Developing a Best Practice Guidance Tool

Developing a Best Practice Guidance Tool, utilising vending to manage risk of allergy from snack food provision in secondary schools

Food allergies and vending in schools

Helping every child to choose a nutritious diet

Governments School Food Standards were introduced for England in September 2006 following many years of campaigning for their improvement, media campaigns instigated by Chef Jamie Oliver, and research reviews into the eating habits of children at school which highlighted that children were not choosing foods that were likely to contribute to a healthy diet and that school meals did not meet their nutritional needs.

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  • Approximately 18% of children aged 2-15 years in the UK are obese (The Information Centre 2006) and this figure is likely to increase further if changes to current dietary and lifestyle practices are not made.
  • The British Medical Association has suggested that over a quarter of children will be obese by 2020, and that they are likely to have a shorter life expectancy than their parents (BMA 2005).
  • School meals need to provide children with adequate nutrition to maximise health and minimise risks of obesity and other diet related diseases including high blood pressure, heart disease and type 2 diabetes.

It is important to ensure that every child is given the opportunity to consume a high quality, nutrient rich diet that will help to maximise their lifelong health. In order to achieve this, children need to be offered nutrient dense food at every eating occasion, including snacks. This fundamental principle underpins the Government’s School Food Standards in relation to snacking. These standards effectively remove all vendible, ambient convenience snacks from school, other than certain healthy snacks that include dried fruit, nuts and seeds (with no added fat, sugar or salt), due to the ban on confectionary and savoury snacks.

The case for “allergy-aware” vending practices in schools

These regulations have highlighted concerns and issues about the potential increase in allergens in school, which may in turn increase children’s exposure to allergens, including nuts and seeds, and may potentially increase the risk of cross contamination. Many of the 14 major food allergens, such as milk, eggs, nuts and peanuts can make a very valuable contribution to a child’s diet. Whilst not underestimating the potential risks associated with food allergens for some individuals, there is a need to provide every opportunity for all children to achieve a nutritious diet especially whilst at school. Banning economical and convenient snack foods such as nuts, peanuts and seeds would not support this policy objective. Having a robust risk management approach, however, including vending in schools will support it. That is why this best practice guidance is needed. It makes the case for “allergy-aware” vending practices in schools. The Anaphylaxis Campaign has voiced concerns that encouraging schools to sell nuts and seeds may increase the risks for allergic children, but acknowledges that these risks can be reduced if there is a high level of allergy awareness within the school and specific measures in place to protect allergic children.

A ban limits food choice for all and is still not 100% safe for the allergic individual

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Getting the allergy policy right for all:

Some schools in America, including Wakefield High School, have placed strict controls over what can be sold in schools and what can be brought in, with the rationale “to protect the health and well being of all students while they’re in school.” A forum was held at Wakefield High School to discuss this restriction. Parents, teachers and students attended the forum, many were concerned that the ban limited food choice, and “the allergy policy in its current form is hindering the real-world education of students.”

Peanut-free tables were discussed – although it was felt that this could create an unhealthy social environment and discriminate peanut allergy sufferers.

(Observer, February 7, 2007)

Read entire online story here: Opinions Abound at Allergy Forum by Travis Lovett
http://www.townonline.com/wakefield/homepage/8998948932625104895

The Health Education Trust’s view is that this can be seen as an opportunity in secondary schools for food-allergic children (and those without allergies) to be educated on the myths, facts and seriousness of allergies and to gain a better awareness of allergies, and learn avoidance strategies, if they move in an environment where allergens may turn up unexpectedly. Anaphylaxis Campaign have stated that if children are trained to be vigilant, their growing awareness may pay dividends one day when, for example, a friend offers them a biscuit at a party. If they are used to a nut-free environment, they may take the biscuit without thinking.

Problem or opportunity?

This is an area that HET is looking into with great depth, and will address in this guidance how best to deal with the concerns, and how best schools can use vending to manage the risk.

