New allergy guidelines to protect children from severe allergic reactions in schools and childcare

Food allergy and anaphylaxis is increasing in Australian children, with up to 1 in 20 school aged children having food allergies [1]. Anaphylaxis is the most severe form of allergic reaction, and the incidence of food-induced anaphylaxis in Australia has risen rapidly over the last decade [2]. New guidelines and resources from the National Allergy Strategy aim to equip schools and children’s education and care (CEC) settings to prevent and manage anaphylaxis.

The National Allergy Strategy has launched best practice guidelines for the prevention and management of anaphylaxis in schools and children’s education and care, including out of school hours care. Developed in consultation with key stakeholder organisations, staff working in the sector and parents, the guidelines are important resources in providing evidence-based information and support to reduce the risk of anaphylaxis, while also enabling children to participate in all activities.

“The reality is that severe allergy and the risk of anaphylaxis is common in the school and children’s education and care settings. Children with known allergies that are at risk of anaphylaxis may have severe reactions, but they can also occur in children not previously known to be at risk of anaphylaxis,” stated Maria Said, Co-chair of the National Allergy Strategy and CEO of Allergy & Anaphylaxis Australia (A&AA). “The new guidelines and supporting resources provide much-needed clarity around best practice.”

“Australia is a leader in this area, however a review of school policies and guidelines across Australian states and territories showed inconsistencies in anaphylaxis prevention and emergency treatment, particularly around the amount and frequency of staff training and incident reporting [1]. These variations create confusion and anxiety for parents and educators in schools, and ultimately put children’s safety at risk. While the sectors have a lot of demands on them, no one wants to live with a tragic incident that could have been prevented,” continued Ms Said.

In schools, there is currently no national mandated approach to training staff in the prevention, recognition and emergency treatment of anaphylaxis and significant variations exist in the approach between jurisdictions and government and non-government school sectors.

In children’s education and care services, the minimum requirements are less than what is required in schools and there is greater variation in the type and amount of training being undertaken. Research has shown that 1 in 10 participating services reported no requirement for staff to undertake anaphylaxis training, which is non- compliant with current national regulations [3]. Staff responsible for preparing, serving and supervising meals in children’s education and care services also have a responsibility for food allergy management, yet there is no requirement for them to undertake food service allergen management training.

To support the adoption of the guidelines, the National Allergy Strategy has also developed a new ‘Allergy Aware’ online hub for staff working in schools and CEC, providing free, evidence-based resources including an Implementation Guide, templates and sample documents, plus links to state and territory specific information. The Allergy Aware hub also includes sections for parents and older students.

Dr Preeti Joshi, a paediatric clinical immunology/allergy specialist and Co-chair of the National Allergy Strategy, says the new guidelines and supporting resources outline what is reasonable and what works.

“It is important to embed consistent standards across all of the environments where children receive care so that everyone is informed and knows what is appropriate and reasonable. As an example, the guidelines might give a school the confidence to discuss appropriate allergy management with a concerned parent, or help a parent discuss what reasonable strategies a school or childcare service should have in place,” said Dr Joshi.

“Trying to completely ban food allergens in these settings simply does not work and is near impossible to enforce. It is not safe or practical to rely on people to not bring food allergens, of which there are many, into a certain environment. A consistent allergy aware approach with age-appropriate strategies is preferred. This includes ensuring staff are adequately trained, especially in the prompt recognition and treatment of an allergic reaction including anaphylaxis,” continued Dr Joshi.

“In addition, a range of appropriate risk minimisation strategies alongside good supervision and open communication is important. Things such as timely administration of adrenaline and correct positioning of the person experiencing anaphylaxis are key factors that can potentially save lives. Standardised reporting of incidents is also critical so we can learn where the gaps are and then work to increase safety. We are prevented from learning and improving after incidents because currently it is not mandatory to report them in schools and childcare services across Australia.”

The guidelines can also be used by overarching education and children’s education and care bodies, when reviewing and updating state and territory legislation, guidelines, policies and procedures to improve standardisation of anaphylaxis management across Australia.

