Managing severe allergies in schools

Sue Clarke is a senior child and family nurse in Cambridgeshire Primary Care Trust, nurse advisor to the Anaphylaxis Campaign and author of the School Nurse Training Programme. She describes the new protocols she has devised.

The prevalence of severe allergy has risen alarmingly in the UK over the last decade. Ten years ago a research study on the Isle of Wight demonstrated that one in 200 children had been sensitised to peanut by the age of four years. Another study on the Isle of Wight in 2002 showed that figure had risen to one in 70 children.

These studies were only looking at peanut allergy, which is the most common cause of severe food allergy in the UK. However, many other children react to a whole range of substances, including milk, eggs, sesame, tree nuts, latex and fish. Some consultants believe that as many as 1 in 20 children could be at risk of a severe allergic reaction.

The burden of responsibility
This increase in prevalence of severe allergy places a huge burden of responsibility on child carers and teaching staff - and on the health professionals who are responsible for teaching school staff and carers how to manage these potentially serious reactions successfully.

Each health trust will have someone who is suitably trained to undertake training of school staff and carers; however with this enormous rise in cases, these health professionals have been overwhelmed with requests from schools and child care institutions for in-depth training so their staff can effectively manage these conditions. Consequently many school nurses have had to bridge the gap when they may have received only rudimentary training themselves.

Appropriate training
This issue of appropriate training is something that has concerned the Anaphylaxis Campaign for some time.

Last year we were fortunate to obtain an educational grant from the American Peanut Council to undertake a pilot project to teach school nurses how to successfully manage severe allergies in schools.

A hundred nurses were recruited to take part from all around the UK. Each nurse who participated in the four-hour training seminar was given a training pack. Each pack contained high quality information on severe allergies to enhance learning for the nurse. But this pack was also designed for the nurse to use the pack to train school staff.

The school staff training within the pack, is available in three different media, so that whatever facilities are available in the school or care setting the nurse can still provide high-quality training. The pack has also been accredited by the Royal College of Nursing accreditation unit, which means that the nurses can use the pack to demonstrate their continuing professional development. In addition all the participating nurses were linked in to an on-line discussion group to keep them up to date on any new developments in allergy and the management of severe allergies.

Focus of the training
In the past, training for school staff has focused on giving an injection of adrenaline, when this is really a very small part of what we want staff to do. This new training focuses on three areas:

• allergen avoidance
• early symptom recognition
• crisis management - which includes demonstrating the correct way to use an auto-injector of adrenaline.

Training all the staff
In the past volunteers from the school staff were asked to attend training in the school so that there was always at least one person in the school who knew how to manage a severe allergic reaction. In the new training we ask that as many staff as possible attend. There are many reasons for this.

A child having an allergic reaction may not be with the 'trained' member of staff when an allergic reaction starts and valuable minutes can be lost if the staff member present doesn't know what to do.

Ideally if all the staff know what the child is allergic to, they can take a pro-active role in avoiding exposing the child to that substance. School staff will also be able to spot the early signs of a reaction and get emergency help more quickly.

This 'whole school approach' is designed to make management of severe allergies in school much safer and less stressful for the staff, parents and the pupils. The training also recommends that every child at risk of a severe reaction should have an individual management plan. This allows school staff to see at a glance what they need to do when a child has an allergic reaction.

Pilot success
The pilot project ran from January to October 2006 and the feedback has been extremely positive. The aim of the project was to improve the lives of children with severe allergies in a school environment. Anecdotal reports suggest that families whose allergic children attend schools where the new training had been delivered felt happier knowing that most of the staff had received comprehensive training and understood the condition.

As the pilot project has been so successful the Anaphylaxis Campaign is planning to roll this project out nationally - a three-year phased programme to encompass every PCT in the country - and is now actively raising funds. A seminar to train 20 nurses and provide them with the training packs cost approximately £3,000. So far we have been offered some financial support from industry but more is needed and we would be happy to talk to any organisation interested in helping us.

For more information on the pack to offer funding please contact The Anaphylaxis Campaign.

First published in 2007

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