General Recommendations

Identification of Individuals at Risk

Administrators should collect information about a student’s medical condition at the time of registration. Ideally, the review of this information should occur before the new school year as well as before special activities, such as school field trips.

Questions or concerns about changes in a child’s condition or treatment protocol should then be addressed. All school staff, including supply or substitute teachers and volunteers, must be aware of students at risk for anaphylaxis, have access to their allergy information and anaphylaxis plan (as appropriate), and be instructed in the proper management strategies including the correct use of an epinephrine auto-injector.

A process should be in place to ensure that all staff receives regular training.

Anaphylaxis Plan

A comprehensive written school anaphylaxis plan (“school plan”) should be prepared which defines roles and responsibilities and includes information about avoidance strategies, staff training, and emergency protocol.

There should be a communication strategy to ensure that the school plan is understood by the entire school community. A school anaphylaxis plan serves to reduce the risk of exposure to allergenic substances and helps school communities prepare for an emergency situation. It should not imply a guarantee (for example a peanut free environment) or that there is zero risk. School communities should strive to create an environment that is described as “allergy-safe” rather than “allergen-free”.

The school anaphylaxis plan should be reviewed and updated on a scheduled basis.

Roles and Responsibilities

Anaphylaxis management is a shared responsibility that includes allergic children, their parents/guardians, caregivers, and the entire school community.

Parents/Guardians

Parents/guardians should make every effort to teach their allergic children to self-protect. Good safety habits should be established from an early age. They should do the following:

• Must educate the allergic child on avoidance strategies.
• Are responsible for informing the school about the child’s allergies, updating the school on any changes (e.g. diagnosis of an additional allergy, outgrowing an allergy), and providing the child/school with an epinephrine auto-injector which is not expired (parents should keep a log of expiry dates and replace outdated auto-injectors).
• Should complete an Anaphylaxis Emergency Plan which has the child’s photograph and allergy information, emergency contact numbers, emergency protocol, signature of a parent/guardian and, if required, the signature of the child’s physician.
• Should provide consent which allows school staff to use an epinephrine auto-injector when they consider it necessary in an allergic emergency.
• Should not sign a waiver absolving the school of responsibility if epinephrine was not injected.
• For food-allergic children, should provide nonperishable foods (in case child’s lunch is forgotten at home) and safe snacks for special occasions.
• Should communicate with school staff about field trip arrangements.
• Should meet with foodservice staff to inquire about allergen management policies and menu items, if their child is to eat foods prepared at the school.

Children at Risk

Allergic children who have been diagnosed as being at risk of anaphylaxis should:

• Have an auto-injector with their name on it, kept in a readily accessible location which is unlocked.
• Carry their own auto-injector when age appropriate, usually by the age of six or seven.
• Refrain from eating if they do not have an auto injector with them.
• Be very cautious about eating foods prepared by others.
• Not share foods or utensils.
• Wash hands with soap and water before and after meals.
• Wear medical identification, such as a MedicAlert® bracelet which clearly identifies their allergy, or a special badge in the case of very young children in the nursery setting.
• Inform someone (preferably an adult) immediately after accidental exposure to an allergen or as soon as symptoms occur.

School Community

• All school staff should be aware of children who have an allergy that may trigger an anaphylactic reaction and be prepared to treat them in accordance with the emergency protocol. Information about children with life-threatening allergies should be readily available. Many teachers keep a copy of their students’ Anaphylaxis Emergency Plans in their “day book”; this is where important information is organized for substitute teachers.
• School staff must consult with the parent before posting the child’s plan. It should be kept in areas which are accessible to staff, while respecting the privacy of the child (for example office, staff room, lunch room or cafeteria). Older children are often more reluctant to have their plan posted in the classroom where it is visible to all.
• The entire student population should be educated regarding the seriousness of anaphylaxis and be taught how to help their peers. This could be achieved through general awareness sessions in an assembly or a special health lesson. Peers should be taught that bullying and teasing students at risk of anaphylaxis is unacceptable. Bullying and teasing incidents should be dealt with immediately.
• The school should have readily available first-aid kits that contain an epinephrine auto-injector. Schools should consider keeping kits in designated areas where the likelihood of an allergic reaction occurring may be higher, e.g. lunch rooms or cafeterias. Epinephrine auto-injectors come in two dosages (i.e. 0.15 mg and 0.30 mg) and are prescribed based on a person’s weight. (Expiry dates should be checked on a periodic basis, for example September and January.)