The Role of Schools in Protecting Students with Severe Allergies

In the UK, 40% of children have been diagnosed with an allergy. The number of people who have allergies is rising by about 5% each year. Allergies cost the NHS around £900 million each year, which is mostly due to the cost of prescriptions, and over 200,000 people have emergency adrenaline prescriptions for their allergies. 

The four most common allergies in children are food allergies, eczema, asthma and hay fever. Figures suggest that at least 1 in 40 children in the UK are suffering from at least one serious allergy. Worryingly, in the last decade, hospital A&E emergency departments have seen a huge increase in anaphylaxis admissions. 

What is an allergy?

An allergy is your immune system responding to a substance that is usually harmless. The immune system’s job is to defend your body against things such as bacteria and viruses. However, in the case of allergies, your immune system mistakenly identifies a substance, known as an allergen, as being harmful to you and reacts to it. Allergies can vary in severity from mild to severe, and the symptoms can range from being slightly irritating to being life-threatening. 

When a person with allergies comes into contact with an allergen, their immune system releases chemicals, called histamines, which can cause symptoms such as sneezing; runny or blocked nose; itching, watery eyes; swelling of the lips, mouth, tongue and throat; and, in more severe cases, having difficulty breathing or anaphylaxis. Anaphylaxis is a severe and potentially life-threatening allergic reaction that can occur rapidly after exposure to an allergen.

Common allergens include:

• Pollen (also known as seasonal allergies) – this is a very fine powder which is produced by trees, flowers, grass and weeds used to fertilise other plants. Hay fever, also known as allergic rhinitis, is an allergic reaction to pollen. Many people are allergic to pollen and can experience hay fever symptoms; however, some people have asthma symptoms due to being allergic to pollen. There are approximately 30 different types of pollen that can cause hay fever and allergies. As different plants produce pollen at different times of the year, people experience hay fever and allergy symptoms at different times. However, hay fever and pollen allergies are usually more prevalent in the spring and summer months when the weather is warmer, and plants and flowers release more pollen.
• Dust mites – these are shaped like spiders but are very small. They live on the soft surfaces of your home, for example soft chairs, curtains and carpets.
• Pet dander – this is flakes of skin in an animal’s fur or hair. When someone has a pet allergy, dander is usually what causes the allergy. Pet hair is often grouped with dander as a common allergen.
• Mould – mould and damp are caused by excess moisture. This can be caused by leaking pipes, rising damp in basements or ground floors, or rain seeping in because of a damaged roof or window. Moulds produce allergens, irritants and sometimes toxic substances. Inhaling or touching mould spores may cause an allergic reaction. Moulds can also cause asthma attacks. It is important to address any mould or damp in your home as it can negatively impact on your and your family’s health.
• Certain medications – allergic reactions to different medications can vary widely, and people may react differently to the same medication. It is important to consult with a healthcare professional if you suspect you are experiencing an allergic reaction to a medication.
• Insect bites and stings – there are some insects whose bites or stings are commonly associated with allergies, including bees, wasps, mosquitos, fire ants, bedbugs, ticks and fleas.
• Certain foods – there are 14 common allergens which are listed below.

In the UK, there are 14 allergens listed in food allergen labelling regulations. These are recognised as the most common ingredients that can cause food allergies and intolerances. A food allergy is an immune response to certain proteins. When someone who has a food allergy comes into contact with or ingests an allergenic food, their immune system perceives the proteins as being harmful. 

The 14 most common food allergens are:

• Cereals containing gluten
• Shellfish
• Fish
• Celery
• Egg
• Sulphites/sulphur dioxide
• Milk
• Mustard
• Lupin
• Tree nuts
• Peanuts
• Sesame
• Soya
• Molluscs

A food allergy is different to a food intolerance which is where your digestive system finds it difficult to digest that particular food. It means that your gut is sensitive to certain foods and cannot tolerate them. A food intolerance affects your digestive system and causes symptoms which are not life-threatening. Symptoms may begin within a few hours of eating the particular food. A food intolerance does not trigger the immune system like an allergic reaction does and the symptoms are usually less severe. 

Allergic asthma, also known as atopic asthma, is asthma which is triggered by allergens. In the UK, 5.4 million people are currently receiving treatment for asthma, with allergy being the most common cause of asthma, occurring in about 80% of cases. Allergic asthma is a breathing condition whereby your airways tighten when you inhale an allergen. When your allergies combine with the breathing condition asthma, this is called allergic asthma. The allergens are also called triggers as they can set off your asthma and even cause an asthma attack. An asthma attack is when someone experiences severe asthma symptoms. Allergic asthma, also known as allergy-induced asthma, is the most common type of asthma in both adults and children.

