Author name: allergy.ringwala@gmail.com

Sending a child with food allergies to school can feel like navigating a minefield. While you’ve carefully controlled their environment at home, school introduces countless variables beyond your direct control—shared cafeteria tables, classroom birthday celebrations, science experiments using food, art projects with potential allergens, and the well-meaning but sometimes uninformed actions of teachers, staff, and other students. For Wisconsin parents, understanding how to effectively manage food allergies within the school environment isn’t just about peace of mind—it’s about keeping children safe while allowing them to fully participate in educational and social experiences. Wisconsin schools vary widely in their allergy awareness and management practices. Some districts have comprehensive protocols and trained staff, while others are just beginning to understand the seriousness of food allergies. According to FARE, more than 500,000 Wisconsinites — including nearly 95,000 children — live with food allergies. Regardless of your school’s current practices, proactive parent involvement makes a critical difference in creating a safe environment for your food-allergic child. If you’re unsure where to begin, our team at Wisconsin Food Allergy can help you build a school safety plan. The Importance of School Allergy Planning Comprehensive planning before the school year begins lays the foundation for a safe and successful year. Without proper preparation, even well-intentioned schools may inadvertently create unsafe situations for allergic students. Understanding risk zones Schools contain multiple high-risk areas where allergic children face potential exposure. Identifying these zones helps focus prevention efforts where they matter most. The cafeteria presents perhaps the most obvious risk. Children eat together at shared tables, food is traded and shared despite rules against it, and cross-contamination can occur through shared serving utensils, residue on tables, or food spills. In Wisconsin schools where hot lunch programs serve milk with most meals and peanut butter is a protein staple, these risks are particularly relevant for children with dairy or peanut allergies. Classrooms also pose significant risks, sometimes in unexpected ways. Snack times, birthday and holiday celebrations, cooking activities, and classroom rewards often involve food. Art supplies may contain milk proteins or wheat paste. Science experiments might use eggs or other allergens. Even math lessons occasionally incorporate food for counting or measuring activities. Buses present unique challenges. The enclosed space, limited supervision, and social dynamics among students create environments where food sharing and bullying around allergies can occur. Food residue on seats from previous passengers can cause reactions in highly sensitive children. Wisconsin’s long bus routes in rural areas mean extended exposure times without immediate access to medical care. Playgrounds and gymnasiums where children engage in physical activity after eating pose particular danger. Exercise can trigger or worsen allergic reactions in children who have recently consumed allergens, a phenomenon called food-dependent exercise-induced anaphylaxis. Recess immediately following lunch requires special attention in allergy management plans. Field trips and special events — from visits to local farms and factories to overnight camping trips — take children into less controlled environments where allergen exposure risk increases. These situations require advance planning, clear communication with chaperones, and sometimes difficult decisions about whether participation is safe. School sporting events, music performances, and after-school activities often involve food — team snacks, concession stands, cast parties, fundraisers. These less formal school activities sometimes receive less attention in allergy planning despite presenting real risks. Understanding these risk zones allows parents and schools to develop targeted strategies for each setting, rather than attempting generic approaches that may miss situation-specific hazards. Our downloadable school safety checklist can help you map and address each of these zones Legal protections Wisconsin parents should understand the legal framework protecting children with food allergies in schools. These protections ensure children receive necessary accommodations without discrimination. Section 504 of the Rehabilitation Act and the Americans with Disabilities Act (ADA) provide federal protections for students with disabilities, which can include life-threatening food allergies. Under these laws, schools receiving federal funding must provide reasonable accommodations that allow allergic students to access education safely and equally. FARE’s Know Your Rights resources provide a comprehensive breakdown of these protections for food-allergic students. For students with food allergies, 504 Plans document specific accommodations the school will provide. These individualized plans might include allergen-free seating in the cafeteria, permission to carry epinephrine auto-injectors at all times, modified food-related classroom activities, and staff training on allergy management. The 504 Plan is a legally binding document that schools must follow. Some students with food allergies may qualify for Individualized Education Programs (IEPs) if their allergies affect educational performance or if they have other conditions requiring special education services. IEPs are more comprehensive than 504 Plans but are reserved for students meeting specific criteria under the Individuals with Disabilities Education Act (IDEA). Wisconsin state law also addresses food allergies in schools. State statutes require school districts to adopt policies for managing students with life-threatening allergies, including procedures for preventing exposure, responding to allergic reactions, and training staff. However, implementation and comprehensiveness of these policies vary by district. The state has stock epinephrine legislation — Wisconsin Statute § 118.2925 — allowing schools to maintain emergency epinephrine for use when a student experiences anaphylaxis but doesn’t have their own auto-injector available, or when someone without a known allergy has a first-time severe reaction. This law has since been updated and expanded under “Dillon’s Law,” which now allows Wisconsin schools to stock all FDA-approved forms of epinephrine delivery, including future nasal spray and sublingual options, providing crucial backup protection. Parents should familiarize themselves with both federal protections and Wisconsin-specific laws. When schools resist implementing necessary accommodations, understanding legal rights helps parents advocate effectively. However, collaborative partnership with schools usually produces better outcomes than adversarial approaches, and most Wisconsin schools genuinely want to keep students safe once they understand the risks and necessary precautions. Speaking with a board-certified allergist like Dr. Ringwala can help you gather the medical documentation schools need to implement proper accommodations. Preparing an Effective Allergy Action Plan A comprehensive, written allergy action plan serves as the roadmap for school staff responding to allergic reactions.

