An allergic reaction is individualized in each child, although each reaction becomes more severe than the previous one. Symptoms may include:

• Hives
• Itching
• Change of color
• Irritated eyes
• Runny nose
• Vomiting, diarrhea
• Tightening of the throat
• Difficulty swallowing
• Sense of doom
• Dizziness, fainting
• Swelling

Loss of consciousness

An elementary school student has a few hives on her face, a runny nose, and appears to be having trouble swallowing. She reports that her mouth "feels hot" and the teacher hears a slight whistling sound when she breathes. This child has an identified peanut allergy, and the teacher has seconds to react to this progressively grave situation. Successful management of severe peanut or food allergies can mean the difference between life and death.

Approximately 3 percent of U.S. children have true immunological food allergies according to the National Institute of Allergy and Infectious Diseases. In an elementary school of 500 students, that equates to a possibility of 15 children with a food allergy, which sometimes can be life-threatening.

Exposure to peanuts can include touching or consuming peanuts, a peanut product, or an item that has come in contact with peanut products or oils. In some extreme cases the smell of peanuts can cause a reaction. Even food preparation items that have been in contact with food containing peanuts or peanut oils can cause a reaction, as can washed surfaces, which harbor peanut oil for long periods of time.

Managing a peanut allergy in an elementary school
Training school staff, at its optimal, can prevent a student with a peanut allergy from being exposed to allergens. A biannual group training session should include the child's classroom teacher, special area teachers, bus drivers, cafeteria workers, and other staff that are responsible for the student. Parents should be partners in the training process whenever possible. Training ought to include

An overview of peanut allergies

The student's history of reactions to peanut exposure

An outline of the student's emergency plan, including:
— Emergency phone numbers
— Specific instructions for staff to follow
— Location of emergency medications
— How-tos for identifying foods that may contain peanuts or peanut products
— Practice of the emergency response plan
A letter should be sent home to the parents in the child's classroom informing them of the presence of a peanut allergy in the class; the letter should preserve the anonymity of the student. Because classroom parties and field trips can be potentially dangerous for students with allergies, parents should send along appropriate treats.

Accommodations in the school cafeteria might include a "peanut-free table," far from trash receptacles, where the student with peanut allergies and students with peanut-free lunches may sit. The table should be washed with a cloth separate from cloths and solutions that have washed other tables. Children with allergies who participate in the free- or reduced-price lunch program must be given the necessary food substitutions.

What to do if a student has an allergic reaction
Identify the individuals who will respond to the emergency and discuss in advance each person's role. For example, the school nurse acts as the emergency coordinator, and administers medications and basic life support (CPR) to the student if necessary. The school administrator summons an ambulance if appropriate, provides support to the classroom teacher and students, and clears the area where care is being administered. The school secretary provides information to parents as to where to meet the child (school or hospital), makes the call to an ambulance service if requested, and meets and directs emergency medical personnel to the emergency location. If the parents are to meet the child at the school, the school secretary can arrange for someone to meet them at the door and bring them to the child. The guidance counselor offers support to the classroom teacher, comforts the students in the affected classroom, and answers student questions in a broad-based confidential manner. Careful planning and communication between student, parents, and school staff can provide a safe school environment for a student with a peanut or nut allergy. Development of a proactive management plan may even save a life should a student experience a severe allergic reaction.

Mark F. Miele, Ed.D., and Sally Zentner Schoessler, RN, have developed a training program for peanut allergy management that's being used statewide in New York.