Following consultation with key people with relevant experience in health and education, policy development, dietetics, vending and food allergies it was concluded that a guidance document on allergy prevention through vending could be helpful in minimising allergy risk.
more Click for more information on the preliminary research.

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Background examination of information relevant to project

A web based search was carried out during 2006 to source available information on the role that vending could have in reducing the risk of food allergies. As expected, minimal recommendations and guidance on these specific subjects were identified.

In general there is a lack of relevant information on the topic

  • There is no information relevant in the Dept for Education and Skills document ‘Transforming School Food; standards for school food other than lunch’.
  • Food allergies –a guide for vending which is not yet published covers the topic but contains a number of inaccuracies but could provide a basic guide. (this was provided as a draft pre-publication document from the AVA- publication expected July 06).
  • The Local Authority Caterers Association (LACA) who are the main group involved in providing school meals, do not provide any information on allergies and vending on their website.
  • The National Association of Care Caterers who are also involved in providing school meals, do not provide any information on allergies and vending. They provide extensive information on nutrition and delivered meals and due to packaging of these meals there could be some similarities with vending.
  • The Food Standards Agency provides extensive information on food allergies but not on vending. Information is found on the website and also in their regular publication FSA news e.g. Safer food, better business: http://www.food.gov.uk/foodindustry/hygiene/sfbb/
  • Safe catering HACCP: http://www.food.gov.uk/northernireland/safetyhygieneni/safecateringni/  (includes a section on food allergy).
  • Coeliac UK provide information on intolerance but not on vending and their booklet of gluten free foods is mainly related to foods bought in shops and retail outlets
  • ‘Turning the Tables: transforming school food’ refers to allergies and the need for these to be accounted for as part of a whole school approach. No mention is made of it in the context of vending.
  • Hungry for success: a whole school approach for Scotland (2002 Expert Panel on School Meals – obtained from the Stationery Office Bookshop in Edinburgh ISBN 0-7559-0701) refers to allergies and the need for these to be coped with by having a diet sheet from a registered Dietitian. No mention is made of it in the context of vending however there is an emphasis on ways to reduce queuing.
  • The ‘Allergy Aware Schools Catering Manual’ (by Michelle Berriedale-Johnson from Berriedale books ISBN 0-9518427-5-7) and the ‘Allergy Catering Manual’ (by Michelle Berriedale-Johnson from Berriedale books ISBN 0-9518427-4-9) which are held by LACA and other cost sector caterers to provide good information on allergies for caterers provide comprehensive information on allergies and what to look for as regards ingredients, but contains no information on vending.
  • ‘Catering for Health’ produced by the FSA and DoH (published by the Food Standards Agency and written by members of the British Nutrition Foundation ISBN 0-907667-27-9) is held up to be a model for good catering practice—food allergies are discussed but there is no mention of vending.

There is up to date information on allergy on the Anaphylaxis Campaign schools website: www.allergyinschools.org.uk.

Opportunities where guidelines fit in

  • All caterers are expected to have a HACCP (hazard analysis critical control point) plan to comply with food safety regulations. This plan not only looks at bacterial contamination but also other types of contamination such as from materials such as metal from machinery but also contamination from allergens.
  • Schools are expected to have policies in place to cope with children who have special medical needs and those with an allergy fit into this category.

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Preliminary consultation and views from key individuals/organisations: research conducted September-October 2006

Introductory telephone interviews were conducted with individuals from two vending companies, and also with the Anaphylaxis Campaign and the Automatic Vending Association, who have relevant experience in vending and food allergies. They were consulted to discover their opinions on the usefulness of a guidance tool on allergy and vending. Joe Harvey, Director of the Health Education Trust was also interviewed as he instigated the three initial healthy school vending toolkits and has already written numerous policy guidance documents for education, in particular Managing Medicines (Harvey 1999, 2004, 2005a, 2005b).

