Managing common allergies in school
More pupils than ever are heading into school with common allergic conditions such as food allergy, eczema and asthma. There is a lot that schools can now do to support these children and below are some techniques for all involved, and to work together.
What is the best approach to managing allergic conditions in school?
Allergic conditions can significantly impact pupils’ well-being, concentration and academic performance in the school setting. Just on food allergies alone, there will be one child in every UK classroom with the condition, while one-fifth of all severe food allergic reactions will occur inside school gates. There is no room for complacency.1
Effective management requires a collaborative approach involving school staff, parents and carers, and healthcare professionals. For the school’s part, they are responsible for creating a safe, supportive environment and to adhere to statutory guidance and legislation.2 This requires a culture of whole school awareness of allergic disease rather than expecting sole responsibility to lay with the child’s teacher. Best practice therefore requires all staff to be trained in adrenaline auto-injector (AAI) administration, as anaphylaxis can escalate quickly.
Children and young people should never be left alone whilst they are experiencing symptoms of allergy or asthma. To help pupils with allergies, schools should also promote a culture of inclusion and understanding to reduce stigma and discrimination. Every person in the school should understand allergy and their role in keeping others safe. This can be facilitated by delivering targeted training and ensuring age-appropriate allergy awareness is woven into classroom activities. A good example is with the caution that should be taken with cooking lessons in schools, to ensure this does not place a pupil with a food allergy at increased risk or lead to exclusion.
Where should medicines be kept in school?
Children must always have access to their medications both in the classroom and when moving around school or travelling off-site. Ideally, schools should also purchase spare AAIs and inhalers which are stored centrally, but are easily accessible.
All schools can legally purchase spare AAIs from pharmacies at retail price without a prescription.3 Schools can also purchase spare reliever inhalers.4
Every pupil with a food allergy or asthma must have a Management Plan provided by a healthcare professional with a list of symptoms and details of how to manage these.
Allergy management plans
Every pupil with a food allergy or asthma must have a Management Plan provided by a healthcare professional with a list of symptoms and details of how to manage these. Examples include the BSACI Allergy Action and BEAT Asthma Action plans.5,6 These plans should include details of a child’s food allergies and medications needed to manage a reaction. Asthma Plans in particular should include details of common triggers (such as colds, exercise, or pollen), symptoms and how to administer reliever medication. Those children with eczema may also have plans in school.
Individual Healthcare Plan
Management plans may be incorporatedinto an Individual Healthcare Plan. These are completed jointly by the school and parent, and detail any medical conditions and medications needed whilst in school. It should include your child’s medical condition, associated symptoms, medications, and the level of support they require and by whom. It will include written permission from parents for medications to be administered by school staff including spare devices.
What can I do to help my child’s school manage allergy?
You can encourage your child’s school to sign up to The School Allergy Code, drawn up jointly by the Benedict Blythe Foundation and The Allergy Team.7 This was written to guide best practice in achieving a whole school approach to allergy safety and inclusion and outlines the principles of good practice – to take every allergy seriously, offer an individualised approach, and prioritise safety and inclusion. These resources are free.
My child is starting school in September. How can I ensure that schools will know how to manage their condition correctly?
Starting school is a significant milestone and might be the first time you have entrusted your child’s care to someone else. It is worth finding out the policies and procedures the school has in place for pupils with medical needs. You should also ask if staff have received relevant training. It is the parent/carer’s responsibility to inform the school of a child’s medical condition, to provide any medication needed and to replace it when it runs out or expires. If your child is starting school you will have completed a medical form as part of the general school admission procedure which should identify your child as needing an Individual
Healthcare Plan. Do ensure this is in place.
Modifying risks within the school environment
Banning nuts in schools is not recommended.
This is difficult to enforce and does not encourage independence or development of skills required to keep the individual safe as a young adult. It leads to a false sense of security and it is not possible to ban all allergenic foods. Nut allergies are not more severe than other food allergies. Poor air quality can exacerbate allergic symptoms. It is possible to reduce common indoor allergens by limiting carpets and keeping windows closed on high pollen days. Schools should also consider keeping windows closed on peak days. Outdoor activities may need to be modified or rescheduled. Research has demonstrated that young people with hay fever during exam season may achieve a grade lower than predicted, so efforts to reduce exposure to pollen can only help.8 Children with eczema may experience problems with synthetic fibres and wool. Choosing a 100 per cent cotton uniform can make a difference. You may also find it helpful to supply an emollient for use in school. Sitting on a carpet for circle time can be problematic so consider providing a cotton cushion. Eczema can be exacerbated if the classroom becomes overheated. If this is a problem, talk to your child’s teacher to ensure they are not seated near the radiator.
What can I do to try and keep my child safe?
Ensure that your child takes all their prescribed medications regularly. If they have a preventer inhaler for wheeze, make sure that you give this diligently from the middle of August as there is always a rise in asthma and wheeze hospital admissions in late September. It is also important to empower pupils to take responsibility for their own health by teaching self-management skills.
I don’t feel that my school are listening to my concerns. What can I do?
If you are unable to resolve any concerns about the management of your child’s health through discussion with the school and head teacher, you may make a complaint via the school’s complaints procedure who will notify the governing board.
My child is now at Secondary School. How is this different?
Part of a young person’s education is to learn to take responsibility for managing their own health. Older children should be encouraged to carry their own medications at all times, although schools should be mindful to purchase spare pens and inhalers as well. Teenagers should be encouraged to have a copy of their management plan on their phone, and should also add emergency health information so that this is visible on their phone’s lock screen.
Summary
The development of best practice policies and procedures is important in ensuring that pupils with allergic disease are kept safe at school. This involves regular training of all staff, the development of an emergency response plan and embedding allergy into all aspects of school life. A whole school approach ensures a safe and inclusive place where all children and young people can feel secure.
References
1. Murano et al. The management of the allergic child at school. Allergy 2010 June 1;65(6):681-9.
2. DfE. Supporting pupils at school with medical conditions, 2015. https://www.gov.uk/government/publications/supporting-pupils-at-school-with-medical-conditions–3
3. Department of Health (2017). Using emergency adrenaline auto-injectors in schools – GOV.UK
4. Department of Health (2014). Emergency asthma inhalers for use in schools – GOV.UK
5. Paediatric Allergy Action Plans – BSACI
6. Personalised Action Plan – Beat Asthma
7. Safe Schools – Allergy Awareness in Schools | Benedict Blythe Foundation
8. Walker S et al. Seasonal allerg
Dr Deborah Marriage
Consultant nurse for allergy and asthma at the Bristol Royal Hospital for Children
Deb Marriage is Consultant nurse for allergy and asthma at Bristol Royal Hospital for Children where she has worked since 2002. She previously worked in allergy at St Mary’s Hospital, London. Deb has completed the MSc in Allergy at Southampton University and a Professional Doctorate in Health at the University of Bath. Deb is involved in local training programmes for GPs and practice nurses and has recently been involved in setting up a new model of community-based asthma care. She is an advocate for nurse-led services and in promoting the extended role of nurses. She enjoys research and her particular interests are in asthma, heath inequalities, in egg and peanut allergy and in looking at alternative ways of delivering healthcare.
