Food allergies affect 11 million Americans, including 6-8% of children. The rate of peanut allergies in children doubled from 1997 to 2002. There is no cure; therefore, strict avoidance of the allergen is the only way to avoid a reaction. Fatalities are associated with delays in or lack of epinephrine administration. Severe reactions, called anaphylaxis, have occurred in schools. In a nationwide telephone survey of 400 elementary school nurses, 44% reported an increase in children with food allergies in their schools over the last 5 years; more than one third had 10 or more students with food allergies; 78% did staff training as a preventive strategy, with 74% developing their own training guidelines; and 90% stated students' epinephrine was stored in the nurse's office. Standardized training in food allergies as well as timely access to epinephrine is needed to respond appropriately to an anaphylactic reaction in the school setting.