The general view was that more guidelines on how to reduce allergic reactions in school would be essential. The Anaphylaxis Campaign have, understandably argued against the Government’s proposals to  include nuts and seeds as the recommended snack foods in schools, stating that the sale of some allergenic foods was not necessary in schools due to their risk of increasing serious allergic reactions (Westminster Education Forum 2006). The specific potential of vending to control allergy risk, however, had not been considered in any detail.

The industry view has been that due to the cessation of the sale of savoury snacks (e.g. confectionary, chocolate and crisps) and fizzy drinks through vending machines (and other outlets in school) from September 2007, commercial vending in schools may no longer be viable, particularly when considering vending as a profit stream for the school. This view, however, relates to the historical supply of rent- free vending machines by specific drink and confectionary manufacturers, whose product range would no longer be allowed in schools. This practice limits the choice and flexibility of the vending operation for the school. Pilot research carried out by the Health Education Trust, however, showed that healthy vending in schools can be viable, even accounting for machine rental. Since September 2006, as a consequence of the proposed regulations, some schools and local authorities have decided to remove their profitable, branded fizzy drinks, confectionary and chocolate vending machines, with nothing planned to replace them as yet. The school healthy snacking and vending market is new and it remains to be seen what products will become available in the future, all the more reason to establish a best practice approach from the outset.

Those actively involved in healthy school vending reported that there is an issue to be addressed. Schools are uncertain about how to manage the sale of allergenic foods, in particular nuts and seeds, in order to minimise allergic reactions. Hence the current situation, where many schools have imposed a nut and seed ban, without considering the beneficial nutrients that these products can offer, or the fact that such a ban effectively removes the opportunity for snack vending. It is likely that most of these schools have not considered fresh food vending as an alternative. When this is considered, however, there remains the potential for many of the 12 major food allergens to be present within the fresh food vender. A policy to manage this remains important.

There was general concern as to why this serious topic had not previously (pre October 2006) been explored in detail within the school food standards. The Government’s School Food Standards (DfES 2006a) did not mention allergy, though two supporting documents highlighted that:

  • “Account will need to be taken of children on special diets, those with allergies, or with beliefs or cultural practices which affect dietary patterns.” (SMRP 2005)

  • “Be aware of nut allergies. Always refer back to the school and catering policies regarding nuts” (SFT 2006a) and

  • “Schools are also required to cater for children with special dietary needs or allergies(SFT 2006a).

No further guidance or recommendations were provided on the impact on allergy risk brought about through alterations to the food and drinks that can be served in schools.

The preliminary telephone interviews highlighted that there appears to be very little understanding, and some confusion, about the provision of both nuts and vending in schools. For instance, there is uncertainty as to which snack products contained nuts. Guidance on foods served at occasions other than lunch, ie through vending machines or tuck shops, had not been finalised prior to this interview process. The general uncertainty among schools, local authorities, caterers, suppliers, manufacturers and vending operators as to how these regulations may be finalised, has led to often incorrect interpretation of the regulations, in the absence of official guidance. This has caused further confusion and chaos within the school vending industry. Suppliers report inconsistent approaches between schools, ranging from total bans on vending in schools, through to continued sales of confectionary and savoury snacks, with little preparation for the September 2007 deadline for implementation.

Since the School Food Standards focus on food sold within school and not food that is brought into school, concerns were raised from interviewees regarding the lack of guidance on both food consumed by children on their way to and from school, plus food brought in from home. Clearly both of these factors will influence the snacking habits of children whilst in school and the good intentions behind the restrictions imposed within school can be undermined by the choices of foods brought into school. The broader consideration of allergy risk has been overlooked by a simple ban approach within school, since this doesn’t overcome the possible, albeit small, potential risk to certain allergy sufferers from food brought into school.

There was a general consensus from the preliminary interviews that although not previously considered, confining the sale of nuts and seeds to vending machines should help to minimise risk and not cause any serious problems. This was with the caveat that there was clear guidance and machines were clearly labelled. There was a consensus too that the risk of an allergic reaction from nuts being available from vending machines in school would be no higher than the risk arising from contact with a non allergic child who had consumed nuts on the way to school.

