for accommodations such as published menus and handwashing.

“We specifically identify some of the accommodations that parents have fought for for years,” Smith says.

Preparing for Allergy Emergencies

FAMS school guidance stresses that it’s essential for staff to be ready to act when anaphylaxis does occur.

The report recommends all schools should have a supply of “stock” (or unassigned) epinephrine. The experts point to the 2013 School Access to Emergency Epinephrine Act that allows all schools to have unassigned epinephrine for emergency use on anyone.

The resource explains the importance of immediately treating a confirmed or suspected severe allergic reaction with epinephrine. It outlines protocols for responding to an allergic reaction, where and how to store epinephrine auto-injectors, and who should have access to them.

For example, the experts recommend that auto-injectors are stored in “an unlocked area that is not easily accessible by students.” The school should ensure that multiple staff members have access to the epinephrine, they state.

School Guidance: Communication is King

The school guidance notes that collaboration among school staff, caregivers and students on a food allergy management program is essential. They even include a chart that outlines the responsibilities of various staff members, including administrators, teachers, nutrition staff, and support staff.

Communication to all staff members about the food allergy policies and protocols are imperative, FAMS states. It recommends that food allergy accommodations documents must be made accessible to all staff, so they know each student’s needs.

In Smith’s view, if a child’s school adopts the FAMS guidance, it’s important to note that this doesn’t replace the need for an individualized 504 plan. For instance, administrators might contend a student does not need an accommodation plan because the school has adopted the 2024 recommendations. Smith says parents can additionally request that the FAMS resource be incorporated into (or attached to) their child’s 504 plan. That said, she says, “it should be remembered that each student’s needs are different.”

The recommendations contain so much meaningful information, says Creter. It’s meant to help schools, caregivers and students.

FAMS is currently available to be distributed, so schools can begin to implement the recommendations. Creter encourages people to read the entire resource so they can integrate the details into school policies.

“I hope that schools implement these guidelines and that we can reduce exposure and reactions at school,” Smith says.