Strategies to reduce risk

Examples of how to reduce the risk of allergic reactions in schools359.5 KB 

Examples of how to reduce the risk of allergic reactions in schools

This document provides schools with examples of strategies to help reduce the risk of exposure to known allergens.

It is recommended that the school decides which strategies in consultation with parents/guardians are appropriate for each student and includes these into individualised anaphylaxis care plans. Schools should also communicate the chosen risk minimisation strategies to staff, parents/guardians and the broader school community.

Food from home

• It is NOT recommended that schools ‘ban’ food and as such schools should not claim to be free of any allergen (e.g. ‘nut free’). An ‘allergy aware’ approach which focuses on implementing a range of appropriate risk minimisation strategies is recommended.
• In cases where the students are of a young age or have cognitive impairments limiting their ability to manage their own food allergies, it may be appropriate to implement allergen-restricted zones to reduce the risk that they will accidentally eat a food allergen. For example, this may be appropriate if there are students eating messy egg meals, grated cheese or drinking milk, so that they are not sitting next to students with egg or milk (dairy) allergy.
• Request that all student lunch boxes and water bottles are clearly labelled with the student's name.
• Educate students and the school community about food allergy so they understand why they should only eat their own food and why they should not share or offer food to students with food allergies.
• In early primary school years, communicate with parents/guardians in classes that have a student with food allergies about not sending ‘messy’ foods that contain the student’s food allergens where possible. For example, sliced cheese is less messy and therefore less risk than grated cheese. Staff need to be aware of students who are eating food that can be messy (such as egg sandwiches, milk in tetra packs or yoghurt tubs) and be prepared to clean appropriately.

Meals and mealtime supervision

Mealtimes

• All students should be encouraged to wash hands before eating (especially children with food allergy).
• All students should be encouraged to wash their hands after eating, especially if they have eaten something that another student in their class is allergic to.
• Hand wipes can be used to remove allergens from hands (and faces) if running water and soap is not available.
• Hand sanitiser should not be used as a substitute to washing hands with soap and water as it does not remove allergens.
• Food, utensils and containers should not be shared.
• Supervision of students eating is recommended in early primary years for students with food allergy. However, students that have food allergy should not be isolated from their peers.
• If using shared platters (such as fruit), give the student with food allergy their own separate serving of fruit on a separate plate.

Canteen/Tuckshop

• It is suggested that all staff preparing and serving food to students undertake All about Allergens for Schools online training so they understand how to select suitable foods for students and staff with food allergy and avoid cross contamination during storing, handling, preparing and serving food.
• A copy of the student’s Australasian Society of Clinical Immunology and Allergy Action Plan (for food allergy) should be displayed in the canteen/tuckshop visible to staff but not students.
• Communicate with the school community regularly through school newsletters, website and social media about how the canteen or boarding school manages food allergies. This can include information about new products or menu items that may or may not be suitable for students with food allergies. Remind staff that the product label must be read each time a student with food allergy is served food or drink.
• Encourage parents/guardians of students with food allergy to discuss menu options and products available with the canteen/tuckshop, or other food providers, when they are ready for others to supply food to their child.
• Provide information about products available to older students with food allergy.
• Consider whether the canteen or boarding school offers foods containing peanuts, tree nuts (such as cashew, hazelnut and almond) or shellfish, as a listed ingredient. These are not essential foods and are easily avoided.
• If using lunch bags for orders, consider using different coloured lunch bags (such as brown/white bags) for students and staff with food allergies to make them more visible, and ask parents/guardians, students and staff to clearly write their name and their food allergy on the lunch bag every time they order.
• If using an online ordering system, ensure all parents/guardians (and older students ordering themselves) and staff to declare their food allergy, so this is recorded against the food order.
• Prepare food for students with food allergy first so their food does not come into contact with other foods being prepared. Food for students with food allergies should be clearly labelled with the student’s name and packaged (wrapped or put into a container with a lid) to avoid cross contamination.
• Foods with precautionary allergen labelling statements (such as "may contain traces of") should not be provided to students allergic to that particular food.
• Thorough washing of kitchen equipment with hot soapy water is needed to remove allergens.
  • When preparing food, clean/separate utensils should be used. If shared utensils are used, they should be washed in hot soapy water or a dishwasher to remove traces of potential allergens.

Indoor activities

• Non-food rewards (such as pencils, stickers, privileges) are encouraged.
  • If food rewards are used, staff should only offer this to a student with food allergy if the parent/guardian has given them permission to do so and ingredients and precautionary allergen statements have been checked for the student’s allergens.
  • Parents/guardians of students with food allergy may provide food treats in a clearly labelled ‘treat box’ for their child.
• Discuss cooking, science experiments using foods, incursions and any other onsite activities involving food with parents/guardians of students with food allergy in advance.
• Games and activities should not involve the use of any foods that students are allergic to.
• Wind toys and instruments (such as whistles, recorders, flutes, saxophones) are high risk. Discuss with parents/guardians the provision of the student’s own instrument if they have a food allergy.
• Avoid using recycled craft items that can contain food allergens (empty plastic milk bottles, egg cartons, cereal boxes, empty peanut and tree nut spread jars, ice cream containers).
• Activities such as face painting or mask making (when moulded on the face of the student), should be discussed with parents/guardians prior to the activity, as products used may contain food allergens such as peanut, tree nut, wheat, milk or egg.
• Some materials (such as play dough) can contain food allergens.
• Discuss options with parents/guardians of students with food allergy (such as using wheat-free flour).
• Check that nut oils have not been used in the manufacturing process.
• If a student with food allergy is unable to use the play dough provided for their classmates, provide an alternative material for the student to use and adequate supervision to avoid cross-contamination.