The Anaphylaxis Campaign believes that the main risk from an increase in the presence of nuts in schools lies with cross-contamination. “Peanut proteins tend to become transferred easily from children’s sticky hands to desks, chairs, computer keyboards and other surfaces, and then on to other children. Contact reactions caused by touch are usually mild, but any reaction would be very unpleasant and disruptive for the school,” the Campaign says.

The Campaign cites a paper published by a German medical team. They reported the case of a 32-year-old man with peanut allergy who suffered a serious allergic reaction during a card game. It transpired that his friends had been eating peanuts. Although they kept them well out of his way, peanut protein from their fingers found its way on to the playing cards. As the cards often stuck together, the player with the allergy licked his thumb to separate them. After one hour he felt swelling of lips and tongue as well as shortness of breath. He received medical treatment and recovered.

The researchers conclude: “Not only patients with peanut allergy have to avoid peanuts and peanut-containing food, but also their relatives and friends if they get in direct and indirect contact with them.”

Reference: Lepp U, Zabel P, Schocker F. Playing cards as a carrier for peanut allergens. Allergy 2002; 57(9):864.

The School Food Standards (DfES 2006a) will inevitably increase the snacking opportunities outside the lunchtime through tuck shops, after school and breakfast clubs, over the counter outlets and vending machines. Some of the principles adopted in this guidance may be applicable to over the counter sales although this has not yet been tested.

HET is currently consulting widely with other key bodies, and the final draft guidance will be freely available on the website. We would like schools to register their interest in ‘trialling’ this draft guidance and to provide feedback.
Please click here to register your interest.

Best Practice Guidance Tool
to manage risk of allergy from
snack food provision in
secondary schools

To download the toolkit click here

Balancing food allergy in school and achieving the School Food Standards

Approximately 5-8% of children have a food allergy (FSA 2006). Parents of severely food-allergic children naturally have concerns about the potential increase in allergens in school due to the Government’s School Food Standards (DfES 2006a), which may in turn increase children’s exposure to allergens including nuts and seeds. Their concerns are highlighted in comments provided by the Anaphylaxis Campaign within the Westminster Education Forum publication (2006). The Anaphylaxis Campaign as the UK’s expert body representing those with severe food allergies has never advocated banning peanuts or nuts from schools, although they point out: “There is a difference, however, between advising against banning nuts and accepting a situation where their presence in schools may increase significantly and possibly put allergic children at risk.” Their concern is for education and effective management of allergens, (www.allergyinschools.org.uk/
teachers_lunch.html
).

Nevertheless, the School Food Trust have restated that the Standards will remain as published, recognising the beneficial nutritional contribution that nuts and seeds could make to a child’s diet. Taking a practical step forward, the Health Education Trust outlined within the same Westminster Education Forum publication (2006) how a best practice protocol could help to minimise the risk of allergy as these standards are implemented. This approach has been stimulated out of the following key concerns:

  1. No school could guarantee a truly peanut-free environment. Allergic children might be led into a false sense of security.
  2. If you ban peanuts, what do you say to the parent who wants to exclude milk, egg, sesame, fish or fresh fruit?
  3. Demands for nut-free zones may engender confrontation between parents. In such an atmosphere, the risks may actually increase.
  4. There is a strong case for arguing that food-allergic children will gain a better awareness of their allergies, and learn avoidance strategies, if they move in an environment where allergens may turn up unexpectedly. If they are trained to be vigilant, their growing awareness may pay dividends one day when, for example, a friend offers them a biscuit at a party. If they are used to a nut-free environment, they may take the biscuit without thinking.

Why do we need guidance on controlling food allergies through vending in school?

