Severe allergies in schools and preschools

Severe allergies present a considerable challenge to early childhood services (ECS), schools, children and families alike.

Symptoms can cause significant health problems for allergic students, leading to absences from school, non-participation in school activities, and increased levels of anxiety.

Some parents may be concerned that an ECS or school setting may be unsafe for their child.

The good news is that even the most severe form of allergic reaction — anaphylaxis — is manageable in most ECS and school settings with good practices and the adoption of approved Anaphylaxis Guidelines.

Allergy New Zealand has developed Allergy and Anaphylaxis Guidelines for Early Childhood Services and Schools.

These guidelines are a part of Allergy New Zealand's Education Kit for Schools and Preschools. There are three different kits available for preschool, primary school and intermediate/secondary school.

For more details on these kits and to buy one, click here.

10-point guide when a student is enrolled with severe allergy

1. Obtain allergy information from parents or caregivers at time of enrolment, e.g. include a question of allergies on enrolment forms.

2. If severe allergy and/or risk of anaphylaxis is indicated, request the parent obtain written medical information from the child’s doctor. This should clearly state what the child is allergic to and include a copy of the allergy or anaphylaxis action plan to be followed in event of a reaction. This needs to be signed by a doctor.

3. Obtain written consent from the parent(s) for:

a) sharing of medical information between the ECS, school, GP and other health professionals as required; and

b) school/ECS staff to administer medication as required by the allergy or anaphylaxis action plan, which has been authorised by the child's doctor.

4. Work with the family to formulate an individual health care plan for the child. If available, include information and support from the school nurse/public health nurse. Assess risks within the school and in EOTC activities, and plan how to minimise risk of exposure to the allergen(s) concerned; and how to implement the allergy or anaphylaxis action plan.

5. Apply for Higher Health Needs Funding (HHNF) if appropriate.

6. Arrange training for all relevant staff about allergy and anaphylaxis, and include allergy as a topic in the school health curriculum if possible.

7. Ensure training on anaphylaxis, including the use of an EpiPen and emergency response, for designated staff — e.g. the child's teacher — from an appropriately trained healthcare professional.

8. Ensure anaphylaxis/allergy action plan for the child is completed and clearly displayed in commonly used areas of the school or ECS.

9. Parents should supply medication in a clearly named and labelled container (with a photo of the child on the label) to be stored in an unlocked, central location, and/or ensure the child is carrying the medication as per the agreed health plan. Parents should also ensure the medication is kept up to date and/or replaced if used.

10. Annually review and update medical information, health care plan and Allergy or Anaphylaxis Action Plan for the child; and refresh staff training.

Risk management suggestions for schools

Each child with severe allergies will have individual needs. This section provides some risk management suggestions for common school/ECS scenarios.

Issue: Relieving teachers

• Can they identify the allergic children in the class?
• Are they trained to recognise the signs of an allergic reaction/anaphylaxis?
• Do they know what to do if a child is having an allergic reaction?
• Who is responsible for relieving teachers’ education?

Suggestion: A copy of the action plan could be inside the roll and on the wall in the classroom.

Issue: Extra teachers

• Assuming that the main teacher is properly trained, are the other teachers (eg art, computer) trained and do they know which are the allergic children in the class?
• Who is responsible for making sure they are prepared?
• Do they use any equipment that would put the child at extra risk?

Suggestion: All staff should have an annual refresher on dealing with food allergies. The public health nurse or school nurse may be the one who responsible for delivering this.

Issue: Duty teachers

• Can they identify the allergic children in the playground?
• Are they trained to recognise the signs of an allergic reaction/anaphylaxis?
• Do they know the emergency procedures?
• Who is responsible for making sure they are prepared?

Suggestion: All the allergic children’s photos should be in the staff room with a list of their allergies so that all staff are familiar with them.

Suggestion: In some schools the duty teacher has a small laminated photo of each of the children with allergies on a key ring, which they carry round in their duty bag, so they can readily identify any children in the playground if they are unwell.

Issue: Morning tea

• Who is responsible for making sure that the children are safe?

Suggestion: A teacher aid could supervise and then have some extra free time later on.
Suggestion: The duty teacher could make a point of checking on the at-risk children.
Suggestion: Set up a buddy system for at risk children. They can help with keeping their friend safe and alerting staff if something is wrong.

Issue: Lunchtime

• Who is responsible for making sure that the children are safe?

Suggestion: The duty teacher could check the children sitting around the allergic child to see if anyone had dangerous food.

