1 Trinity 2018 ALLERGY AND ANAPHYLAXIS MANAGEMENT POLICY POLICY STATEMENT Scope SHSK recognises that students, parents, visitors and staff may suffer from potentially life- threatening allergies or intolerances. SHSK believes that the safety and wellbeing of those members of the school community suffering from specific allergies and who are at risk of anaphylaxis is the responsibility of the whole school community. The School position is not to guarantee a completely allergen free environment, rather to minimise the risk of exposure through: hazard identification, instruction, information, encourage self-responsibility, and plan for an effective response to possible emergencies.

SHSK is committed to:  Providing, as far as practicable, a safe and healthy environment in which people at risk of allergies and anaphylaxis can participate equally in all aspects of the school program.  The encouragement of self-responsibility and learned avoidance strategies amongst students suffering from allergies.  Raising awareness about allergies and anaphylaxis amongst the school community.  Ensuring each staff member has adequate knowledge of allergies, anaphylaxis and emergency procedures.  Close liaison with parents/guardians of students who suffer allergies, to assess risks, develop risk minimisation strategies, and management strategies for their student.  Facilitating communication to ensure the safety and wellbeing of the person with an allergy who is at risk of anaphylaxis.

 menu planning, food labelling, stores and stock ordering and customer awareness of food produced on site to reduce potential exposure Purpose The aim of the policy is to:  Minimise the risk of an allergic/anaphylactic reaction while the person is involved in school related activities.  Ensure that staff members respond appropriately to an allergic/anaphylactic reaction by initiating appropriate treatment, including competently administering an Adrenaline Auto Injection (AAI) device.  Raise, within the SHSK community the awareness of allergy/anaphylaxis and its management through education and policy implementation


2 BACKGROUND Any allergic reaction, including anaphylaxis occurs because the body’s immune system reacts inappropriately in response to a substance that it perceives as a threat. Anaphylaxis is a severe and potentially life threatening allergic reaction at the extreme end of the allergic spectrum. It can occur within minutes of exposure to the allergen or the reaction may develop over hours. It can be life threatening if not treated quickly with adrenaline. KEY STRATEGIES SHSK will ensure:  The establishment of clear procedures and responsibilities to be followed by staff in meeting the needs of student with additional medical needs.

 The involvement of parents, staff and the student in establishing an individual medical care plan.  Ensuring effective communication of individual student medical needs to all relevant teachers and other staff  Ensuring First Aid Staff training includes anaphylaxis management, including awareness of triggers and first aid procedures to be followed in the event of an emergency.  Parents of students who send their daughter to school with food are be requested to give careful thought to eliminating food that may be of risk to those members of staff and students who suffer from such allergies.

 Students are reminded of the need to avoid bringing food into school that could be hazardous to others and to label home-made food in events such as cake sales. [Clarification from Admissions/Director of Students[ Nut Related Aspects  Due to the fact that nuts and legumes are the food groups which can cause the most severe reaction when only a trace amount is ingested, the catering staff eliminate nuts, legumes and food items with nuts or legumes as ingredients from meals as far as possible. This does not extend to those foods labelled “may contain traces of nuts/legumes”.

 Students are encouraged to self-manage their allergy as far as possible in preparation for life after school where nut-free environments are rare. Dairy and Egg Related Aspects  Students with dairy product or egg allergies are managed by the School in consultation with the parents on a case by case basis. Insect Related Aspects  Diligent management of wasp, bee and ant nests on School grounds and proximity. This must include the effective system for staff reporting to management, and a system of timely response to eradicating nests.

 Education of staff and students to report any above normal presence of wasps, bees or ants in all areas of the school.


3 Latex Related Aspects  If a student is allergic to latex teachers will be aware that they should avoid contact with some everyday items including, rubber gloves (unless latex free), balloons, pencil erasers, rubber bands, rubber balls, and tubes and stoppers used for science experiments. ALLERGEN AWARENESS/AVOIDANCE The School will promote food allergy information (including anaphylaxis) through, Food and Nutrition lessons in particularly in classes where a student has a severe allergy to food products.

While the aim is to significantly diminish the risk of accidental exposure to known food and other allergens it can never be completely removed. EDUCATIONAL VISITS The Trip/Event Organiser will follow guidance in the trips and visits folder and check with any food provider to identify the need for ‘safe’ food to be provided. They need to consider areas of potential risk and methods of control to minimise risk of exposure for students with allergies. Where a student is prescribed AAI, the Group Leader will ensure they or another supervising staff member is trained in first aid and the administration of AAI. The group leader or other designated member of staff are responsible for checking that the student has their allergy medication with them before leaving the school premises. If they do not possess it then the student may not take part in the activity. If a student arrives at a meeting venue without their medication the student will not be able to join the activity until such time as the medication is provided.