  • Eating patterns have changed and the grazing, grab-and-go way of eating is the norm in Secondary Schools. This is reinforced by the shorter break and lunch times. This means vending can make a more significant contribution to school food provision and children’s nutritional intakes.
  • School meals need to provide children with adequate nutrition to maximise health and minimise risks of obesity and other diet related diseases including high blood pressure, heart disease and type 2 diabetes.
  • Approximately 18% of children aged 2-15 years in the UK are obese (The Information Centre 2006) and this figure is likely to increase further if changes to current dietary and lifestyle practices are not made. The British Medical Association has suggested that over a quarter of children will be obese by 2020, and that they are likely to have a shorter life expectancy than their parents (BMA 2005).
  • The Governments School Food Standards (DfES 2006a) effectively remove all vendible, ambient convenience snacks from school, other than certain healthy snacks that include dried fruit, nuts and seeds (with no added fat, sugar or salt), due to the ban on confectionary and savoury snacks.
  • Snack vending machines may be removed from some schools as a consequence, leading to the possible increase in availability of convenience snacks over the counter in school canteens and from other outlets within school, such as tuck shops/‘snack shacks’.
  • Currently caterers take much of the responsibility for a child’s allergy, even where a nut ban is adopted as a means to manage any risks. The alternative, more supportive approach is for schools to adopt an educational policy, so giving the opportunity for a child to manage their allergy while still in a semi protected environment.
  • To achieve improvements in the nutritional adequacy of school food it is recommended (Harvey 2004, 2005a, 2005b, School Food Trust 2006b) and anticipated that there will be an increase in availability of fresh food vending, e.g. sandwiches, salads, yoghurts and milk.
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    • The Health Education Trust (HET) has carried out 3 pilot studies and produced toolkits based on the feasibility of healthy vending in school with funding through the Food Standards Agency, the Department of Health and the Welsh Assembly Government (Harvey 2004, 2005a, 2005b). Following the introduction of the Schools Food Standards and their consequent effects on vending provision, HET developed the SFT s Vending Guide (SFT 2007) which guides schools on how to establish viable vending provision and meet the standards.

  • There is a need to consider the implications of the anticipated changes in school catering practices, as regards availability of all 14 major allergens, many of which could be utilised as ingredients for fresh food vending.
  • Vending offers the potential to positively manage the availability of some of the 14 major allergens in a controlled and safer environment, whether through ambient or refrigerated, fresh food vending machines. It is hoped that this may help to minimise the risks of allergic reactions caused as a consequence of the increased availability of such foods within schools. more click for more
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    • As a consequence of the work HET has carried out on healthy vending in schools, we have always considered that if schools are providing a vending service that includes drinks, snacks and fresh food, especially where snacks include nuts and seeds are sold, a suitable policy for managing food allergy should be considered. In addressing this issue HET has identified the potential for vending to contribute positively to the management of allergies in school, with positive educational benefits for the entire school population (Westminster Education Forum 2006).

Food allergies- the facts

A food allergy is a reproducible adverse reaction to a particular food which involves the immune system. Reactions can range from relatively mild, such as skin irritation, through to the most severe form of reaction that may cause anaphylaxis. The most common 12 food allergens in Europe, according to the Directive 2003/89/EC include:

Celery

Fish

Crustaceans

Egg

Mustard

Milk

Cereals containing gluten:
barley, kamut, oats, rye, spelt, wheat

Nuts: almond, brazil nut, cashew, hazelnut, macadamia nut, pecan nut, pistachio nut, Queensland nut, walnut

Peanuts

Sesame

Soya

Sulphur dioxide and sulphites

NB – this list has been increased to include Molluscs and Lupin (Heller 2007).

Food allergies- the facts
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Exact data on the incidence and severity of allergy in children remains difficult to establish, the most recent figures state that approximately 5-8% of children have a food allergy (FSA 2006). Previous data on allergic reactions to one or more foods within the National Diet and Nutrition Survey of young people aged 4-18 years (Gregory 2000), show 9% of boys and 13% of girls reporting food allergies. No clear patterns were seen by age for either sex. A doctor had diagnosed food allergies in 4% of boys and 6% of girls. See table 1 for further details.

