Managing Allergies and Anaphylaxis in Childcare

Allergies in children are a significant and growing public health concern. Approximately 5–8% of children in the UK have a food allergy of some kind, and around 1–2% have a food allergy that carries a risk of anaphylaxis – the severe, potentially life-threatening systemic allergic reaction. The prevalence of food allergy has been rising steadily for decades, for reasons that are not fully understood but are thought to relate to changes in diet, reduced microbial exposure and other environmental factors.

In a childcare or school setting, food allergy management is both a legal duty and a fundamental safeguarding responsibility. A child who experiences anaphylaxis in a setting that is not prepared (that does not have the child’s adrenaline auto-injector to hand, that does not have trained staff, that does not have a clear emergency protocol) is in genuine danger of death. Allergy management is not an administrative formality. It is a matter of life and safety.

The 14 Major Allergens

Under UK food law, there are 14 major allergens that must be declared whenever they are used as ingredients in food. They are: celery; cereals containing gluten (wheat, rye, barley, oats); crustaceans (prawns, lobster, crab); eggs; fish; lupin; milk; molluscs (mussels, oysters, squid); mustard; peanuts; sesame; soybeans; sulphur dioxide and sulphites (above 10mg/kg); and tree nuts (almonds, hazelnuts, walnuts, cashews, pecans, pistachios, macadamia nuts, Brazil nuts).

These 14 allergens account for the vast majority of serious food allergic reactions in the UK. However, it is important to note that individuals can be allergic to any food, not just these 14 – kiwi, banana, latex and many other foods cause significant allergic reactions in some individuals. Settings should not assume that an allergen is safe simply because it does not appear on the list of 14 major allergens.

Natasha’s Law

Natasha’s Law, which came into force in October 2021, is named after Natasha Ednan-Laperouse, who died in 2016 at the age of 15 following an allergic reaction to sesame seeds in a sandwich she purchased at Pret A Manger. At the time, pre-packed food for direct sale (food packaged on the same premises from which it was sold) was not required to carry full ingredient labelling. Natasha’s Law changed this, requiring all pre-packed for direct sale (PPDS) food in England to carry full ingredient labelling with allergens emphasised.

For childcare settings that prepare and package food on-site (including lunches, snacks or food for collections) this means ensuring that all such food is clearly labelled with its full ingredients, with the 14 major allergens highlighted. Settings that provide meals and snacks to children must also ensure that kitchen staff are aware of the allergen requirements and that there are robust systems for preventing cross-contamination. The Food Standards Agency (FSA) provides detailed guidance for food businesses on compliance with allergen labelling law.

Understanding Anaphylaxis

Anaphylaxis is a severe, systemic allergic reaction that develops rapidly and can be life-threatening. It involves the release of large quantities of histamine and other mediators following exposure to an allergen in a sensitised individual, causing a combination of symptoms that may include:

• swelling of the throat and tongue, causing difficulty breathing and swallowing
• a sudden drop in blood pressure and collapse
• rapid heart rate
• severe urticaria (hives)
• abdominal pain, vomiting and diarrhoea

In the most severe cases, anaphylaxis can cause loss of consciousness and death within minutes.

The immediate treatment for anaphylaxis is the administration of adrenaline (epinephrine) by intramuscular injection, typically via an adrenaline auto-injector device such as the EpiPen or Jext. Adrenaline acts rapidly to reverse the effects of anaphylaxis, reducing throat swelling, raising blood pressure and slowing the allergic response. An ambulance must always be called even if the initial adrenaline injection appears to have resolved the reaction, as symptoms can recur (biphasic reaction) several hours later. All children at risk of anaphylaxis should have at least two adrenaline auto-injectors available at all times.

Individual Healthcare Plans in Settings

Every childcare setting that cares for a child with a severe allergy must produce an Individual Healthcare Plan (IHP) in consultation with the child’s parents and, where appropriate, the child’s GP or paediatric allergist. The IHP should describe: the child’s specific allergens; the signs and symptoms of their allergic reactions; the location of their emergency medication; the steps to be taken in the event of an accidental exposure, including when to administer the adrenaline auto-injector and when to call 999; which members of staff are trained to administer adrenaline; and any dietary restrictions or food management requirements.

Staff who may be required to administer an adrenaline auto-injector in an emergency must receive training. The training should cover recognition of anaphylaxis, use of the specific device the child carries (EpiPen and Jext have slightly different mechanisms), and the post-administration protocol. Anaphylaxis UK and Allergy UK both provide excellent training resources for schools and childcare settings. The adrenaline auto-injectors should be stored where they are immediately accessible in an emergency – not in a locked cabinet or the child’s bag.

Cross-Contamination and Food Management

For children with severe allergies, cross-contamination (the accidental transfer of allergen proteins from one food to another via contact, shared utensils or surfaces) is a significant and often underestimated risk. Trace amounts of allergen that would be entirely harmless to a non-allergic person can be sufficient to trigger anaphylaxis in a highly sensitised individual. “May contain traces of nuts” warnings on food packaging are taken extremely seriously by families of children with nut allergies and should be respected in settings.

Settings should have clear food management protocols:

• separate preparation areas and utensils for allergen-free food
• careful hand washing before food preparation and after any contact with allergens
• clear labelling and storage of allergen-free food
• strict avoidance of communal food-sharing activities (such as children sharing snacks) when allergens are involved. Parents should be encouraged to communicate any changes in their child’s allergy status promptly, as allergy profiles can change over time

For related guidance, see also our articles on health requirements under the EYFS, SEND and children with additional health needs, play-based learning and quality childcare provision.