Anaphylaxis is a medical emergency that strikes fear into the hearts of families managing food allergies. This severe, potentially life-threatening allergic reaction can progress rapidly from initial symptoms to respiratory distress, cardiovascular collapse, and—without prompt treatment—death. For Wisconsin families living with food allergies, understanding anaphylaxis isn’t optional—it’s essential knowledge that could save a life. The statistics are sobering: food allergies are the leading cause of anaphylaxis treated in emergency departments, accounting for approximately 40% of anaphylactic reactions in the United States. Each year, roughly 200,000 Americans require emergency medical care for allergic reactions to food. While fatalities from food-induced anaphylaxis are relatively rare—estimated at 150-200 deaths annually nationwide—each death represents a preventable tragedy, often occurring when epinephrine wasn’t administered quickly enough or at all. Wisconsin families dealing with severe food allergies face unique challenges. The state’s strong food culture, from Friday fish fries to cheese curds at festivals, creates numerous social situations where food is central. Rural areas may be far from emergency medical facilities, making rapid recognition and treatment of anaphylaxis even more critical. Understanding what anaphylaxis is, recognizing its symptoms, knowing how to respond, and implementing long-term prevention strategies empowers families to manage this serious condition while maintaining quality of life. This comprehensive guide provides Wisconsin families with the knowledge needed to recognize, treat, and prevent anaphylaxis, ensuring they’re prepared for emergencies while understanding how to minimize risks in daily life. What Causes Anaphylaxis Anaphylaxis occurs when the immune system overreacts dramatically to a substance it perceives as dangerous, even though that substance is actually harmless to most people. Understanding what triggers these severe reactions helps families identify and avoid risk factors. Food triggers Among children, eight foods account for approximately 90% of food-induced allergic reactions, including anaphylaxis: milk, eggs, peanuts, tree nuts, soy, wheat, fish, and crustacean shellfish. Sesame was added to this list as the ninth major allergen in 2023, reflecting its increasing recognition as a significant trigger. However, not all of these allergens pose equal anaphylaxis risk. Peanuts, tree nuts, fish, and shellfish are most commonly associated with severe, life-threatening reactions. These allergens tend to cause more intense immune responses and are less likely to be outgrown compared to milk or egg allergies, which many children eventually tolerate as their immune systems mature. Peanut allergy affects approximately 1-2% of children in the United States and is the leading cause of fatal and near-fatal food-induced anaphylaxis. What makes peanut allergy particularly dangerous is the severe reactions that can occur from even trace exposures. Someone with severe peanut allergy might experience anaphylaxis from residue on shared equipment, airborne particles in facilities processing peanuts, or cross-contact with surfaces that previously touched peanuts. Tree nut allergies—including reactions to walnuts, cashews, almonds, pecans, pistachios, hazelnuts, and macadamia nuts—similarly carry high anaphylaxis risk. Individuals allergic to one tree nut are often allergic to multiple tree nuts, though not always to all of them. The varying proteins in different nuts mean each must be tested and evaluated individually. Shellfish allergy, which typically develops in adolescence or adulthood rather than childhood, frequently triggers severe reactions. This category includes crustaceans like shrimp, crab, and lobster, as well as mollusks such as clams, oysters, and squid. Wisconsin’s Friday fish fry tradition means shellfish and finned fish are prevalent in restaurant settings, requiring vigilance from those with these allergies. Milk and egg allergies, while common in young children, less frequently cause anaphylaxis compared to nuts or shellfish. However, severe reactions can still occur, particularly in children with histories of significant reactions or those with concurrent asthma, which increases anaphylaxis risk. Many children outgrow milk and egg allergies by school age, though those with persistent allergies into later childhood may be less likely to achieve tolerance. The severity of previous reactions doesn’t always predict future reaction severity. Someone who has experienced only mild symptoms in the past could potentially have a severe reaction upon subsequent exposure. This unpredictability is why all IgE-mediated food allergies are taken seriously, with epinephrine prescribed even for patients who haven’t yet experienced anaphylaxis. Beyond the major allergens, any food can theoretically trigger anaphylaxis in sensitized individuals. Less common culprits include seeds (sesame, sunflower, poppy), fruits (particularly in individuals with oral allergy syndrome who have reactions beyond the typical mild oral symptoms), legumes other than peanuts, and various spices. Wisconsin allergists evaluate each patient’s specific sensitizations rather than making assumptions based only on common allergens. Cross-contact Cross-contact, sometimes called cross-contamination, occurs when an allergen is unintentionally transferred from one food or surface to another. For individuals with severe allergies, cross-contact represents one of the most common causes of accidental reactions, including anaphylaxis. Manufacturing environments create significant cross-contact risk. Food processing facilities often handle multiple products on shared equipment. Even with cleaning between production runs, trace amounts of allergens can remain. This is why food labels include precautionary statements like “may contain” or “processed in a facility that also processes” specific allergens. While these warnings are voluntary and sometimes used overly cautiously for legal protection, they reflect real risks that individuals with severe allergies must consider seriously. Restaurant kitchens pose substantial cross-contact challenges. Shared fryers cook both allergen-free and allergen-containing foods—for instance, french fries might be cooked in the same oil as breaded fish or onion rings containing wheat. Grills, cutting boards, knives, and other utensils touch multiple foods throughout service. Even when restaurant staff try to accommodate allergies, the fast-paced kitchen environment makes complete allergen separation difficult. Wisconsin’s beloved fish fry tradition exemplifies these challenges. Restaurants serving fish fries typically use shared fryers for multiple items, shared preparation surfaces, and the same utensils. Someone with shellfish allergy might assume the fish itself is safe while not realizing the fryer was also used for shrimp. Someone with wheat allergy might not consider that breading particles contaminate the oil even if they order unbreaded fish. Home kitchens aren’t immune to cross-contact issues. Families managing food allergies must implement careful protocols: using separate cutting boards and utensils for allergen-free food preparation, thoroughly cleaning surfaces between