Dr Katie Allen MP, food allergy expert and Member for Higgins – “Australia does not take a back seat when it comes to safety from anaphylaxis in schools and children’s education and care. These guidelines ensure that best practice is standardised across each state and territory. I welcome the work of the National Allergy Strategy in making these guidelines a reality”

The new guidelines and supporting resources are available at www.allergyaware.org.au.

pdfNAS Best practice guidlenes media release226.19 KB

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About the National Allergy Strategy
The National Allergy Strategy (NAS) aims to improve the health and quality of life of Australians with allergic diseases and minimise the burden of allergic diseases on individuals, carers, healthcare services and the community. The NAS is a partnership between the Australasian Society of Clinical Immunology and Allergy (ASCIA) and Allergy & Anaphylaxis Australia, the leading medical and patient organisations for allergy in Australia. For more information about the NAS go to: www.nationalallergystrategy.org.au

Read more: New allergy guidelines to protect children from severe allergic reactions in schools and childcare

Surviving a severe allergic reaction: Three of the most dangerous mistakes

World Allergy Week (13-19 June, 2021) seeks to raise awareness of anaphylaxis, potentially life-threatening allergic reactions that cause approximately 2,400 hospital admissions and approximately 20 deaths in Australia each year. Over 4 million Australians live with allergic disease, and that number is on the rise. During this week, leading allergy organisations are promoting important resources that could save lives, whilst they eagerly await a response to the Parliamentary Inquiry into Allergies and Anaphylaxis.

“For many people, allergic reactions are uncomfortable and unpleasant, but for others they can be life threatening, culminating in anaphylaxis. Most commonly these can be caused by food, insect stings or bites or certain medications. When a person experiences anaphylaxis, a large amount of histamine and other chemical mediators are released into the body, causing an inflammatory response,” said Dr Preeti Joshi, Co-chair of the National Allergy Strategy (NAS) and paediatric clinical immunology/allergy specialist.

“There are few things more frightening than having or witnessing an anaphylaxis. The symptoms can go from bad to worse very quickly. Your blood pressure can suddenly drop, and your airways narrow, affecting breathing. If anaphylaxis isn’t recognised and treated immediately, it can result in serious complications and can even be fatal,” explains Dr Joshi. “It is important to educate yourself about what to do, or not to do, if someone is having a severe allergic reaction. We strongly recommend positioning the patient appropriately, giving adrenaline if it’s available and calling triple zero.”

Three dangerous mistakes people make when responding to anaphylaxis:

To increase community awareness this World Allergy Week, allergy experts provide insight into the common mistakes people can make when responding to severe allergic reactions.

1. Assuming it is not a severe allergic reaction because there is no skin rash or facial swelling

“Many people assume that a person can’t be having a severe allergic reaction if they don’t have a skin rash or swelling, but 1 in 6 people will have no skin symptoms at all. In fact, skin symptoms tend to be a mild to moderate allergic symptom,” said Prof Michaela Lucas, President of the Australasian Society of Clinical Immunology and Allergy (ASCIA) and clinical immunology/allergy specialist. “While it is important to be alert to those symptoms, do not ignore more serious symptoms just because there is no rash, particularly if there has been known exposure to an allergen. Breathing difficulties, tongue or throat swelling, dizziness or collapse are all possible symptoms of anaphylaxis and require immediate attention. ASCIA Action Plans and First Aid Plans for Anaphylaxis provide excellent guidance on what to do in an emergency.”

2. Delaying the administration of adrenaline (epinephrine)

“Many people still believe that taking an antihistamine will prevent a mild to moderate allergic reaction from progressing to anaphylaxis. This is not the case. Antihistamines do not treat the symptoms that affect breathing and blood pressure. Adrenaline is the first line treatment for anaphylaxis - a delay in giving adrenaline can cost a person’s life,” said Ms Maria Said, Co-chair of the National Allergy Strategy and CEO of Allergy & Anaphylaxis Australia (A&AA). “If in doubt, always give an adrenaline autoinjector, such as EpiPen®. These are emergency devices that work to reverse a severe allergic reaction. General use adrenaline autoinjectors can often be found at schools, larger hotels, convention centres or on planes.”