Parents should ensure the Student has a labelled, in date AAI for the visit, and that the student will be responsible for its security. A designated member of staff on the trip/event will have the back-up AAI for the specific student(s) as supplied by the Health Centre. If in doubt over the risk of a student with an allergy taking part in an educational visit, the Trip/Event Organiser should seek advice from the Parent, School Nurse and Director of Students. MANAGEMENT OF ALLERGIES High Risk of Anaphylaxis Parent informs School in writing via Admissions Parents complete Health Care Plan as sent by School Nurse Student photo added and document saved on iSAMS Medical Centre List of students carrying AAI amended and distributed to Staff Room, PE, Drama, Music and Reception Parents required to provide 2 AAIs one to be kept with student, the other in the Health Centre.


4 RESPONSIBILITIES Parents are responsible for:  Providing ongoing, accurate and current medical information in writing to the School. Whilst the school will play a role in reminding parents when information requires updating this responsibility lies wholly with the parents.  Completion of the Student’s Health Care Plan (see Appendix A for Example Care Plans relating to three types of AAI, and Allergy Form). Note those who have not been prescribed an AAI will be required to complete the BSACI form for non AAI users.

 Providing the School with updated information via a Student’s Health Care Plan at the commencement of each calendar year. Should a student develop a condition during a year, or have a change in condition the parents must advise the School of the fact, with details to be clarified in the Student Health Care Plan.  Ideally, providing written advice from a doctor, which explains the student’s allergy, defines the allergy triggers and reaction, and any required medication, including completion of an action plan with supporting photographic or other evidence.  Supplying AAIs and medication at the start of the school term or as soon as an allergy is diagnosed if during the school year.

 Ensuring medication is replaced as necessary i.e on change of dose or use by date.  Ensuring all medication has the original pharmacy label attached stating the student’s name, date of birth and dose.  Highlighting any classes/topics or activities which in the parent’s view may need to be avoided or flagged up as ‘high risk’ e.g food preparation in Home Economics or use of certain materials (eg latex) in science lessons.  Providing appropriate foods to be consumed by the student if necessary.  Ensuring an appropriate medical pack is with the student prior to embarking on a school trip Parents should also teach their daughter with allergies to:  Recognise the first symptoms of a food allergic/anaphylactic reaction  Communicate with school staff as soon as she feels a reaction is starting  Carry his/her own AAI where appropriate  Not share snacks, lunches, drinks or utensils  Understand the importance of hand washing before and after eating  Report to the Health Centre or Trip Organiser promptly when he/she feels an allergic/anaphylactic reaction is beginning The parents and the student’s medical adviser are responsible for teaching the student to manage their allergy in the school setting.

The School’s Health Centre is responsible for:  Contacting parents for required medical documentation regarding a student’s allergy and informing the Director of Students where important information is lacking. (The responsibility lies with parents to ensure this information is provided). Should


5 information not be forthcoming, the student will not be allowed in School or on any school trip or out of hours event.  Ensuring that there is an effective system to regularly update and disseminated medical information to staff and others  Ensuring that parents are reminded of their responsibilities to provide a current Allergy Action Plan and appropriate medication  Ensuring that where students with known allergies are participating in external visits, the risk assessment and safety management plans for these external visits include the Student’s Health Care Plan  Ensuring that first-aid staff are trained in the use of AAIs and management of anaphylaxis and that similar training/information is provided periodically to all other staff Teachers are responsible for:  Acquiring knowledge of the signs and symptoms of severe allergic reaction  Being familiar with information provided in the student health care plans, be aware of and implement the emergency plan if a reaction is suspected  Participating in nurse led training about students with life-threatening allergies including demonstration on how to use the AAI  Determining suitable protocols regarding the management of food in the classroom (particularly in high-risk subjects) in collaboration with the Principal Teacher and Health Centre. This protocol will be communicated by the teacher to the students of the class  Reinforcing appropriate classroom hygiene practices eg. hand-washing before and after eating or tasks potentially leading to contamination  Responding immediately to reports of students being teased or bullied about their food allergies  Follow Allergy Action Plan and call 999 when life-threatening allergy related symptoms occur Catering Staff are responsible for:  Ensuring suppliers of all foods and catering are aware of the school minimisation policy  Ensuring supplies of food stuffs are nut free or labelled “may contain nuts” as far as possible  Being aware of students and staff who have severe food allergies  Clear labelling of items of food stuffs that may contain nuts  Producing accurate menus in support of those with severe allergies at least one week in advance and publishing them on the SHSK Parent Portal EVALUATION The School Management Team shall:  Get feedback from staff following their participation in allergy/anaphylaxis management training  Audit enrolment documentation to ensure it is current and complete  Discuss this policy and its implementation with parents/guardians of students at risk of allergy/anaphylaxis and gauge their satisfaction in relation to their students


