Almost 1 in 10 children in the UK are affected by allergy with a fifth of allergic reactions happening at school – and yet only half of primary schools say they are confident managing anaphylaxis. Tracey Dunn advises
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Unhelpfully for people with allergies there are many misconceptions about their life-threatening condition. There is confusion about allergy and intolerance as well as a rising number of people who excuse their dislike of a food by saying that they are allergic to it.

People with allergies must avoid eating the substance they are allergic to as even a tiny bit can cause a reaction. 

At best they will have a mild reaction including hives, nausea, itching and swelling – at worst they will have anaphylaxis with compromised airway, breathing and circulation which without life-saving adrenaline could be fatal.

The immune system in a person with an allergy has misread the food/substance and treats it as a threat, attacking the body. An intolerance doesn’t affect the immune system and while a person eating the food may be unwell, the resulting symptoms are not life-threatening and the person will recover. For a person with an allergy, even a little bit will hurt. 

And this can be from contact with the allergen on a surface, cross-contamination in food or through ingestion. It is surprising how little is needed for a reaction to occur.

The statistics are concerning, not least that 8% of children in the UK are affected by allergy and 20% of allergic reactions happen at school (Muraro et al, 2010).

Meanwhile, more than 3 in 10 families say that their child’s allergy affects their attendance and education, while only half of primary schools in the UK say they are confident managing anaphylaxis. 

The seven most common foods that trigger an allergic reaction are cow’s milk, egg, soy, peanut, tree nuts, fish, and shellfish. Other recognised allergens include celery, gluten, lupin, molluscs, mustard, sesame and sulphites (see EFA, 2024; Nwaru et al, 2014).

Allergy has a significant impact on a family and a child’s life. Additionally, it affects attendance and subsequently a child’s progress and attainment. 

Considering this picture, it is concerning that only half primary schools in the UK report feeling confident in managing anaphylaxis (Santos et al, 2022).

Thankfully fatalities are rare, but they do happen, and they can happen in school. In 2019, Karanbir Cheema, aged 13, died from anaphylaxis in school. The coroner concluded that the school’s actions contributed to his death. The anaphylaxis was caused through an incident of bullying. In 2020 a six-year-old girl was awarded compensation after suffering a severe allergic reaction at school.

Schools often feel anxious about having children on roll with allergies while families often experience considerable anxiety about safety too.

Anaphylaxis UK is a charity which has been supporting people living with serious allergies for 30 years, offering evidence-based information for individuals and their families, as well as for schools and others, including via our training course AllergyWise and our Safer Schools programme.

 

Whole-school awareness

We advocate whole-school allergy awareness as the best way of ensuring that pupils are safe whether they are in reception or year 6.

There is a common misconception that “nut-free” schools are the thing to become, however one has to question whether schools would be willing to become milk-free or gluten-free to ensure the safety of pupils with these allergies.

Becoming “nut-free” has widespread ramifications including complacency as “a reaction couldn’t happen here, we’re nut-free” to the boxes of chocolates (often containing nuts and hazelnuts) that keep staff fuelled at Christmas time – are you really going to start sorting through these or banning them?

But being allergy-aware addresses these issues because, like safeguarding, schools maintain an attitude of “it could happen here” and know how to respond if it does. All allergies that pupils have can be given the same attention and strong policies and practices are based on robust risk assessment which subsequently enable pupils to be safe and learn free from anxiety. Becoming an allergy-aware school is easier than you may think. Good practice comes from thinking whole-school and following the principles below.

 

Good practice principles

Schools demonstrating good practice in allergy management follow the statutory guidance Supporting pupils at school with medical conditions (DfE, 2017) and they will have an allergy risk assessment and an allergy policy. 

Anaphylaxis UK, Allergy UK and the British Society for Allergy and Clinical Immunology (BSACI) have collaborated on a model policy which is available free of charge on our website (see further information for links to resources cited in this article).

All staff will be trained in allergy awareness and management which enables them to recognise the signs and symptoms of an allergic reaction and of anaphylaxis. It will give them the confidence to respond positively to an emergency incident being able to use an adrenaline autoinjector.

Each pupil will have an allergy action plan that details their treatment and where necessary an individual risk assessment or individual healthcare plan that unpicks their allergy and supports staff in providing a safe and inclusive education.