Allergies in general can affect what products you use on your skin, what you eat and what you breathe.

What is the prevalence of severe allergies in children at school?

Every school class is likely to have at least one pupil with allergies. Anaphylaxis is the most serious type of allergic reaction and usually begins within minutes of coming into contact with the allergen. Anaphylaxis is potentially life-threatening. Very sadly, there have been cases of fatal anaphylaxis within schools.

The responsibility of schools in allergy management

Under section 100 of the Children and Families Act 2014, schools have a duty to support pupils at their school with medical conditions, including allergies. The Food Information Regulations 2014 requires all food businesses including school caterers to clearly show the allergen ingredient information for the food they provide. This makes it easier for schools to identify the food that pupils with allergies cannot eat. The Food Standards Agency has produced guidance for food businesses to help with this. It includes information on:

• Food labelling requirements
• The 14 most common allergens
• How to handle allergen ingredients
• How to access further training

It is vital that staff within schools are aware of how to spot the signs of an allergic reaction and how they should respond. 

There are many things schools can do to ensure that children with allergies are kept safe.

• Bottles, other drinks and lunch boxes should be clearly labelled with the name of the child they belong to.
• Food should not be given to food-allergic children in primary schools without parental engagement and permission.
• When planning out-of-school activities such as sporting events and excursions, think early about the catering requirements for food-allergic children, and emergency planning while away from school premises.

The government provide specific allergy guidance for schools.

How to be prepared in managing anaphylaxis in schools

Anaphylaxis happens when your body has a serious reaction to something you are allergic to. Managing anaphylaxis in schools requires education, training and careful planning. It is essential that staff in school:

• Have a good understanding of anaphylaxis – this will involve education and training including the common triggers such as food allergies, insect stings and medication. If there are students within school who have severe allergies, it is important that staff are aware of who these children are and have a good understanding of their condition. School staff should be educated about anaphylaxis, its causes, symptoms and the importance of prompt intervention.
• Provide regular training for school staff on recognising anaphylaxis symptoms and administering epinephrine.
• Educate other students – ensure that students are aware of their classmates who are at risk and the importance of not sharing food in these circumstances. It is important that students know how to seek help in an emergency situation.
• Maintain up-to-date records – keep staff up to date with any changes.
• Support students who are at risk – this should involve working closely with parents, healthcare providers and students of those at risk of anaphylaxis. This should also involve creating individualised care plans, which should include triggers, symptoms and emergency contact information as well as clearly outlining the steps for prevention and an emergency response.
• You should develop and implement an Anaphylaxis Policy – this should be done with the help of healthcare professionals who can advise you accordingly. Develop clear, step-by-step emergency response procedures including contacting the emergency services and parents or carers. You should review and update policies regularly and periodically review and update the school’s anaphylaxis policies and procedures to incorporate any new information or changes in students’ health conditions.
• Ensure that emergency medication is available – there should be a designated member of staff available at all times who has been trained to administer the medication. Ensure the emergency medication is available and the expiration dates are checked.

Anaphylaxis can come on very quickly, so it is important to know what to do in an emergency. It requires immediate medical attention. If you suspect someone is experiencing anaphylaxis, you should follow these steps:

• Call an ambulance immediately.
• Administer epinephrine, if available. This is sometimes called an EpiPen. You should use it as directed, which usually involves injecting the person into the outer thigh and holding it in place for 10 seconds.
• If their symptoms have not improved after 5 minutes, use a second adrenaline auto-injector.
• Lie the person down and elevate their legs.
• Stay with the person and monitor their breathing.
• Do not offer any food or drinks as this could potentially make their condition worse.
• Do not ask the person to stand or walk at any time, even if they feel better.
• If the person has been stung by an insect, try to remove the sting if it’s still in the skin.

Symptoms of anaphylaxis happen very quickly and include:

• Swelling of the throat and tongue.
• Difficulty breathing or breathing very fast.
• Wheezing, coughing or noisy breathing.
• Difficulty swallowing or tightness in the throat.
• Feeling faint, dizzy or fainting.
• Feeling tired or experiencing confusion.
• Skin that feels cold to the touch.
• Blue, grey or pale lips or face.

