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A macaroni necklace, a class goldfish, a birthday party with cake: all common parts of elementary school life, and just a few examples of the minefields that children with severe allergies have to dodge.

Chris Bloch of Mount Airy, a mother of two including a son who has severe food allergies, is thankful for what she says is a school system that listens to parents who have children with allergies.

"With these schools, they are listening and we're constantly evolving best practices," said the mom of Alex at Mount Airy Elementary and Nicholas at Parr's Ridge Elementary. "It's not perfect, but it's far better than other areas."

Nicholas, whose allergies include milk, eggs, peanuts, tree nuts and sesame, could react to an allergen as mildly as hives or as severely as anaphylactic shock, she said.

Bloch said Maryland has no laws to oversee food allergy procedures in schools or restaurants. "There are a handful of states that do," she said.

In Carroll County schools, cafeteria workers work with nurses at each school, said Eulalia Muschik, supervisor of Food Services for Carroll County Schools.

"That way they can deal with their specific population," she said.

Muschik said one of the biggest threats schools see is cross contamination. She said if cafeteria workers deal with peanut products and know of a peanut allergy, the products are always prepared in a certain area using certain tools.

She said education is key.

"We've talked about it a number of different times at various in-service meetings," she said. "The person in charge of school nurses has spoken to managers."

She said handling food allergies can be similar to handling to diabetic students.

Jen Byers, the Parr's Ridge Elementary School nurse, said Parr's Ridge is well versed in food allergy reaction prevention.

"Anyone that may come in contact with that child — special teachers, administration — all know this child has a severe food allergy and have an action plan that we follow," she said.

She said if a student exhibits signs or symptoms of an allergic reaction, they are sent with another student to the school nurse.

Ravinder Sandhoo, a Howard County resident, attended a November PTA meeting where Bloch gave a presentation about allergies.

She said her kindergartner son, Shaan, who has multiple allergies including peanuts and shellfish, was segregated from the other children during lunch.

She was frustrated by the Howard County's school's response to his allergies by isolating him. "It's not complicated," she said. "It's simple. It's a lot of work, but it can be simple."

Byers said at Parr's Ridge, children with severe food allergies sit at a separate desk at the end of tables. "They're still sitting with their friends, but they're a little bit in a distanced." She said allergies reach beyond the cafeteria.

"Like in an art class," she said. "Certain things need to be avoided. Kids with egg allergies need to avoid egg cartons, obviously."

Bloch said danger lies all over in schools. Class pets can even pose a threat, with goldfish food possibly containing shellfish, milk and eggs. For class parties, such as birthday celebrations, school officials suggest parents bring in pencils instead of cupcakes to share with students.

"The parents and staff work really well together here to make sure everybody's safe," Byers said.

Byers said she thought the school is on board and on top of things.

Bloch has recently given a presentation to Carroll County bus drivers as part of their annual in-service training. She said she was approached for the presentation, which trained about 400 bus drivers.

"I think we're far ahead in education and awareness. They deserve the recognition," she said.

Bloch said as Nicholas grows older, he takes on more responsibility and the schools take less. "As he moves through the school system and as he moves through life, he takes on different roles," she said.

Byers, who is in her second year of working as the school's registered nurse, said teachers are trained at the beginning of the year.

The school has 15 to 20 children who have severe allergies out of the more than a 500-student body.

A number of students with severe allergies have epinephrine pens, which gives a rush of adrenaline similar to the natural fight or flight reaction, Byers said.

"It basically speeds everything up and stops the production of the histamines," she said. "Releasing epinephrine shuts down the body's response to the reaction. It kind of reverses the effects."

A side effect of the pen can be an increased heart rate.

"When in doubt, pen them," Bloch said. "There's way too many stories of ‘I should have known.'"

"There is no cure. The goal here is minimize risk," Bloch said. She said severe allergies were outgrown in the past, but they're not going away now.

"They say the numbers are going to keep growing," said Byers, who has been a nurse for 12 years. "I do see that it's growing, and it's definitely something that more schools are going to have to be able to accommodate these kids."