As children head back to school, the daily grind of packing lunches begins as well. But this fall, children may be eating fewer peanut butter and jelly sandwiches around school.

Food allergies, especially peanut allergies , are on the rise among school-age children and although the common reactions are sometimes just a cough or a sneeze, these allergic reactions lead to more than 30,000 emergency room visits a year in this country.

Though most parents with allergic children can peanut-proof their homes, it is important that school administrators and staff help provide a safe environment when children are at school. Since the risks of exposure are life-threatening for some children, more schools are looking into creating peanut-free zones in classrooms and lunchrooms.

By wiping the table of possible peanut residue and making sure all lunches at the table are peanut free, school cafeterias can provide children with the food allergy a safe place to eat their lunch. Also, to avoid a potential reaction in the classroom, a no-peanut policy should be the rule for those students and staff sharing a room with the allergic child.

Parents should work with the school system, their child's classmates and other parents to make sure everyone involved understands just how serious the child's reaction can be.

"Everybody that has contact with this child and any room this child goes into has to essentially be made peanut-free," says Marc McMorris, M.D., assistant professor of internal medicine and pediatrics in the division of allergy-immunology at the University of Michigan Health System . "A peanut-free classroom and lunchroom takes a lot of work and a lot of coordination. It's important to start planning with school administrators and staff early on. Most efforts start in the spring for the next academic year and letters go out to all families of children who will be in the classroom."

A recent study showed that 50 percent of patients react to the equivalent of one-fiftieth (1/50) of a peanut, a very small amount, says McMorris. The allergy is even more serious because the food does not have to be ingested to have fatal effects. Some patients react to inhalation of peanut products or even touching an object that has been in contact with the allergen.

Pam and Mike Swanson's son, Patrick, 10, was in computer class when he touched the mouse and then touched his face and eye. Peanut residue happened to be on the mouse from another child and gave Patrick a swollen, itchy eye.

Schools can only control so much, making it important for faculty and staff to be aware of the conditions and recognize any signs of an allergic reaction immediately. Also, Benadryl and Epinephrine should always be immediately available wherever the child goes during the course of the day at school.

Keeping the home, the classroom and the lunchroom peanut-free becomes difficult because of the prevalence of peanuts in foods, and the unclear labeling of some products.

"Often times you will find foods that may contain peanuts but that may not be adequately labeled. Another problem would be the issue of peanuts getting into foods in the production process that contaminate another normally safe food," explains McMorris.

Food manufacturers frequently change the process they use when manufacturing food products. The food can potentially be harmful for children due to cross contamination. Even if a product was safe last week, parents should still check labels on foods they have previously eaten, to ensure safety.

Allergic parents or those who have a family history of bad allergies should keep in mind that their children may be susceptible to food allergies. Families with a history of allergies should keep their children away from certain high-risk foods such as peanut, tree nuts and shrimp until at least age 3 or 4.

Once a child has been diagnosed with the food allergy, parents should be attentive to their child's diet, while educating themselves and everyone else involved, including grandparents, babysitters, school and church about the dangers involved with certain foods.

Children also should be aware of their allergy and the ingredients of the foods they encounter. When children go to birthday parties, sporting events or church outings they should plan on taking their own food or avoid foods their parents haven't approved.

Peanut or tree nut allergies affect approximately 3 million Americans and cause some of the most severe food-induced allergic reactions. Reactions vary from a few hives or a skin rash, to lip swelling, tongue swelling, trouble breathing, coughing, wheezing, shortness of breath or vomiting. The most severe reaction, called an anaphylactic reaction, can be fatal and includes sudden, difficulty breathing and swallowing and a rapid fall in blood pressure - sending the person into shock.

"I would say to all parents who have children that are in the classroom or lunchroom with allergic children that it's important to put yourself in their shoes," says McMorris. "Peanuts are just a small factor in life and if these children have life-threatening reactions to this food, there are always alternatives. I doubt any of us would want a child to have a fatal reaction in a classroom because another family neglected to follow the rules that have been laid forth by the school district."

These foods contain peanut protein:

• Artificial nuts
• Beer nuts
• Ground nuts
• Madelonas
• Mixed nuts
• Monkey nuts
• Nu-Nuts flavored nuts
• Peanut butter
• Peanut flour
• Peanut oil (cold pressed, extruded, expelled)
  Nut pieces

These foods may contain peanut protein:

• African, Chinese, Indonesian, Mexican, Thai and Vietnamese dishes
• Baked goods (pastries, cookies, etc.)
• Candy (including chocolate candy)
• Chili
• Egg rolls
• Enchilada sauce
• Flavorings (natural and artificial)
• Marzipan
• Nougat

Facts about food allergies:

• About 2 to 2 1/2 percent of the general population suffers from food allergies -- between 6-7 million Americans.
• Among children under three years of age, the incidence of allergies is 8 percent.
• Eight foods account for 90 percent of the reactions--peanuts, tree nuts, fish, shellfish, eggs, milk, soy, and wheat.

For additional information on food allergies, visit the following Web sites:

U-M Health Topics A to Z: Food Allergies

Food Allergy: Sending your child to school

The University of Michigan Division of Allergy and Clinical Immunology