3. Allowing the person to walk (even to or from an ambulance) after having adrenaline

“Anaphylaxis always requires a trip to an emergency department, even if a person appears to have recovered, as they need to be carefully monitored. A common mistake is allowing a person to walk, even to an ambulance or even worse, drive themselves,” said A/Prof Kirsten Perrett, paediatric clinical allergy specialist and Chief Investigator of the Centre for Food & Allergy Research (CFAR). “This is incredibly dangerous because of the impact of anaphylaxis on blood pressure. Walking or standing can take blood away from the heart which could impede resuscitation if required. That is why it is always important to lay a person flat or allow them to sit with their legs outstretched if they are having trouble breathing, but not to walk or stand – this could save their life.”

Read more: Surviving a severe allergic reaction: Three of the most dangerous mistakes

National Allergy Strategy launches first free national food allergy online training for hospital staff

All about Allergens for Hospitals

  • Australia has one of the highest incidences of food allergy in the developed world with around one in 10 infants [1], one in 20 children (aged 10-14 years) [2] and one in 50 adults affected [3].
  • The most recent data shows that food-induced anaphylaxis doubled between 1999 and 2012 [4].
  • Fatalities from food-induced anaphylaxis increase by around 10% each year between 1999 and 2012 [4].
  • Hospitals have a legal requirement and duty of care to provide safe and suitable food for patients including those with food allergies.

Today, a free, potentially life-saving online food allergy training course for hospital staff working in kitchens and on wards has been launched by the National Allergy Strategy, a partnership between the Australasian Society of Clinical Immunology and Allergy (ASCIA) and Allergy & Anaphylaxis Australia (A&AA). This project has been funded by the Australian Government Department of Health. “All about Allergens for Hospitals” is the first nationally standardised training for food allergen management for food service in Australian hospitals.

“The National Allergy Strategy is proud to launch this free training that increases food safety and has the potential to save lives,” says Ms Maria Said, CEO of Allergy & Anaphylaxis Australia and Co-chair of the National Allergy Strategy. “People understandably assume that their food allergies are going to be managed well in a hospital environment because they see hospitals as a safe place. Currently, many hospitals do not have adequate practices in place and this is concerning.”

“Until the death of 13-year-old Louis Tate in 2015, only a few hospitals in the whole of Australia had a food allergy policy. Tragically, Louis’ death was preventable and we know that even since losing him there have been other incidents in hospitals that have been near misses. This new training aims to improve the understanding of both food preparation staff and hospital ward staff about the seriousness of food allergy, and to improve food safety, prevent allergic reactions and ultimately save lives,” continued Ms Said.

Louis Tate had a severe anaphylaxis after he ate a spoonful of the breakfast he was served. This was despite the fact that his mother had communicated Louis’ food allergies multiple times. His family want hospitals to have robust policies and processes in place for providing appropriate foods to patients with food allergy.

The “All about Allergens for Hospitals” training is aimed at all staff involved in the food service chain in a hospital. This includes kitchen managers, kitchen staff, ward managers, dietitians, nurses and other ward staff. They all play an important role in keeping patients with food allergy safe when they are in hospital. The training provides practical information and there are free downloadable templates and resources available from the Food Allergy Training website.

Read more: National Allergy Strategy launches first free national food allergy online training for hospital...

National Allergy Strategy launches first free national food allergy e-training program designed for cooks and chefs

30 July 2019

  • Food allergy rates in Australia are rising, with around one in 20 children (aged 10-14 years) [i] and 2-4 per cent of adults [ii] affected
  • Food-induced anaphylaxis has doubled in the last 10 years, and fatalities from food-induced anaphylaxis increase by 7 per cent [iii] each year

A free, potentially life-saving online food allergy training program for cooks and chefs, funded by the Australian Government Department of Health, has today been launched by the National Allergy Strategy, a partnership between the Australasian Society of Clinical Immunology and Allergy (ASCIA) and Allergy & Anaphylaxis Australia (A&AA).

