Anaphylaxis (pronounced ana-fill-ax-is) is a severe and life-threatening allergic reaction that can be fatal. Severe symptoms such as: swollen tongue or lips,
usually develop suddenly, often within minutes after being exposed to an allergy trigger such as: a particular food,
When families send a child with allergies to school, this can be a stressful time as they are handing over the care of their child to someone outside the family. However, this natural part of growing up can also be a very positive and an important part of helping your child to learn to manage their allergy independently.
This article will provide parents and carers of school age children with advice about managing allergies at school and how to ensure good communications with school staff.
The laws relating to looking after children with medical conditions in school in the UK vary depending on whether the school is in England, Scotland, Wales or Northern Ireland but all schools have a duty of care to all pupils and need to have procedures in place to minimise the risk of an allergic reaction occurring. Parents should work with the school to develop a plan that accommodates the child’s needs with the support of their doctor, school nurse, allergy specialist or paediatrician.
Since October 2017, the law has changed to allow schools in the UK to buy adrenaline auto-injector devices without a prescription to use in an emergency on children who are at risk of a severe allergic reaction but whose own device is not available or not working. It is therefore vitally important that all school staff are adequately equipped and trained to act in an emergency to safeguard the children in their care.
The signs and symptoms of a severe allergic reaction can be remembered by using the phrase think ABCDE.
If someone is having a severe allergic reaction, it is vital that they receive an adrenaline injection as soon as possible. If they have their own adrenaline auto-injector, this must be given as soon as a severe reaction is suspected to be occurring and an ambulance must be called immediately.
In the UK it is estimated that 5–8 %of children have a food allergy; peanut allergy is particularly common with up to 1 in 55 children thought to be affected. Children can also be allergic to non-food allergens such as natural rubber latex, bee or wasp stings or certain drugs.
Two-thirds of all schools are estimated to have at least 1 child who has experienced anaphylaxis or who has a prescription for life-saving medication, called an adrenaline auto-injector or AAI.
The laws relating to looking after children with medical conditions in school in the UK vary depending on whether the school is in England, Scotland, Wales or Northern Ireland but all schools have a duty of care to all pupils and need to have procedures in place to minimise the risk of a reaction occurring. The guidance issued to schools is publicly available from government websites.
Children who are at risk of severe allergic reactions are not ill in the usual sense. They are normal children in every respect – except that if they come into contact with a certain food or substance, they may become unwell. It is important that these children are allowed to develop in the normal way and are not stigmatised or made to feel different. All efforts should be made to ensure that children have the opportunity to participate in all school activities.
A core team should be identified to work with families to establish prevention and treatment strategies and staff training arranged so that every member of staff can recognise the signs and symptoms of anaphylaxis, understand how to minimise risk and know what to do in an emergency.
For younger children, their medication should be appropriately stored and easily accessible (i.e. not locked away) in a secure, central location. Emergency kits should be checked termly to ensure they are stored correctly, are still in date, and are ready for use. Older pupils may wish to take responsibility for carrying their own adrenaline auto-injectors with them at all times.
School activities should be designed and developed to ensure every pupil is included. There is no need to exclude a child with allergies from cooking lessons, but extra care is needed. Risk can be minimised by measures such as cleaning the cooking area thoroughly before use and ensuring that recipes are thought out carefully, and, if possible, all the pupils using ingredients free from the allergen. Also consider how materials used in arts and crafts projects may contain food derived ingredients that may pose a risk.
The school should ensure that catering supervisors are aware of the dietary and allergy requirements of children at risk, for example, by creating a log with photographs. However, this should be dealt with sensitively, and not be visible to students.
We recommend schools to adopt a culture of allergy awareness and education rather than choosing to ban certain foods from in packed lunches. However, in nurseries and infant classes, it is reasonable to ask parents not to allow children to bring certain allergens into school in their lunch, in order to reduce the risks of cross-contamination for particularly young and vulnerable children. Schools caring for older children should undertake a thorough risk assessment and may wish to write to parents asking for their cooperation in making life safer for the children in their care.
