Food allergy is a major national concern. As children spend much of their time in school, allergic reactions will inevitably occur. Nowak and colleagues conducted a phone survey collecting information from the families of 132 food allergic children followed in an allergy clinic and found that almost 1 in 5 experienced a reaction at school over a 2 year period, and that approximately 1 in 3 of these reactions involved more than one organ system.

Food allergy management in schools must be aimed at avoiding exposure to allergens and preparing for managing allergic emergencies. (This also applies to other potentially life threatening allergies). Avoidance and preparedness strategies need to be employed in a fashion that accounts for multiple settings (class room, cafeteria, playground, etc.) and multiple care providers (school nurse, teacher, cafeteria monitor, coach, etc) necessitating well thought out and worked through guidelines. Massachusetts has such a set that has been in use since 2002. Coupled with these guidelines is a mandated policy of reporting to the Massachusetts Department of Public Health details concerning the administration of epinephrine in schools. This provides information used to strengthen avoidance and preparedness planning. Massachusetts’ experience provides insights and a powerful set of guidelines that can be employed nationally and can increase the safety and quality of life for millions of children.