Food technology

• Encourage the All about Allergens for Schools online training for food technology staff and students.
• Cooking activities can present a risk to students with food allergy as common allergens such as milk, egg and wheat are often ingredients.
• Engage parents/guardians and older students in discussions prior to cooking sessions and activities using food. Where possible, known allergens should be substituted with suitable ingredients – parents/guardians of students with food allergy can provide advice. Where this is not practical, another recipe should be used by the student with food allergy, or a different recipe used for all students. This should be planned well in advance of the cooking lesson so alternate ingredients can be provided/purchased.
• If other students are using ingredients a student is allergic to, consideration must be given to cross contamination risk during preparation and cooking.
• Be aware of all students with food allergy when considering options, as food for one student with food allergy might not be safe for another with a different food allergy.
• It is important to ensure that cooking equipment used by students with allergies has been thoroughly cleaned before and after use, preferably in a dishwasher.
• Remind all students not to share food they have cooked with others outside of the class (such as at recess and lunch time). Students with food allergy should only eat food they have prepared themselves using ingredients they are not allergic to.

Outdoor activities

Insect allergy

• Ensure students with insect allergy wear shoes when outside.
• Have bee and wasp nests removed by a professional.
• Consider poisoning of ant nests if there are students with ant allergy (this should be done when students are not at the school).
• Cover outdoor bins as they attract insects.
• Be aware of bees around water and in grassed or garden areas.
• Keep lawns and clover mowed.
• When purchasing plants, consider those less likely to attract bees and wasps (such as non-flowering plants).
• Specify play areas that are lower risk - away from garden beds, flowering plants, water, or garbage storage areas.
• Do not have open drink containers outside, particularly those containing sweet drinks, as they may attract stinging insects.
• Students with insect allergy should not be asked to pick up litter, even with gloves on.

Tick allergy

• To reduce the risk of tick bites in tick prone regions, students should wear a hat and cover skin when outdoors and remove these before going indoors, where possible.
• They should tuck their pants into their socks and wear long sleeved tops, where possible.
• Consider having an ether containing spray in the first aid kit when engaging in activities in areas where ticks may be present.

Animal allergy

• Some animal feed contains food allergens (such as nuts in birdseed and cow feed, milk and egg in dog food, fish in fish food, peanut butter in dog food, fish in cat food). If possible, source animal feed that does not contain foods students are allergic to.
• Students with egg allergy, should only handle chicks that hatched the previous day or longer (no wet feathers) and must wash their hands afterwards. Further information is available from Allergy & Anaphylaxis Australia.
• Exposure to animals such as domestic dogs, cats, rabbits, rats, mice, guinea pigs and horses may trigger contact rashes including worsening eczema, allergic rhinitis (hay fever) and sometimes asthma.
• Anaphylaxis to animals such as horses or dogs are rare but may occur and should be considered with activities such as “show and tell”, or visits to farms or zoos.

Food allergy

• Consider that the paint/coloured powder used for “colour runs” may contain food allergens. Ingredients of the paints used in colour runs should be sought and avoided if they contain a student’s allergen.
• Do not use sunscreen containing food products (such as nut oils, cow’s or goat’s milk).
• Students at risk of anaphylaxis to food should be provided with gloves or an instrument to pick up the rubbish to avoid skin contact with potential allergens when doing yard duty, or be offered an alternative duty.
• Mulches used for gardens can contain food allergens (such as peanut shells) and mould allergens. If possible, source mulches that do not contain allergens and store in a dry place to minimise the growth of mould.
• Children may be allergic to foods grown in the garden (it is possible to be allergic to any food including fruits and vegetables).

Off-site activities including camps

Excursions

• Complete an anaphylaxis emergency response plan for each excursion.
• Assess how many general use adrenaline injectors need to be taken (along with Australasian Society of Clinical Immunology and Allergy First Aid Plans).
• Ensure all staff are aware of the location of the student’s adrenaline injectors and Australasian Society of Clinical Immunology and Allergy Action Plans, as well as the general use adrenaline injector and Australasian Society of Clinical Immunology and Allergy First Aid Plan.
• Ensure the student at risk of anaphylaxis is in the care of the staff member carrying the adrenaline injector. This staff member should have completed anaphylaxis training.
• Check that high school students who should be carrying their own adrenaline injector/s (as agreed in the individualised anaphylaxis care plan) have their adrenaline injector/s with them.
• Check if the excursion includes a food related activity and if so, discuss with the parents/guardians and plan accordingly.
• Depending on the age of the students and the type of excursion, consider adding a reminder to all parents regarding children with allergies on the excursion form and encourage parents not to include specific foods in lunches (e.g. foods containing peanuts or tree nuts).
• Discourage eating on buses.

