Allergy & Anaphylaxis Australia tackles life-threatening allergies in high schools
If you speak to the ever-increasing number of parents of children with food allergies, they openly communicate that starting kindergarten, school and certainly high school are major milestones that are often overshadowed by some fear and anxiety. As parents “let go” and entrust the care of their children at risk of anaphylaxis to others, there is an underlying unrest as they know they can never entirely eliminate all dangers. This unrest is what spurs on schools, parents and Allergy & Anaphylaxis Australia to take every manageable precaution possible to reduce the risk of anaphylaxis.
While parents and schools can take a deep breath and remind themselves of the rarity of anaphylaxis-related fatalities, the reality is that despite being an uncommon occurrence, fatal reactions are reported. Recent fatalities in Australia and around the world show that teenagers and young people are a high-risk group.
President of Allergy & Anaphylaxis Australia, Maria Said, says many people manage the risk of anaphylaxis in school and outside of school very well each day. “This does not mean they have never been subject to a severe reaction,” says Maria. “However, when it does happen (and it will), they and those caring for them are well prepared to recognise what is happening and can administer their adrenaline autoinjector (EpiPen® or Anapen®) according to their ASCIA Action Plan for Anaphylaxis.”
First steps in choosing a high school Parents of children at risk of anaphylaxis should start researching a high school placement well in advance. Attending open days, reading a school’s website information and a phone call to the school office are the first steps, but not enough to assure peace of mind.
Parents should make an appointment to meet face-to-face with a school representative to discuss allergy management at a school community level, school staff level and individual student level. Discussions must include staff training (all school staff), classes and other activities such as food technology, excursions, sporting events and school camps, which pose an increased risk. Peer education, strategies to reduce risk, school emergency response plans and, of course, an individual Health Care Plan should also be spoken about at length. Schools need to be familiar with the requirements of the NSW Anaphylaxis Procedures for Schools (www.schools.nsw.edu.au/media/downloads/schoolsweb/studentsupport/studenthealth/conditions/anaphylaxis/guidelines/anaphylaxis-procedures.pdf).
“Parents tend to breathe a sigh of relief when they discover that a school has had a student at risk of anaphylaxis in their care before. They feel that this assures them that the school is fully equipped to manage, should their child experience a reaction,” says Maria. “However, this relief should only be felt once there has been extensive conversation regarding the many aspects of management and current policies and procedures.”
How does a school manage a student at risk of anaphylaxis? Management is not simply about asking students not to bring a particular food to school. This approach is often used during primary school, but is rarely helpful in high school, where students are much more independent.
Management of food allergy in secondary school includes:
All high school staff members have a duty of care to do everything they can to keep students safe. Whether a student is seven or 17 years old, their teacher and their school are responsible for implementing strategies that reduce the risk of an allergic reaction and developing a health care plan that includes information on their medically diagnosed allergy, ideas on risk minimisation strategies to reduce the risk of allergic reactions, and an ASCIA Action Plan for Anaphylaxis that helps work through what may be a mild, moderate or severe allergic reaction. School staff must check that an adrenaline autoinjector is always easily accessible. If a student is responsible for carrying their medication, staff and parents should frequently check that this is happening.
Maria says that all staff must know students at high risk of food and insect anaphylaxis by face and know what to do in an emergency. “Duty of care does not sit solely with the class teacher or specific subject teacher. It must be shared among all staff members so that the responsibility and workload is manageable.”
When is anaphylaxis an even greater risk? When Allergy & Anaphylaxis Australia reviewed how or when severe allergic reactions have occurred in school, they found it is often when something out of the ordinary is happening at the school. Anecdotally, severe allergic reactions often occur when there is disruption to the usual school routine. It may be a sports carnival, excursion, school camp, school fun day, a cooking activity or a rewards day. Staff and parents of students at risk must consider added hazards when “other” or “new” activities are planned, including when the class group has a relief teacher. Forward planning and communication helps schools and parents manage the increase in risk.
“It is not reasonable for a teacher who has no knowledge of students at risk of anaphylaxis to be on yard duty, nor is it reasonable for a student to travel by bus to a sport session with a teacher who does not know they have a student at risk in their care,” says Maria. “Likewise, it is not acceptable to have a student at risk in the sole care of a staff member who has not been trained in how to prevent, recognise and respond to a reaction.”
A word on Food Technology The increase in food allergy, especially peanut and tree nut allergy, in recent years is of concern to all schools. Most children with peanut and tree nut allergy will have their allergy for life. This increase in the number of teens at high risk of peanut or tree nut anaphylaxis means we now have a greater number of food-allergic students doing Food Technology classes in high school. This has prompted some to suggest that “kids with food allergy just should not do Food Tech”. Students with food allergies need to learn how to cook like any other student. With forward planning, parental involvement and some sensible strategies in place, the student with a food allergy should be able to easily join their classmates.
While some rules may need to be different, many can be implemented for all. For example, students must bring a container in which to take home cooked food; food cooked in Food Tech must not be eaten on the playground; no sharing of food cooked in Food Tech. As an extra precaution, the student at risk should have their own utensils stored in a covered plastic tub, which are only used by them for the duration of the class.
“Food Tech teachers are in the position to educate students about food allergy,” advises Maria. “Once the basics of food allergy are presented, the teacher can, with the parent and the student, work on safety strategies to help reduce the risk of an accidental allergic reaction. This could include the student with milk or egg allergy working with a willing buddy classmate at a bench that is a no-go zone for others using the food allergen/s. If the allergen is peanut or tree nuts, serious consideration should be given to finding alternative ingredients.”
Who is responsible for management in high school? Successful anaphylaxis prevention only occurs when responsibility is shared between parents, the school and the student. Each person or group has a specific role preventing allergic reactions and ensuring that fatalities never occur.
First, the student has an individual responsibility. They should know the signs and symptoms of an allergic reaction, always read the labels of foods that they have purchased from the school canteen, and always be equipped with their adrenaline autoinjector. They must know not to accept food from their peers and, if they feel unsafe during a class activity, they should speak up and voice their concerns.
As parents, your main responsibility is to keep yourself and the school informed of your child’s needs during any circumstance. Parents should work together with the Food Technology teacher to create a safer cooking experience that does not exclude their child, or meet up with event organisers and offer to help with the preparation. It is the school’s responsibility to aid in the prevention of severe allergic reactions and be aware of what action to take when a reaction occurs.
The student at risk of anaphylaxis As children approach their teen years, they need to be building on the skills, knowledge and understandings they already have in order to navigate through life with a serious allergy that could lead to anaphylactic shock. Children and their carers need to understand that small amounts of a food allergen have the potential to trigger life-threatening allergic reactions. “We need to empower individuals at risk from an early age,” says Maria. “We want them to learn to care for themselves and this includes disclosing their allergy to their teachers and peers; telling those serving them food that they have an allergy; taking 20 to 30 seconds to read a food label; and carrying on them their adrenaline autoinjector and ASCIA Action Plan for Anaphylaxis (emergency plan). Teens need to manage their food allergy with adult guidance, support and supervision.”
By the time children reach high school, they need to be managing aspects of their care with the understanding that school staff members are aware and willing to support their healthcare needs.
For more information on managing food and insect allergy, visit www.allergyfacts.org.au or call 1300 728 000. Allergy & Anaphylaxis Australia has many helpful resources to assist parents, children and school staff.