Developed in conjunction with chefs and cooks with experience in commercial kitchens, “All About Allergens: The next step for cooks and chefs” focuses on food preparation, handling and storage, and highlights the importance of effective communication between the kitchen and other staff and consumers with food allergy.

“Food allergy rates are continuing to rise in Australia, and we know that the majority of fatalities from food-induced anaphylaxis occur when people are eating out,” says Associate Professor Richard Loh, co-chair of the National Allergy Strategy and past President of ASCIA.  “So that is our area of focus with the All About Allergens online training program. We had great uptake of the first stage of the free All About Allergens program for people in the food service industry, so we’ve developed this next stage specifically for cooks and chefs to maximise their understanding of food allergies and hopefully reduce the number of food-induced allergic reactions we see.”

The first All About Allergens online food allergy training program has seen almost 11,000 food service industry workers from all over Australia enrol in the course since its launch in July 2017. This next stage of the training program provides information specific to cooks and chefs and aims to educate them on the safest way to handle, prepare, cook and store food to prevent food-related allergic reactions.

There are two versions of the new training program; one for general food services such as restaurants and cafes, and one for camp food services, such as school camps or sports camps. Free to access for all users and delivered in a convenient online format that can be completed at the user’s convenience, All About Allergens: The next step for cooks and chefs has been developed for anyone providing a food service.

Martin Latter, Group Director of Kitchens for AEG Ogden, who has managed some of Australia’s largest commercial kitchens and has even cooked for royalty, welcomed the new training program, saying, “It can be very difficult to manage all of the different dietary requests that come through a large kitchen, and often customers don’t have any concept of the type of pressure cooks and chefs are under and make requests at the last minute.

“Over my many years of working in large kitchens I’ve often seen little things happen that can put people with food allergies at serious risk, like not using the same utensils across different foods, or wearing gloves for hygiene purposes but not understanding the cross-contamination risk.”

“This training program will go a long way towards minimising the risk of food allergen cross-contamination by spelling out, in simple terms, the best way to reduce risk and help to keep our customers safe. It also provides some great resources and templates that can be used in commercial kitchens to help reduce the risk.”

Maria Said, CEO of A&AA, says “Hospital admissions for food-induced allergic reactions have increased fivefold over the past 20 yearsii, and fatalities from food-induced anaphylaxis are increasing by about 7 per centiii every year. While we know that food allergen management in kitchens needs to improve, we’re certainly not wanting to point the finger at cooks and chefs. What we do want to do is encourage a sense of shared responsibility when it comes to preventing episodes of anaphylaxis and food-related allergic reactions. Customers with allergies are primarily responsible for their health needs and need to advise food service staff about their allergies, preferably in advance, and kitchen staff need to take their food allergy seriously and understand how to manage those requests.”

Jaclyn Jauhianan, a 24-year-old university student who is allergic to honey and at risk of anaphylaxis to tree nuts, is pleased to see more being done to educate those working in food service about food allergies, saying “I dream about the day when I can eat out with my family and friends without having to be on high alert about my allergies even after I disclose them. When I can trust that the kitchen staff have taken my dietary requirements seriously and haven’t just brushed me off as being ‘fussy’. I know it is my responsibility to clearly communicate, but there definitely needs to be more awareness and education about managing food allergies in the food services industry.”

“It really needs to come from both sides,” continues Ms Said. “We urge customers with food allergies to contact the establishment about their food allergy requirements in advance when making the booking, and then to double check with staff when they arrive that their food allergy requirements have been understood and can be managed. We encourage all cooks and chefs to complete the new All About Allergens training course to ensure they understand their role in preventing food-related allergic reactions, including preventable deaths.”

