Banning foods or claiming to be ‘nut free’ are ineffective strategies for preventing or managing anaphylaxis in schools. Instead, an ‘allergy aware’ approach is recommended. Banning certain foods, such as peanuts, is not only difficult to enforce in a school setting, but gives students, staff and families a false sense of security. Students can also be allergic to staple foods such as wheat, egg, or cow’s milk which cannot be removed from school environments. Banning one food, such as peanuts, does not protect students with non-peanut allergies.

It is fundamental that staff know which students are at risk of anaphylaxis, and which allergens need to be managed within the school. Schools can minimise the risks identified by implementing appropriate strategies. For example, the school could introduce some food restrictions (this is different to ‘banning’ a food) such as asking families of young students not to pack sticky nut spreads or messy egg sandwiches in lunch boxes.

Schools can also implement an allergy aware approach by informing all students about allergies and therefore how they can keep their friends safe. Students can be educated to not share food with one another and to wash their hands after they eat.

Anaphylaxis management policy and plans

Parents/carers of students with allergies should provide the school with the student’s ASCIA Action Plan, and provide an updated ASCIA Action Plan if there is a change in the student’s allergy.

As outlined above, there are different types of ASCIA Action Plans, however, students with allergies to dust mites, mould or grasses do not require an ASCIA Action Plan as these allergens do not trigger anaphylaxis.

Schools must be prepared to respond appropriately to an anaphylaxis emergency, even for students not previously identified as being at risk of anaphylaxis. In an anaphylaxis emergency, the ASCIA Action Plan or ASCIA First Aid Plan should be followed. After an adrenaline injector has been administered, these ASCIA Plans direct school staff to call an ambulance to transport the student to a hospital for at least four hours of medical monitoring and must not allow the student to stand or walk while waiting for the ambulance to arrive, even if they appear well. For further information on anaphylaxis positioning, visit the National Allergy Council’s online resource.

Adrenaline is the first line treatment for anaphylaxis; therefore, it is crucial the student receives adrenaline as quickly as possible. Students experiencing anaphylaxis are not expected to be fully responsible for self-administration of an adrenaline injector, instead, staff should follow ASCIA Action Plan procedures in an emergency.

If in doubt, ALWAYS administer the adrenaline injector FIRST, and then other medication (as outlined in the ASCIA Action Plan).

In Australia, EpiPen® and Anapen® are authorised adrenaline injectors. Schools should ensure that staff are trained in how to administer both devices, as the Anapen® was only introduced to Australia in September 2021.

Schools should communicate with their school community about anaphylaxis management and the school’s current anaphylaxis management policies. Age-appropriate student education programs should also be implemented.

Medical anthropologist Theresa MacPhail states that “looking after children with food allergies is something that requires collective action,” therefore, it is important that schools regularly communicate with the school’s community. This can be done at the start of each year to remind parents that students with severe allergies attend the school. Communicating more than once each year is encouraged, such as through a notice in the school newsletter or in parent information sessions.

All allergic reactions (where there is risk of anaphylaxis) should be reported to the relevant organisation, typically the state or territory education department.

After an incident, schools should hold debriefing meetings to discuss the incident for emotional processing and to identify areas of improvements. Support (such as in the form of counselling) should be offered to affected students and staff.

Also, after an anaphylaxis incident, the student’s individualised anaphylaxis care plan should be reviewed and updated if required.

Australia does not have a nationally centralised system for collecting standardised anaphylaxis data, so data should instead be reported at a jurisdictional level. Allergy Aware’s incident reporting template for schools can be used by schools to identify potential risks and implement appropriate risk minimisation strategies.

If a packaged food or food provided by the school has caused an allergic reaction, it should be reported to state or territory’s health department, in accordance with Allergy and Anaphylaxis Australia’s Report a Reaction flowchart.