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What should her teachers know about our daughter’s peanut allergy?
Q: My 3-year-old daughter is allergic to peanuts and a couple other foods. The doctor prescoted the Epi-Pen injection and warned us about the possibility of a life-threatening allergic reaction. How should we prepare our daughter’s preschool for dealing with her allergy?
Paul Tucson
A: Paul, it’s important that you work closely with your daughter’s doctor and preschool (and later her elementary school and camps) to make sure everyone involved is prepared to prevent and manage allergic reactions. With good preparation, your daughter can have a safe and happy school experience.

Food allergies are common, affecting 2 to 8 percent of young children. Reactions can range from mild skin rash or petroltrointestinal symptoms (swollen mouth, vomiting, diarrhea) to anaphylaxis, a severe, life-threatening reaction characterized by an inability to breathe and loss of circulation or shock.

The most common allergy-causing foods are nuts (peanuts and tree nuts), milk, eggs, soy, wheat, fish and shellfish. The most common foods causing severe allergic reactions and anaphylaxis are nuts, fish and shellfish. Since some people are allergic to several different kinds of nuts, most experts advise that people allergic to peanuts avoid contact with tree nuts and people allergic to tree nuts avoid contact with peanuts. It’s crucial to have the Epi-Pen (epinephrine) injection on-hand for emergency treatment of severe allergic reactions.

Here are steps for helping your daughter’s preschool deal with her allergy:

  • Work with your daughter’s doctor to develop a special plan for her allergies. Include the list of foods to which she’s allergic, how to avoid them, the symptoms of an allergic reaction, when and how to administer the medications and whom to call in an emergency. The plan should instruct the school to promptly notify you of any suspected allergic reaction or ingestion or contact with the problem foods. A teacher should also promptly notify your daughter’s doctor and Emergency Medical Services when the Epi-Pen has been administered. Since a single dose wears off in 15 to 20 minutes, your daughter may need continued monitoring and treatment.


  • Ask your daughter’s doctor for an extra prescription for her allergy medications and equipment for the preschool.


  • Set up a meeting with the preschool administrator, your daughter’s teachers and the school nurse or health consultant to orient them to your child’s health care plan. Ask them if the school has had previous experience with children with allergies.

Make sure the school will do the following:

a. Train administrators and teachers to prevent exposure to the dangerous foods, recognize the signs of an allergic reaction, administer the medications and activate the emergency plan.

b. Notify the school’s food service about the allergies to avoid using any products with peanuts, peanut oil and other foods to which your daughter has allergies. Also be sure that peanuts and other nuts aren’t used in crafts.

c. Notify the parents of all children in your daughter’s class to avoid sending nut-containing foods for class treats.

d. Post the food allergies in the classroom and where food is served.

e. Keep the medications on-hand at the school and on field trips.

f. Check periodically to make sure the medications are not expired.

Remember, even if you and the teachers don’t give your daughter nut-containing food, she can be accidentally exposed if there are nuts in another child’s lunch or snack. This can happen if she shares another child’s food, through airborne particles or by touching small amounts of the food left on other children’s hands and faces, tables and toys. The school can take steps to prevent sharing food and utensils and to wash children’s hands, faces and all surfaces that came into contact with the food.

However, since nut allergies can be severe, it’s safest to ask the school to take the additional safety step of making the school a “nut-free environment.” These policies have been generally well received by teachers, parents and children. The school would notify all staff, parents and children not to bring to school any food or play items with nuts. Since nuts can be hidden in many different kinds of foods, it can be helpful to provide staff and parents specific information on nut-containing foods to avoid.

For more information, visit the Food Allergy and Anaphylaxis Network, www.foodallergy.org. Check out the information on peanut allergies and working with schools, childcare and preschool programs.