The prevalence of peanut allergy in children has tripled in the last decade, according to the findings of a study published November 2002. The researchers, who tested a large population of pre-school children in the Isle of Wight over a ten-year period, concluded that more than one in 70 children across the UK are allergic to peanuts. The figure they had arrived at a decade before was one in 200 children (Rising prevalence of allergy to peanut in children: Data from two sequential cohorts, Grundy, 2002).

A House of Commons report in 2004 said the figure may now be as high as one in 50 – a quarter of a million children. (House of Commons Health Committee report, “The Provision of Allergy Services”, November 2004).

What is anaphylaxis?
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What is anaphylaxis?

Anaphylaxis is an acute, severe allergic reaction needing immediate medical attention. It can be triggered by a variety of allergens, the most common of which are foods (especially peanuts, nuts, eggs, cow’s milk, shellfish), certain drugs such as penicillin, and the venom of stinging insects (such as bees, wasps or hornets). In its most severe form, the condition can be life-threatening.

Useful information on anaphylaxis, including the following topics, can be found at
http://www.anaphylaxis.org.uk/information/
basic_facts.html

· What is anaphylaxis?

· What are the symptoms?

· Mild allergy symptoms

· What is the treatment for a severe reaction?

· Why does anaphylaxis occur?

· What exactly is going on?

· Why does adrenaline work?

· How do I know if I am at risk from anaphylaxis?

· What are the most common causes of anaphylaxis?

· What will an allergy specialist do?

· How can I avoid problems?

· What should I do if I think I am having a serious reaction?

Managing anaphylaxis at school
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Managing anaphylaxis at school

There are estimated to be at least a quarter of a million children in UK schools who are at risk of anaphylaxis. A child at risk of anaphylaxis presents a challenge to any school. However, with sound precautionary measures school life may continue as normal for all concerned. The vast majority of children with anaphylaxis are happily accommodated in mainstream schools, thanks to good communication, support and consensus between parents, schools, teachers, doctors and education authorities (Anaphylaxis Campaign, 1994).  

When a school has a child at risk of anaphylaxis, or when admission for such a child is sought, it is important to ensure that the child is treated normally and the parents’ fears are allayed by the reassurance that prompt and efficient action will be taken in accordance with medical advice and guidance.

Schools that manage a child at risk of anaphylaxis should draw up an individual management plan, agreed by the parents, the school, the treating doctor and the education authority. This crucial partnership agreement ensures that the best possible support is in place for both the child and the school staff. The management plan should deal with all of the important issues:

  • Emergency procedure
  • Medication
  • Food management
  • Staff training
  • Precautionary measures
  • Professional indemnity
  • Consent and agreement

Food allergies in secondary school
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Food allergies in secondary school

Whilst at primary school level it is more appropriate for the full management of a child’s food allergy to be in the hands of the adults closest to the child, by secondary school age, the student is beginning to make his/her own decisions and hence take on increasing responsibility for his/her food allergy. This is not without difficulties and dangers, as with all aspects of teenage years. However, school represents a place for education and the opportunity to learn to manage personal food allergies, in a ‘managed’ environment should not be overlooked. Additionally, an effective policy for educating and managing food allergies in school can provide an opportunity for all students to learn, understand and appreciate the realities of food allergies.

Qualitative research carried out by the Food Standards Agency looking at the information needs of teenagers with food allergies and food intolerances highlighted that “within the education system, secondary school seems especially fraught, and any encouragements and support the Food Standards Agency can give to positive, practical support would be welcomed.” (FSA 2005). 

In 2005 the American Peanut Council granted £11,500 to the Anaphylaxis Campaign to carry out a pilot training programme for school nurses. The objective was to raise the level of care that severely allergic children receive in schools. The project had two parts:

1.      A training pack for school nurses, containing high-quality, comprehensive information.

2.      A programme of training seminars for school nurses that will be used as a pilot for a larger, UK-wide programme.

Five areas of the UK were selected for the pilot programme: Cambridge, Barnstaple in North Devon, Bradford, Omagh and Edinburgh.