Again, BSACI has a model allergy action plan available to download, while Anaphylaxis UK’s Safer Schools Programme can support with risk assessments.

Storage and access to pupil’s medication should be swift and easy. Pupils should always have their medication with them and quickly accessible. The medicine should be in an easily identifiable container or insulated bag, named with a picture.

Pupils who are prescribed adrenaline autoinjectors should always carry two. Schools must not split these up and they should never be locked away. Since 2017, schools have been permitted to hold “spare” adrenaline autoinjectors that are not prescribed to a person and can therefore be used to save a life of anyone experiencing anaphylaxis (for details, see DoH, 2017).

 

Fully inclusive approach

Schools must ensure that pupils with allergies are fully included in the life of the school, with curriculum adaptations should these be necessary – for example, not using eggs in an experiment to test forces if there is a pupil with an egg allergy. It would not be acceptable to exclude the pupil from the activity, and it would not be safe for the pupil to return to the environment without all pupils and staff having washed their hands and the room having been thoroughly cleaned. It is simplest to change the egg and make the activity inclusive and safe. 

Trips including residentials in the UK and abroad are possible with early careful planning and effective communication and liaison with the parents and carers and the venues where food will be provided.

Clear, thought-out systems must be in place for food in school, from the milk in the Foundation Stage classroom to celebration food at parties, discos, and events – as well as of course school lunches. 

Pupils with allergies are just the same as everyone else, they want to do the same as everyone else. Exclusive practice hurts them – they already have to live with daily worry and disappointment when they can’t eat what everyone else is. 

By being inclusive schools are supporting healthy development and pupils’ positive mental health.

 

Communication is vital

Frequent communication with parents and carers, sharing what you are doing and asking questions, will enable them to have confidence that their child is safe in your school. Include information about allergies in staff briefings, newsletters, and trip letters.

Include learning about allergies for all children in assemblies, through lessons or visitors. Remember, the relationships and sex education curriculum stipulates that children should be taught about allergies by the end of key stage 2, specifically “the facts and science relating to allergies” (DfE, 2019).

Transition is a particular time of anxiety for pupils and their families, particularly for the Foundation Stage year and for the year 6 to 7 move. Meeting parents and carers early in the transition process will help to allay any fears, build confidence and trust ensuring a positive working relationship. 

Parents and carers are walking encyclopaedias for their child’s allergy care. If they don’t know the answer to your question, they will find it. They will be your best resource when on side or the biggest drain on your time if not. Remember also that a pupil’s needs will change as they get older and as they are able to take more responsibility for managing their allergy, which should be encouraged. But remember equally that it is always the school’s responsibility to ensure that children are safe and looking after themselves appropriately.

 

Recommendations for schools

  • Review or implement an allergy policy using the model policy based on the guidance Supporting pupils at school with medical conditions (DfE, 2017).
  • Ensure that there is whole-school training for all staff at the earliest opportunity and arrange for this to be updated annually.
  • Ensure that all pupils have allergy action plans plus risk assessments, or have individual healthcare plans in place as necessary.
  • Obtain “spare” adrenaline autoinjectors (see below for a link to Spare Pens in Schools).
  • Review catering arrangements. Are pupils safe when eating? Is the allergen information easily accessible for parents and carers without them needing to ask? Remember, allergen information has to be available to consumers by law. The Food Standards Agency has detailed information and downloadable allergen cards and matrix which can be completed and displayed.
  • Review the curriculum and make any necessary adaptations to ensure that pupils with allergies are fully included in school life 
  • Participate in Anaphylaxis Awareness Week (which runs in the autumn) and Allergy Awareness Week (each spring). Include teaching about allergies the curriculum.
  • Foster excellent relationships with the experts – the pupil’s parents and carers!

 

  • Tracey Dunn is education and AllergyWise manager at Anaphylaxis UK. Anaphylaxis UK offers evidence-based information for individuals and their families, for businesses and for schools and other places of education. Its work is supported by a Clinical and Scientific Panel offering expert insight into health and scientific issues related to serious allergies, associated research, and advice on current management of serious allergies. Visit www.anaphylaxis.org.uk  

 

Headteacher Update Summer Term Edition 2024

  • This article first appeared in Headteacher Update's Summer Term Edition 2024. This edition was sent free of charge to UK primary schools in May 2024. A free-to-access digital edition is also available via www.headteacher-update.com/content/downloads 

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