6  Respond in a timely and appropriate manner to any complaints received in relation to this policy  Review the adequacy of the response of the school if a student has an allergic/anaphylactic reaction and consider the need for additional training and other corrective action. The Health Centre shall: Conduct “anaphylaxis scenarios” and supervise practice sessions in administration of adrenaline auto-injection devices to determine the level of staff competence and confidence in using the device.

 Routinely review each student’s auto-injection device to ensure that it remains complete and is in date  Liaise with the students/parents at risk of anaphylaxis Parents/guardians shall:  Read and be familiar with the policy  Identify and liaise with the nominated staff member  Bring relevant issues to the attention of the school Many children with allergies experience respiratory symptoms which may respond to salbutamol. If salbutamol is listed as a treatment in a student’s allergy care plan this should be offered or administered in an emergency. We therefore require that all students who have been prescribed salbutamol carry it on their person at all times, and we also require consent for Emergency Salbutamol (see Appendix B).

Policy last reviewed . Trinity 2018 Next review due . Trinity 2019 Person responsible for review . Bursar/Senior Nurse Audience . Staff/Parents/Pupils

A Appendix A SHSK Allergen Policy Dated Trinity 2018 FOOD AND NURTITION – USE OF ALLERGENS Nuts are not used in Food and Nutrition, although other allergens may be used. Management  Girls with food intolerances and allergies are identified in: a) Teacher’s mark book (once confirmed by health centre and individual student during H+S induction). b) On the room layout/student location plan. c) Photograph display in the home economics office (supplied by the health centre).  Girls AAIs must show their injector before they enter the home economics room.  All students wash hands on entering the room before practical work commences and are expected to wash hands regularly throughout the lesson.  Separate storage areas for cooked/prepared foods are used, including fridges.  Separate ovens and grills are used to minimise cross-contamination.  When food is made and consumed within the lesson, separate cutlery and crockery are used by all students for this purpose. Following consumption and handwashing, all items are sanitised thoroughly in the dishwasher.

Gluten intolerance  When necessary, students with allergies to gluten work in the restricted zone of the kitchen. Coeliac disease  Girls with a coeliac disease condition use their own ‘coeliac equipment’ housed in separate and clearly labelled cupboards and drawers.  Following use of the equipment, the student hand washes and dries the items which are then removed and sanitised thoroughly in the dishwasher.

B Appendix B SHSK Allergen Policy Dated Trinity 2018




B Please complete and return to the Senior Nurse by … … Name . Form … . Date of birth … … Is allergic to the following allergens (e.g. nuts, stings etc … . . . How long has your daughter had this allergy … . What symptoms does your daughter experience when she is exposed to this allergen? (e.g. breathlessness, skin reaction etc) … … … . When was her most recent reaction … … How quickly did the reaction occur … . Has your daughter been admitted to hospital as a result of her allergy … … … .

How have you/your daughter been advised to treat a subsequent reaction? (e.g. Epipen, antihistamine, salbutamol, inhaler etc). Please include a copy of your daughters care plan if appropriate. … . Please delete as appropriate: My daughter has not been prescribed an adrenaline autoinjector for her allergy. My daughter has been prescribed an adrenaline autoinjector for her allergy. Do you agree to the above information being passed on to the teaching staff? Yes/No I agree to provide two ‘in date’ adrenaline autoinjectors for use in school (one to be carried by your daughter and one to be kept in The School Health Centre).

Does your daughter know how to use her adrenaline autoinjector? (If prescribed) Yes/No Sign . Date … . Print name … Relationship … . Parent’s address and contact details: . .

