Currently schools are required to have a medical conditions policy. Many also have a first aid policy. In some instances these call out allergies explicitly, however there’s no legal requirement for them to do so. In our recent Teacher Survey, over 1/3 of teachers didn’t have or weren’t aware of policies relating to allergies. Of those who did, many described the policy as being a small mention within another policy.

Policies are important documents that explain each school’s approach to the specified topic. They outline roles, responsibilities and protocols clearly and transparently – often available on a school’s website. This means there’s a shared understanding of what happens for all school staff and for parents.

Anaphylactic allergic reactions typically take place in seconds and minutes, where every second counts. Having an understanding of what to do in an emergency – who to contact, what the process is, and what measures the school has in place is crucial. It’s why we don’t believe allergy policies can be a ‘nice to have’.

In 2019, the Department for Education recognised the need for a standalone allergy policy in English schools and supported British Society for Allergy and Clinical Immunology (BSACI), the Medical Conditions in Schools Alliance, Allergy UK and Anaphylaxis UK, in the production of a Model Policy for Allergy Management at School. The guide is designed to support schools to develop a ‘Gold Standard’ policy to manage children’s allergies safely so that children and their parents feel reassured that a robust policy is in place. The Model Policy for Allergy at School draws on lessons learnt from Prevention of Future Deaths reports where children have sadly died as a consequence of anaphylaxis while they are at school. They are intended as a standalone section included within a school’s medical conditions policy, referred to as an ‘Allergy Policy’.  An allergy policy must be read in conjunction with the schools’ Health and Safety Policy as the management of anaphylaxis is integral within the management of First Aid.

There are several reasons why allergies should be elevated above other conditions in having a standalone policy, or a specific section called out within a school’s Medical Conditions Policy. These are:

• Allergic disease is the most common chronic condition among children in England
• Allergies have the potential to cause an anaphylactic reaction – in this instance a child can become severely unwell within minutes, with four recorded instances of fatality in school. Allergy is one of only two conditions where there is combined prevalence and severity
• There is often still a belief that allergies, particularly those where a child does not carry an adrenaline autoinjector, are dietary rather than medical – meaning there’s no explicit link between a child with allergies and the medical conditions policy.

We ask that it is made mandatory for an Allergy Policy to be in every English school, whether as part of a Medical Conditions or First Aid Policy or as a standalone, but for it contain details of what should happen in terms of emergency response in an Anaphylaxis Action Plan.

In 2017, The Department for Education has issued Statutory Guidance and Departmental Advice (best practice) on “Supporting pupils at school with medical conditions“. The governing body of a maintained school, proprietor of an academy and management committee of a pupil referral unit must have regard to the Statutory Guidance in this document. This means that they must follow it unless there is a good reason not to. A key aspect was to develop, implement and regularly review a medical support policy. Contained therein, should be details regarding the development of individual healthcare plans (IHPs) for pupils with a medical condition, along with clear roles and responsibilities of those supporting them.

Section 100 Children and Families Act 2014 places a statutory duty on governing bodies of maintained schools, academies and pupil referral units to make arrangements at school to support pupils with medical conditions. A child’s mental and physical health should be properly supported in school, so that the pupil can play a full and active role in school life, remain healthy and achieve their academic potential.

Individual healthcare plans provide clarity about what needs to be done, when and by whom, in order to support a child’s medical condition. An individual healthcare plan might be appropriate if a medical condition:

• is long-term and complex;
• fluctuates;
• is a recurring condition; or
• there is a high risk that emergency intervention will be required.

It is down to individual schools to recognise allergy as a medical condition and put appropriate measures in place. Recent data show that schools do not always recognise allergy in this way. A national survey of 244 teachers carried out by the Benedict Blythe Foundation in the autumn of 2023 found that teachers lack clear allergy information about pupils in their care, receive inadequate training, and rely on their own initiative to adopt inclusive practice. Key findings include that 40% of teachers reported not having access to an individual healthcare plan for a child with allergies. Many schools still perceive allergies (particularly non-IGE allergies) to be dietary rather than medical.

There have been four known deaths from Anaphylaxis within a school setting 2016-2021. Prevention of future deaths reports consistently call for care plans to be made available and updated for each child. One report states ‘[it’s a matter of concern that] care plans are not in place for pupils that require them…That there are delays in issuing care plans. Care plans need to be issued quickly where a child has an allergy.’(Report to Future Deaths 2017). It’s therefore concerning that this recent survey shows 2 in 5 teachers does not have access to, or is unaware of, an Individual Healthcare Plan for every child with an allergy.

In a 2023 article in The Guardian, Dr Paul Turner, allergy researcher at Imperial, is asked whether someone’s food allergies could be either mild or serious, he says “That’s rubbish. Allergy is allergy.” The unsettling thing is that every food allergy has the potential to cause an anaphylactic reaction even if someone’s symptoms are currently not too bothersome. Turner’s research has shown it is extremely difficult to predict who will suffer fatal or near fatal anaphylaxis.

Currently many schools are making clinical decisions about whether a child has a ‘severe’ or ‘non-severe’ allergy, using indicators including previous reactions or if they’ve been prescribed an AAI. Teachers are not qualified to be making decisions about whether a child’s future allergic reactions are likely to manifest as anaphylaxis, which is why making it mandatory for all children with a history of allergy to have an IHP is so important.

The DfE guidance also suggests children prescribed AAIs should have two devices with them at school. However, it is now recognised that delays in administering adrenaline arising from problems accessing the child’s AAI device can lead to fatalities. Accordingly, since 2017, new legislation under the Human Medicines (Amendment) Regulations 2017 allows schools to buy two of their own AAI devices, without a prescription. However, guidance explains that these can only be used in an emergency and when the child’s own device is unavailable (Department of Health, 2017).

The “spare pens in school” (2023) website has been set-up to support schools, parents, pupils/students and healthcare professionals in implementing the guidance to support children with food allergies in schools, and, where appropriate, the use of emergency “spare” AAIs. Several different brands of AAI exist. EpiPens cost upwards of £50 each and EpiPen® Junior has a maximum shelf-life of 19 months. No Government funding is available to subsidise these purchases, nor to help train school staff regarding the administration of adrenaline. Indeed, writing in the medical journal Clinical and Experimental Allergy in 2019, two leading UK allergy specialists, Paul Turner and Adam Fox, reported that most schools had not taken up the opportunity to obtain spare AAIs and the level of staff training was well below what is considered acceptable (Turner et al., 2020).

In schools, 30% of allergic reactions take place in children with no known history of allergy. It’s therefore not always possible to rely on a child’s own AAI. Almost 8000 deaths in 2018 mentioned anaphylaxis on their death certificate, showing how significant allergy is.

We are asking that spare pens be made mandatory in English schools, with full funding for schools, similar to the roll-out of defibrillators in 2023 in memory of Oliver King.

We want training on administration of AAIs to also be mandatory for all school staff, to ensure they’re confident in responding quickly in an emergency.

In our 2023 Teacher Survey, only 4% of respondents had received training on allergy awareness and management beyond emergency response. This means that they are faced with having to make daily choices about what is safe and appropriate for children with potentially life-threatening conditions without the knowledge or education to do so.

We are asking for training to be made mandatory on allergy awareness and allergy management, however we also ask that a consistent framework for what this training should include is implemented so that schools are able to choose providers in the knowledge their training is robust.

We ask this training is fully funded for all teachers and school staff, with regular CPD.