Children with allergies should have every opportunity to take part in out-of-school activities such as school holidays, sports events hosted by other schools and educational visits to museums. These activities will need careful planning and preparation and a meeting with the child’s parents will be necessary to ensure that everyone is happy with the arrangements. If the child has been prescribed an adrenaline auto-injector, at least one person trained in administering the device must accompany the school party. From the child’s point of view, it is not advisable for a parent to accompany them on school trips, although in some cases this may be unavoidable.
Families can help the school by ensuring there are clear channels of open communication between parents, carers and school staff. Parents and carers should work with the school to develop a plan that accommodates the child’s needs with the support of their doctor, school nurse, allergy specialist or paediatrician and review these regularly. Parents and carers should also provide written medical documentation, instructions and medications as directed by a doctor and replace medications after use or upon expiry. If your child has a food allergy, you may also wish to provide a ‘stash’ of safe snacks for special events to be stored in school.
Every child who is at risk of a severe allergic reaction, should have an up-to-date and accurate care plan in place which should be familiar to all staff in the school.
The Paediatric Allergy Group of the BSACI (British Society for Allergy and Clinical Immunology) has developed Allergy Action Plans which are designed to facilitate first aid treatment of anaphylaxis, to be delivered by people without any special medical training nor equipment apart from access to an adrenaline auto-injector.
The plans are medical documents and should be completed by a child’s health professional, not by parents or teachers. Families should contact their GP or allergy specialist, complete the plans together and provide a copy to the school. You can access care plans from the BSACI website here: http://www.bsaci.org/about/pag-allergy-action-plans-for-children.
We advise you to speak to your child and help them learn to be more independent about managing their allergies, for example, talking about what foods are safe and unsafe, strategies for avoiding allergens, how to spot symptoms of allergy, how and when to tell an adult of any reaction, and how to read food labels.
It is really important that children understand that they shouldn’t swap food with others at lunchtime or eat anything they don’t know the ingredients for. They should always wear their medical alert bracelet or some other form of medical identification and tell an adult if they believe they are having a reaction, even if the cause is unknown.
Including friends in the conversation and helping them understand the signs and symptoms of a reaction can also be a great support at school.
Thankfully, the vast majority of the children living with severe allergies are happily accommodated in mainstream schools thanks to good communication between parents, school staff, doctors and education authorities.
We advise you to have a conversation with your child to help them understand that if they are being bullied they need to tell the school and you what is happening. If you are worried about your child being bullied, for example, being teased due to their allergy, or more seriously, another pupil threatening to feed your child with the thing they are allergic to or throwing their allergen at them, we advise you speak to the school immediately to help resolve the issue.
By law, all state schools must have a behaviour policy in place that includes measures to prevent all forms of bullying among pupils. All teachers, pupils and parents must be told what it is, and allergy bullying should be treated seriously, like any other bullying. Your school may find having an allergy awareness day helpful to encourage a culture of support. Including school friends in a child’s allergy management strategies can also be a great support.
After two years of campaigning by the Anaphylaxis Campaign – together with Allergy UK, the British Society for Allergy & Clinical Immunology (BSACI), the British Paediatric Allergy Immunity and Infection Group (BPAIIG), and the Royal College of Paediatrics and Child Health (RCPCH) – in October 2017 the law changed to allow schools in the UK to buy adrenaline auto-injector devices without a prescription to use in an emergency on children who are at risk of a severe allergic reaction but whose own device is not available or not working.
The website www.sparepensinschools.uk– a collaboration between the Anaphylaxis Campaign, the BSACI, the RCPCH and Allergy UK – has been set-up to support schools, parents, students and healthcare professionals in implementing the new guidance from the UK Departments of Health to support children with food allergies in schools, and where appropriate, the use of emergency ‘spare’ adrenaline auto-injectors now permitted under UK legislation.