B … … Telephone . Email: … …

C Appendix C SHSK Allergen Policy Dated Trinity 2018

F Appendix D SHSK Allergen Policy Dated Trinity 2018 Action to be taken in the event of an Allergic Reaction Mild-moderate allergic reaction Swollen lips, face or eyes Itchy / tingling mouth Hives or itchy skin rash Abdominal pain or vomiting Sudden change in behaviour ACTION Stay with the child, call for help if necessary Give antihistamine (if vomited can repeat dose) Contact parent / carer Appendix E SHSK Allergen Policy AIRWAY: Persistent cough, hoarse voice, difficulty swallowing, swollen tongue BREATHING: Difficulty or noisy breathing, wheeze or persistent cough CONSCIOUSNESS: Persistent dizziness / pale or floppy suddenly sleepy, collapse, unconscious If ANY ONE of these signs are present: 1) Lie child flat. If breathing difficult, allow to sit. 2) Administer the student’s Adrenaline Auto Injector (AAI) if prescribed.

3) Dial 999 for an ambulance say ANAPHYLAXIS (ana-fil-ax-is) If in doubt administer the student’s AAI if prescribed. After giving AAI 1) Stay with child, contact parent / carer 2) Commence CPR if no signs of life 3) If no improvement after 5 minutes , administer AAI again. Additional Instructions: If wheezy and salbutamol has been prescribed for the student, give 10 puffs salbutamol (blue inhaler( via spacer) and dial 999 for the student, give 10 puffs salbutamol (blue inhaler( via spacer) and dial 999 Watch for signs of ANAPHYLAXIS (life threatening allergic reaction)

F Dated Trinity 2018 Major Allergens Celery. This includes celery stalks, leaves, seeds and celeriac. Celery is commonly found in salt, salads, some meat products, soups and stock cubes Cereals containing gluten. Wheat, rye, barley and oats are often found in flour, baking powder, batter, breadcrumbs, bread, cakes, couscous, meat products, pasta, pastry, sauces, soups and fried food. Crustaceans. Crabs, lobster, prawns, scampi and shrimp paste. Eggs. Cakes, meat products, mayonnaise, mousses, pasta, quiche, sauces and pastries. Fish. Pizza, relishes, salad dressings, stock cubes, Worcestershire sauce. Lupin. Flour, seeds, bread, pastries and pasta.

Milk. Butter, cheese, cream, milk powders, yoghurt, powdered soup and sauces. Molluscs. Mussels, land snails, squid, whelks, oyster sauce and fish stews. Mustard. Liquid, powdered and seeds. Used in breads, curries, marinades, meat products, salad dressings, sauces and soups. Nuts. (note not peanuts as they are a legume). This refers to nuts which grow on trees, such as: cashews, almonds and hazelnuts. Commonly used in bread, biscuits, crackers, puddings, nut powders, stir-fried food, ice-cream, marzipan, nut oils and sauces. Peanuts. Sometimes referred to as a groundnut as they are legumes and grow under the ground. Often used in biscuits, cakes, curries, puddings, sauces (e.g. satay), groundnut oil and peanut flour.

Sesame seeds. Often found in bread, breadsticks, hummus, sesame oil, tahini and salads. Soya. Found in bean curd, edamame beans, miso paste, textured soya protein, soya flour, tofu, puddings, ice cream, meat products, sauces, vegetarian products and much oriental food. Sulphur dioxide. Often found in dried fruit, meat products, soft drinks, vegetables, wine and beer. Asthmatics have a higher risk of developing a reaction to sulphur dioxide.

F Appendix F SHSK Allergen Policy Dated Trinity 2018 DEFINITIONS  Allergen – A normally harmless substance that triggers an allergic reaction in the immune system of a susceptible person.  Allergy - A condition in which the body has an exaggerated response to a substance (e.g. food or drug). Also known as hypersensitivity.  Allergic reaction – A reaction to an allergen. Common signs and symptoms include one or more of the following: hives, generalised flushing of the skin, tingling around the mouth, swelling of tissues of the throat and mouth, difficulty breathing, abdominal pain, nausea and/or vomiting, alterations in heart rate, sense of impending doom, sudden feeling of weakness, collapse and unconsciousness.  Anaphylaxis – Anaphylaxis, or anaphylactic shock, is normally a sudden, severe and potentially life threatening allergic reaction to food, stings, bites, or medicines though a delayed reaction is possible in certain cases.

 Adrenaline Auto Injector (AAI) – AAI is a syringe style device containing the drug adrenaline which is ready for immediate intramuscular administration.  Minimised Risk Environment - An environment where risk management practices have minimised the risk of (allergen) exposure to a reasonable level. Not an allergen free environment.  Anaphylaxis Health Care Plan – A detailed document outlining an individual student’s condition, treatment, and action plan for location of AAI.  Management System – A record system managed by the person in charge which describes the individual student medical care plans and the particular members of staff who will need to be trained and informed of these plans.