Camps

• Complete an anaphylaxis emergency response plan for each camp.
• Assess how many general use adrenaline injectors need to be taken (along with Australasian Society of Clinical Immunology and Allergy First Aid Plans).
• Ensure all staff attending the camp know the location of the camp and the procedure for calling an ambulance.
  • They need to advise the call centre that anaphylaxis has occurred, and adrenaline and transport to a medical facility is required.
  • They should also know where the closest hospital is located, and the ability of ambulance staff to get to camp site or students (e.g. if hiking), including being able to stretcher the person to the ambulance.
• Encourage parents/guardians to provide two adrenaline injectors along with their child’s Australasian Society of Clinical Immunology and Allergy Action Plan for Anaphylaxis and any other medications required.
• It is suggested that all staff preparing and serving food on excursion and camps undertake All about Allergens for Camps online training so that they understand how to select suitable foods for students and staff with food allergy and avoid cross contamination during storing, handling, preparing and serving food.
• Camp organisers need to consider activities (such as cleaning and tidying/packing away) they assign to students on camp. It is safer to have the student with food allergy set tables, for example, rather than clear plates and wipe down tables after eating.
• Avoid using food in activities and games, including as rewards.
• Examples of topics that need to be discussed with parents/guardians in preparation for a camp might include:
• Food options/menu, food brands, cross contamination risks, food service staff training.
• Whether any foods can be removed from the menu (e.g. if a student with a peanut/tree nut allergy is attending camp).
• Whether there is opportunity for the menu to be adapted to accommodate a student with food allergy (such as removing pavlova as an option for dessert if a student with egg allergy is attending and there are other dessert options that do not contain egg).
• What risk management strategies will be in place to manage risk of exposure to allergens that cannot be removed (such as egg, milk, wheat)?
• Possibility of the student’s parent/guardian providing all or some of the food for the duration of the camp if this is considered the safest option (such as students who have multiple or complex food allergies). Appropriate storage and heating of the food needs to be discussed and organised with staff and the camp caterers.
• Allergy & Anaphylaxis Australia has comprehensive information about managing food allergy and anaphylaxis on camp.

Special events

• Students should not miss out on activities because of their food allergy, however they (or the school/class as a whole) may have to do things slightly differently to increase safety.
• Special events are high risk for students with food allergy as staff can be distracted with organising extra activities and students may be distracted. Speak with parents/guardians of younger students and students with complex needs that have food allergy to see if they (or trusted relative) can attend as a helper to supervise the student.
• Consider students with food allergy when planning any fundraisers, cultural days or stalls, breakfast mornings, picnics and other celebrations involving food.
• Liaise with the parents/guardians of the student with food allergy well in advance so they can provide suitable food or adjust the activity to accommodate their child's allergies.
• Students with food allergy should not consume food brought in by other students even if they are thought to be safe.
• Students with food allergy can participate in spontaneous birthday celebrations by way of their parents/guardians supplying a ‘treat box’ or safe cupcakes stored in the freezer in a labelled sealed container to prevent cross contamination.
• Cultural days can be especially difficult for students with food allergies due to the involvement of outside catering (often by parents/guardians). A risk minimisation plan should be put in place for students with food allergies due to the high risk of accidental exposure to a student’s allergen. This should be developed with the student’s parent.
• Be aware that events where food is being provided (such as Father’s Day breakfast) can be a stressful event for parents/guardians of students with food allergy and the student themselves. Try to avoid foods students are allergic to where possible.

Medications, creams and latex

• Any medication administered in the school should be given in accordance with school or education department/sector guidelines; school policy and procedures; and with the written permission of parents/guardians.
• Students in the later years of primary school and secondary school need to be reminded that they should not share medications for conditions such as asthma, period pain or headaches.
• Do not use sunscreen containing food products (such as nut oils, cow’s/goat’s milk).
• Use non-latex gloves in first aid kits and facilities such as kitchens, canteens and the sick bay.
• Food for students with latex allergy should be prepared with clean hands or non-latex gloves.
• A student with latex allergy should not be asked to wear a school latex swimming cap.
• Non-latex balloons should be used when there is a student with latex allergy.
• First aid kits should have non-latex sticking plasters and non-latex gloves available.

This information has been adapted from a table that was initially produced by Allergy & Anaphylaxis Australia (A&AA). To ensure consistency of information A&AA, Australasian Society of Clinical Immunology and Allergy (ASCIA) and the National Allergy Council endorse these anaphylaxis risk minimisation strategies.

Disclaimer

This document has been developed by A&AA, ASCIA and the National Allergy Council and has been peer reviewed by ASCIA members. It is based on expert opinion and the available published literature at the time of review. Information contained in this document is not intended to replace medical advice and any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner.

The development of this document is not funded by any commercial sources and is not influenced by commercial organisations.

Content updated November 2023.