children eating lunch at a cafeteria table

Most parents send their children off to begin a new school year with excitement. But parents of children with severe food allergies often have real fear. They often wonder: Will their children accidentally eat the food they’re allergic to?

Food allergies are a growing public health concern that affect about 4-8% of America’s children, according to the Centers for Disease Control and Prevention (CDC). While there is no cure for food allergies, early recognition and education is important to keep your child safe. There are some treatments for some food allergies, including an FDA-approved treatment for peanut allergies called palforzia.

As a parent of a child with food allergies, make sure you do your research and know the symptoms to watch for. It's also important to talk to your child and your child's teacher about their allergies. Being a strong advocate and educator for your child's health can help keep them safe from serious health problems.

What are the most common food allergies?

Infants and young children are most commonly allergic to cow's milk, eggs, soy, peanuts and wheat. Most of these reactions involve skin rashes (hives) or gastrointestinal (GI) symptoms. However, reactions can be more serious. Children often outgrow these food allergies by age 3.

However, allergies to peanuts, tree nuts, fish or crustaceans (shrimp and crab) are often more severe and can last through adulthood.

About 1% of Americans have peanut or tree nut allergies. In addition to peanuts, the most common nut allergies are walnuts, pecans, cashews and Brazil nuts. For some, allergic reactions are life-threatening and can be caused by more than one nut.

Read more about food allergies in children: Pediatric guidelines, diagnosis and more (from UC Davis Health)

What are some common food allergy symptoms?

Allergic reactions often occur at school. It might be in the cafeteria, during class celebrations, or while doing crafts, such as those using peanut butter or walnut shells.

An allergic reaction typically happens within minutes. But sometimes, a reaction can take up to two hours after exposure. That's why it's important for parents to meet with their child's teacher and school principal to discuss food allergies.

Less severe symptoms

Symptoms may be mild, with just an itching sensation in the mouth. Hives may appear on the skin. Gastrointestinal (GI) symptoms can be common, including vomiting, cramping or diarrhea.

Severe and life-threatening symptoms

More severe symptoms may involve swelling of the tongue, soft tissue of the mouth, upper airway and constriction of the airways, leading to wheezing and shortness of breath. If not treated quickly enough, this can lead to serious health problems or death within minutes.

The most severe reaction is a potentially life-threatening condition called anaphylaxis. This can cause:

  • breathing problems listed above
  • blood pressure to drop
  • gastrointestinal (GI) symptoms of vomiting and diarrhea
  • flushing
  • decreased responsiveness

These symptoms of anaphylaxis can quickly lead to loss of consciousness and death. If you see a child suffering these symptoms, you should administer an epinephrine pen (EpiPen) immediately. (Note: There are other brands besides EpiPen, including generic versions of the medication.)

Listen to UC Davis Health's Kids Considered podcast with two pediatricians as they discuss food allergies in children

Tips to prevent food allergy reactions at school

1. Provide information about your child's food allergy

Prepare a complete list of foods your child is allergic to and give it to your child's school administration and teacher. Include the possible symptoms of a reaction and medications.

Make sure your child's teacher can recognize an allergic reaction. Develop a written plan with your child's physician in case there's an emergency. This information should be shared with school staff and cafeteria workers.

2. Help reduce food allergens in the classroom

Parents can institute an "only-from-home" policy, in which the child knows to eat only food from their home. You can also provide teachers safe snacks to have on hand when other children get a special treat.

Nuts and seeds are often hidden ingredients in cupcakes or cookies that come from stores or other people's homes. Even if nuts are not mentioned on a label, ingredients may be processed on machinery that previously handled nuts, leaving residues that can cause a reaction.

3. Make sure your child's teacher and school staff know how to use an EpiPen

Children with a history of a severe reaction should wear a medical alert bracelet and have at least one epinephrine pen (known as an EpiPen) at school. If possible, it's preferred that the school has a two-pack of EpiPens in case the first one doesn't work or your child has a second reaction (biphasic reaction).

Your child, their teacher and school staff should be taught how to use it. The dose of EpiPen changes with your child's weight (there are three doses for children). Make sure to check in yearly with your child's pediatrician or allergist to ensure their dose is accurate.

The EpiPen should be administered at the start of an allergic reaction. If you're going to administer an EpiPen, someone should also call 911. Many people mistakenly wait and see if severe symptoms develop before acting. Such delays have had tragic outcomes. Even if the child seems to recover, symptoms can come back. The child should be under observation for several hours in an emergency room if they have a severe allergic reaction.

Get step-by-step instructions on how to use an EpiPen

Watch this video from FARE (Food Allergy Research & Education) on how to use an EpiPen

4. Teach your child how to manage their food allergy

It's important for parents to educate their child about their food allergies. Teach your child to recognize what is safe to eat. Practice ways to be assertive in discussing their problem, refusing foods they shouldn't eat and asking for help if they feel an allergic reaction coming on.

They should also get used to bringing the EpiPen with them anywhere they go. Help your child at an early age to develop lifelong skills to cope confidently with this potentially life-threatening condition.

Resources on food allergies in children