Reducing the risk of allergic reactions in schools

Up to 8% of children in the UK have a food allergy. On average, most school classes in the UK will have one or two children with food allergy.

Even with the best dietary avoidance, most younger children will have at least one accidental exposure every 2-3 years. Accidental reactions are common: however, most reactions present with mild-moderate symptoms, and do not progress to anaphylaxis – even in children who have had anaphylaxis before.

Fatal allergic reactions are rare, but they are also very unpredictable. In the UK, 17% of fatal allergic reactions in school-aged children happen while at school. Schools therefore need to consider how to reduce the risk of an allergic reaction, in line with Supporting pupils at school with medical conditions:

• Bottles, other drinks and lunch boxes should be clearly labelled with the name of the child for whom they are intended.
• If food is purchased from the school canteen, parents should check the appropriateness of foods by speaking directly to the catering manager.
• Where food is provided by the school, staff should know how to read labels for food allergens and instructed about measures to prevent cross-contamination during the handling, preparation and serving of food. Examples include: preparing food for children with food allergies first; careful cleaning (using warm soapy water) of food preparation areas and utensils. The Food Standards Agency (FSA) has provided useful guidance for caterers which schools and parents may find useful.
• Children should also be taught to check with catering staff and read ingredients labels before buying food. Many children of primary school age are able to do this.
• Food should not be given to food-allergic children in primary schools without parental engagement and permission (e.g. birthday parties, food treats).
• Implement policies to avoid trading and sharing of food, food utensils or food containers.
• Use of food in crafts, cooking classes, science experiments and special events (e.g. fêtes, assemblies, cultural events) needs to be considered and may need to be restricted, depending on the allergies of particular children and their age.
• In arts/craft, an appropriate alternative ingredient can be substituted (e.g. wheat-free flour for play dough or cooking). Consider substituting non-food containers for egg cartons.
• When planning out-of-school activities such as sporting events, excursions (e.g. restaurants and food processing plants), school outings or camps, think early about the catering requirements for food-allergic children, and emergency planning (including access to emergency medication and medical care).

Food bans

Many schools have a policy to ‘ban’ certain foods (such as nuts) from school premises. However, schools should consider:

• Banning a particular food does not stop the risk of accidental exposure and are very difficult to enforce.
• There is no evidence that food bans help reduce the risk of accident exposures, and may result in a false sense of security.
• Food bans often focus on nuts: however many food allergies are caused by other foods such as cow’s milk or wheat. In the UK, more fatal reactions in children are caused by milk than by peanut.
• Food restrictions (as opposed to food bans) may be useful in primary schools, where children are less able to check for themselves what a food might contain, and sharing toys is more common.
• Unlabelled food poses a greater risk of allergen exposure than prepacked foods with precautionary “may contain” labels.
• Children should be taught to check foods themselves as soon as they are able to do so.
• Many schools have successfully made “food allergy” an example of how children can “look after” their classmates.
• It is far safer for a school to be “allergen-aware” than “allergen-free”.

If a school does decide to implement a nut ban, it should never claim to be “peanut or nut free”. Evidence suggests this may lead to a false sense of security about the risk of accidental exposure to peanuts or nuts. A recent editorial in an allergy journal discussing this can be accessed here

School trips including sporting activities

Schools should conduct a risk-assessment for any pupil at risk of anaphylaxis taking part in a school trip away from school premises, in much the same way as is required with regards to safeguarding etc. Pupils at risk of anaphylaxis should have their adrenaline auto-injector(s) (AAI) with them, and staff trained to administer an AAI in an emergency should be available. Under some circumstances, it may be appropriate for “spare” AAI(s) obtained for emergency use to be taken on some trips.