Common causes of food-related allergic reactions in commercial settings

  • Wait staff not communicating the customer’s food allergy to cooks and chefs
  • Food service staff presuming a menu choice is fine without checking ingredients
  • A chef or cook not checking ingredients in a garnish
  • Using utensils across multiple food types, including knives, tongs, spoons, etc
  • Not checking the ingredients label on pre-prepared products, e.g. mayonnaise, tomato sauce
  • Suppliers changing ingredients without informing the kitchen staff
  • Mistakes in communications: e.g. delivering special dietary requests to the wrong customer
  • Customers not informing kitchen staff about their allergy
  • Customers not clarifying whether their request is due to an allergy, an intolerance or that they simply dislike something i.e asking, “Does this have egg in it?”

pdfNAS All About Allergens for cooks and chefs media release 30 July 2019235.81 KB

For further information go to www.foodallergytraining.org.au

Read more: National Allergy Strategy launches first free national food allergy e-training program designed...

World-first national health campaign to help parents prevent food allergies

24 June 2019 

  • World first national health campaign advises parents to introduce common allergy causing foods to babies before they turn one, to reduce food allergies
  • Includes a new online resource Nip Allergies in the Bub that provides parents with a ‘one-stop-shop’ for the latest evidenced-based information
  • In large published studies, researchers found that introducing smooth peanut butter/paste to babies between 4-11 months of age, reduced the rate of allergy by about 80 per cent
  • Optimising eczema management is also important, as babies with eczema may develop food allergies after exposure to foods through their skin

Nip Allergies in the BubAs part of the National Allergy Strategy, Australia’s leading allergy organisations have today launched the Nip Allergies in the Bub Food Allergy Prevention Project - a world first national health campaign to educate parents on how to prevent food allergies, funded by the Australian Government Department of Health. It includes the Nip Allergies in the Bub website, that outlines the most up-to-date recommendations for introducing common food allergens to babies.

“We know that parents, understandably, can be extremely apprehensive about introducing common foods associated with allergies to their babies, but doing so to avoid development of food allergy can actually prevent a lifetime of added stress around leaving children at day-care or school, eating out, assessing allergic reactions for severity, and constant vigilance,” said Maria Said, Co-Chair of the National Allergy Strategy and CEO of Allergy & Anaphylaxis Australia (A&AA).

“The Nip Allergies in the Bub website provides a one-stop-shop for parents explaining what foods to introduce when, how to introduce them and how to recognise if their baby has an allergic reaction,” explained Ms Said. “While some babies will still develop a food allergy despite early introduction of common food allergens, this number will be greatly reduced.”

 “Australia has the highest rate of allergies in the world, with around 20 per cent of the population affected, and the prevalence of food allergies continues to rise” explained Dr Preeti Joshi, consultant specialist in Paediatric Allergy and Immunology. 

“In the past, the advice has been to delay the introduction of common food allergens, such as peanuts, cow’s milk, eggs, wheat, soy, shellfish and fish, particularly in babies with a family history of allergies or other risk factors. However, the most recent evidence tells us that we actually need to be introducing these foods before the age of one to prevent allergies from developing. One study found that introducing peanuts between 4-11 months of age can reduce peanut allergy in high risk babies by about 80 per cent.”

Read more: World-first national health campaign to help parents prevent food allergies

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National Allergy Strategy Rationale

Allergic diseases have become an increasingly important chronic disease and public health issue in Australia and other developed countries over the last two decades, contributing to increased demand for medical services, significant economic cost of care and reduced quality of life of people with allergic diseases and their carers.

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Australasian Society of Clinical Immunology and Allergy (ASCIA) is the leading medical organisation for allergy in Australia. 

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Allergy & Anaphylaxis Australia (A&AA) is the leading patient support organisation for allergy in Australia. 

The National Allergy Strategy has received funding from the Australian Government Department of Health for the following projects:
Food allergy prevention | 250K Youth Project | Food service | Drug allergy | Shared Care Model

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