Anaphylaxis needs to be treated in a hospital straight away. Treatment may include oxygen, adrenaline given by an injection or drip into your vein and fluids given by a drip into your vein. 

Allergy UK offer a helpful factsheet about anaphylaxis.

How do schools protect allergic students?

Schools have a duty to protect students with allergies. Processes may vary slightly but schools should have clear procedures in place to protect allergic students. These might include:

• Having allergy action plans.
• Providing appropriate training and awareness for staff and other students.
• Having correct medication on site.
• Having allergy free zones.
• Working collaboratively with healthcare professionals.
• Working collaboratively with parents.

It’s important for parents of allergic students to actively communicate with the school, provide relevant and up-to-date medical information, and collaborate on a plan that ensures the child’s safety and well-being while they are in school.

Staff training in allergy management

Training staff in schools in allergy management involves ensuring that they are provided with the skills necessary to prevent, recognise and respond to allergic reactions in pupils. The training may cover:

• Understanding allergies – this should include education around common allergens, and what the common symptoms are of an allergic reaction. This should range from mild allergies to severe allergies.
• Understanding of prevention strategies – this should include training around prevention of exposure to allergens. The training should focus on allergies ranging from mild to severe.
• Understanding and implementing individualised care plans – the plans should be created with healthcare professionals and parents. The plans should include prevention, risks and what to do in an emergency situation.
• The importance of communication – training should emphasise the importance of effective communication and collaboration between school staff, parents and healthcare professionals in order to ensure a coordinated, informed and planned approach to allergy management.
• How to administer medication – staff should receive training on how to administer medications, such as epinephrine auto-injectors, which are commonly used in the emergency treatment of severe allergic reactions, known as anaphylaxis. This training should include recognising when to administer medication, administration techniques, and an understanding of the potential side effects.
• Emergency response training – staff should receive training about their specific school’s emergency response protocol. This should include how to contact emergency services, administer medications, and provide initial care until professional help arrives.

Staff should be required to regularly update their knowledge by going on refresher courses and keeping up to date with any new information about allergies or allergy management. 

Partnership working between schools and parents

By ensuring a collaborative relationship with parents, schools can create a safer and more supportive environment for children with allergies. Schools can ensure there is effective partnership working by:

• Having open communication.
• Ensuring that medical records are disclosed and up to date.
• Ensuring that an allergy action plan is created jointly.
• Regularly reviewing and updating allergy-related policies based on feedback from parents.
• Actively involving parents in decision-making processes related to their child’s safety and well-being at school.
• Seeking input from parents on how the school can better support their child.

Managing the risk of exposure to allergens

It is vital to ensure that the risk of exposure to allergens is managed effectively in schools in order to ensure the safety of pupils who have allergies. By having clear plans in place, schools can significantly reduce the risk of exposure to allergens and create a safer environment for all students. This can be done by ensuring that:

• Staff are adequately trained.
• Medical records are kept up to date.
• Each child with an allergy has their own personal plan and this is kept up to date.
• Effective communication between schools, parents and health professionals is prioritised.
• School caterers are adhering to their own rules and regulations around allergy management.
• Clear protocols are established to prevent cross-contamination in food preparation areas.
• Parents are encouraged to provide snacks that are free of common allergens or to follow guidelines provided by the school.
• Policies are established and enforced regarding food in classrooms/on school premises. Try to have allergen free zones.
• Allergy precautions are extended to off-site events and field trips.
• Education is provided for other students about allergies and how they can protect their peers who have allergies.
• Emergency response protocols for allergic reactions are developed and regularly reviewed.

Having a serious allergic reaction can be a traumatic experience for young children and this can affect the whole family. It can be particularly difficult with food allergies as eating is an essential part of daily life and finding food that’s safe to eat can be a challenge. There are things parents can do to help their child cope in managing their allergies particularly if they are struggling emotionally: 

• Becoming well educated about allergies can help parents to reduce their own anxiety as they will then understand the risks and how to manage them. It is important to feel as confident as you can about the process of managing your child’s allergy.
• Only reliable sources of information such as health charities should be used and discussing any concerns with a health professional.
• Try not to create fear in your child when helping them to understand their own allergy and how to manage it. How you talk about allergies in front of your child is also important. The aim is to help your child feel able to manage their allergy and speak up for themselves when you are not around.
• Try to involve your child when talking to other people about their allergies.