Issue: Insect sting allergy

How will the school minimise risk to those at risk of anaphylaxis to insect sting (eg bee wasp)

Suggestion: Keep lawns mowed; keep rubbish bins covered; check food is covered when eating outside; child should wear shoes at all times (etc – per guidelines)

Issue : Wet lunch time

• Who is responsible for making sure that the children are safe?
• What procedures are in place to ensure adult supervision of eating times?
• How will the food be contained (eg food dropped on the carpet)?
• Is the child kept safe in a way that doesn’t ostracise them or set them up for bullying?
• Who is responsible for training wet day monitors?

Suggestion: The children could sit on a big plastic mat which is taken out and cleaned after lunchtime.The allergic child would sit on the edge of the mat or on a chair.
Suggestion: The children sit at their tables which are cleaned down at the end of the lunchtime.There is no wandering around with food. The allergic child sits at a table with others who have “safe” food.
Suggestion: If the classroom teacher is unavailable a teacher aid could supervise eating time and then have some extra lunch time in the afternoon.
Suggestion:The class could all eat in another room so that their classroom is kept clean and safe.They would still need to be supervised.

Issue: Bullying

• Is the child kept safe in a way that doesn’t ostracise them or set them up for bullying?
• Who is responsible for ensuring the child is able to participate in all activities with their peers?
• Who should the child go to if they feel bullied?
• Who should the parent go to if they feel their child is unsafe through bullying?

Suggestion: The school set up a strict no-bullying policy that incorporates safety issues for children with allergies.

Issue: Responding to a reaction in the classroom

• Is there a procedure for dealing with a reaction in the classroom?
• If the child is sent to the sick bay who will go with them?
• If a child is too sick to go to the sick bay what will happen?

Suggestion: The public health nurse could help write this procedure.

Issue: Responding to a reaction in the playground

• Is there a procedure for dealing with a reaction in the playground?

Suggestion: The public health nurse could help write this procedure.

Issue: Hand washing

• Is food residue being spread by unclean hands?

Suggestion: Children can be encouraged by their teachers to wash and dry their hands after eating.
Suggestion: All children have to wash and dry their hands before they come back into the room after lunch or morning tea. If there is a sink in the classroom hand washing could take place there.

Issue: School trips

• Who is responsible for carrying the medicine and supervising the child?
• Are they trained in administering the Epipen?
• Is the trip to a remote area and if so, how long would it take for a life-support ambulance to reach you?
• Are there policies and procedures for keeping allergic children safe on a school trip?

Suggestion: If travel is by bus there should also be a car available in case of emergencies.
Suggestion: Check where the nearest life support ambulance service is (Rescue Helicopter service may be necessary).
Suggestion: if the parent is available they could be included as parent help.

Issue: After-school care

• If a parent is unavoidably late is there a safe place for the child to wait?
• Who will make sure they are sent to the right place?

Concern: if they are sent to after-school care will they be given food?
Suggestion: they could wait in the staffroom or at the office.

Issue: Food in lessons

• Is food used in lessons?
• Who is responsible for making sure that food is used in a safe way?

Suggestion: The parent should be included in planning this kind of activity. They are more likely to identify risks and may be able to think of alternatives.

Issue: Contaminated equipment

• Are food containers (eg yoghurt containers, egg cartons) used in lessons?
• Who is responsible for making sure that unsafe equipment is not used?

Suggestion: Check with the parents.
NB Egg cartons are not safe unless they have come straight from the factory and have never been used. Dairy containers can be safe if they have been through the dishwasher.

Issue: Cooking in class

• How can cooking be done so that the allergic child is included and safe?
• Who is responsible for making sure that all ingredients are safe and there is no cross-contamination?

Suggestion: Ask the parents for recipe ideas and to check ingredients. They might be able to come and help.

Note: It’s easy to bake without milk or eggs if you know how.
Note 2: All ingredients must be checked. Bulk bins are not safe. Raisins may have nut traces.

Issue: Shared food

• Is there any shared food (eg birthday cakes)?
• Who is responsible for making sure the allergic child doesn’t eat the unsafe food?
• How can the allergic child be made to feel included?

Suggestion: If advance warning is given to the parent, they may be able to provide a safe alternative.
Suggestion: The parents can have a “treat” box kept in the classroom so that the allergic child always has something nice to eat when the others are eating.

Issue: Educating classmates

• Who is responsible for making sure that classmates are educated about allergies?
• Do they know how to help keep their classmate safe?
• Do they know when and how to get help if their classmate has a reaction?

Suggestion: A note can be sent home informing the families of the other children about the child’s condition.
Suggestion: Allergy New Zealand has a range of DVDs and books for children that can be used in class.
Suggestion: Allergy New Zealand has a poster about keeping your food-allergic friends safe which should be on the wall.
Suggestion: Some schools have run allergy drills – this could be part of general first aid education.
Suggestion: Some parents would be willing to help with this.

Food allergen labelling guide

You can download our food allergen labelling guide, which gives you a list of words to look out for on ingredients labels and potential hidden sources of allergens.

Click here.