Writing about food allergies from a pediatric allergist's perspective

Anaphylaxis: What School Staff Need to Know

Anaphylaxis: What School Staff Need to Know

Written by Michael Pistiner MD, MMSc, Reviewed by Anne Sheetz MPH, BSN, RN, CNAA, Adapted from Food Allergies & Anaphylaxis in School: What School Staff Need to Know

The below is intended to serve as a guide to assist in, not replace, training provided by the school nurse or designee. Although written for a target audience of school staff this post can give parents, school nurses, administration and others an outline of things to consider when preparing for anaphylaxis in our schools. As laws and policies vary state by state and district by district, discuss your locale’s regulations with your school nurse or principal. 

Anaphylaxis is like water damage. The longer it lasts, the harder it is to fix.

Anaphylaxis is like water damage. The longer it lasts, the harder it is to fix.

Anaphylaxis is a severe, life threatening, allergic reaction.  Children with food allergies and other allergic disorders, like latex and insect sting allergy, are at risk for this allergic emergency. Anaphylaxis occurs in schools, and first time allergic reactions and anaphylaxis can also occur. Anaphylaxis, a reaction that can involve more than one organ system, like skin, lungs, heart, gastrointestinal, and brain may start off mild in severity and quickly evolve into a more severe reaction that can be more difficult to treat.  Children can experience allergic reactions in very different ways, and each child can have different reactions from ones that they had in the past.  Keep in mind that anaphylaxis can start with mild symptoms but progress quickly.  Delays in treatment with epinephrine increase the risk of dying from these reactions. Epinephrine, a quick acting and safe medicine, is the first line, treatment of choice for anaphylaxis and given using an auto-injector. Policies and procedures should be developed to ensure that allergic emergencies are quickly recognized and appropriately treated. Like water damage, the longer anaphylaxis goes on for, the harder it is to fix the damage done.  Anaphylaxis or food allergy emergency care plans are tools created by a healthcare provider for the specific student and it is important to refer to this plan during a reaction. Talk to your school nurse and/or administration to learn more about anaphylaxis and learn your role in your schools emergency protocol.

Are you prepared to R.E.Act?


  • All staff should get to know the symptoms of allergic reactions and anaphylaxis.
    anaphylaxis symptoms

    Click on image to enlarge

  • Know your role in your school’s anaphylaxis/allergy emergency protocol and respond quickly.
  • For suspected allergic reactions or anaphylaxis, immediately contact your school nurse if available, and follow your school’s emergency response plan.  If the school nurse is not available—someone must call 911 immediately.
  • Have quick access to the Food Allergy/Anaphylaxis Emergency Care Plans for students that you are responsible for  and understand which signs and symptoms will require epinephrine


  • got epinephrine HROnce anaphylaxis is recognized, the next step is for the life saving epinephrine to be administered. Epinephrine is the treatment of choice for anaphylaxis.  Rapidly getting the school nurse or school doctor and contacting emergency services (911) are critical.
  • For those with a known allergy and an auto-injector, in some states, a trained non-licensed staff member can administer an epinephrine auto-injector in the event that a nurse or physician is unavailable. Please discuss your state’s regulations with your school nurse or principal. If the affected person has a known allergy—administer epinephrine as per training and school policy and confirm that 911 was called.
  • For those with an unknown allergy—confirm that 911 was called and continue to attempt to contact the school nurse. In some states, stock auto-injector laws allow for trained unlicensed personnel to administer epinephrine auto-injectors to those with unknown allergy history.  Please discuss your state’s regulations with your school nurse or principal.
  • Anaphylaxis may require a second dose; therefore, students should have two auto-injectors available.
  • Keep epinephrine in a well-defined, accessible but secure location, avoiding temperature extremes.
  • Staff should be trained and have periodic refreshers to administer the specific student’s auto-injector. Please discuss your state’s regulations with your school nurse or principal.  Make sure you are comfortable with using the auto-injector that is specific to the student or students for whom you are responsible.
  • Remember that antihistamines are second-line treatment and do not prevent or stop anaphylaxis. Do not allow antihistamines to delay giving epinephrine. 


  • Call the school nurse if available and 911 or local emergency medical services.  The caller should state that a child is having anaphylaxis and request a licensed responder that has epinephrine available. 
  • Anyone experiencing anaphylaxis should be taken to the emergency department via ambulance.  Also, epinephrine is short-acting.  Further evaluation and management in the emergency department is essential.   This is important because the child may need additional care and can also experience a second phase of their reaction called the biphasic response. 
  • After epinephrine is administered( if appropriate) and after 911 is called, then contact emergency contacts as per the Emergency Allergy Action Plan. 
  • While awaiting EMS and after giving epinephrine, do not have the child or adult rise to an upright position.  Laying on the back with legs elevated is ideal but alternative positioning is needed if vomiting or breathing difficulty (discuss with your school nurse). There have been cases of deaths that have been associated with rising to an upright position. The student should be observed for at least 4-6 hours in the emergency department.

This supplemental material compliments the staff education module, Food Allergies and Anaphylaxis in School: What School Staff Need to Know, found at Schools.AllergyHome.org (recently updated to be consistent with the CDC’s Voluntary Guidelines on Managing Food Allergies in Schools and Early Care and Education Programs).

(Please note that this is for educational purposes only. The information provided is not intended to be a replacement or substitute for professional medical advice. Any information that you have received from AllergyHome.org should be verified with your/the licensed health care provider and/or the school nurse).


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