The pilot took place in early 2006 and was so successful that the programme is now being rolled out across the UK.  Further financial support has come from various industry sources.

The training pack comprises information and instruction relating to symptom recognition, treatment of allergic reactions and daily management of anaphylaxis. The pack contains a Powerpoint presentation, overhead transparencies, speakers’ notes and flip chart, enabling school nurses to provide training to school staff in an informal setting. The pack contained the information in several different ways to meet the varying technical facilities of individual schools.

Interactive training seminars form a crucial part of the programme, in which school nurses are shown how to use the pack to inform and train school staff.

Proportion of young people reported to be allergic to certain foods and the nature of the allergic reaction by sex and age of young person (Gregory 2000)
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Whether reported any food allergy and nature of reaction*

Males aged (years):

Females aged (years):

4-6

7-10

11-14

15-18

All

4-6

7-10

11-14

15-18

All

%

%

%

%

%

%

%

%

%

%

Reported being allergic to certain foods, of whom:

8

11

5

10

9

14

9

3

16

13

Had allergy diagnosed by doctor

2

7

1

5

4

7

3

6

8

6

Nature of allergic reaction**:

Hyperactivity, behavioural problems

2

5

1

1

3

2

2

2

3

2

Rash, blotches

4

1

1

3

2

2

3

4

3

3

Eczema

0

1

-

0

1

8

0

-

4

3

Asthma, wheezing

0

1

1

0

1

1

1

1

2

1

Upset stomach, diarrhoea, vomiting

0

3

1

2

2

1

2

6

1

3

Swelling

-

0

0

2

1

1

0

1

-

1

Itching

0

-

1

-

0

-

0

-

-

0

Allergic rhinitis ***

-

-

-

-

-

-

0

0

-

0

Migraine

-

1

-

-

0

-

-

1

1

1

Other

1

0

1

2

1

0

0

1

1

1

Base

230

304

290

258

1082

224

277

280

264

1045

* As reported in response to question why certain foods were not eaten

** If more than one allergic reaction was reported, all were coded. No order of priority was assigned in coding reactions

*** Itchy eyes and runny nose or other nasal symptoms

Food allergies and management issues in schools

The full spectrum of food management issues are covered in depth by the Anaphylaxis Campaign www.anaphylaxis.org.uk and on their Allergy in Schools website www.allergyinschools.org.uk. Day-to-day policy measures will include the following (Harvey 1999):

  • Awareness of the student’s needs in relation to the menu, individual meal requirements; snacks in school; outdoor activities; school trips; food technology and some science experiments with food.
  • The catering supervisor should be fully aware of the student’s particular requirements and an appropriate code of practice should be in place.
  • The individual student and the family have a right to confidentiality. However, the benefits of an open management policy could be considered. As with any other medical condition, privacy and the need for prompt and effective care are to be balanced with sensitivity.

References
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British Medical Association (2005) Preventing childhood obesity. BMA, London.

Canadian Society of Allergy and Clinical Immunology (2005) Anaphylaxis in Schools and Other Settings. Available from Anaphylaxis Canada www.anaphylaxis.ca

Crawley H (2005) Eating well at school: Nutritional and practical guidelines. The Caroline Walker Trust and National Heart Forum, London.

Department for Education and Skills (2006b) Managing medicines in schools and early years settings. DfES.

Department for Education and Skills (2006a) Nutritional standards for school lunches and other school food. www.teachernet.gov.uk/wholeschool/healthyliving

Directive 2003/89/EC of the European Parliament and of the Council of 10 Nov 2003 amending Directive 2000/13/EC as regards indication of the ingredients present in foodstuffs.

FSA (2005) Qualitative research into the information needs of teenagers with food allergy and intolerance. FSA/0991/0905.

FSA (2006) Guidance on allergen management and consumer information. FSA/1064/0606.

Gregory J et al (2000) National Diet and Nutrition Survey: young people aged 4 to 18 years. Volume 1: report of the diet and nutrition survey. The Stationery Office, London.

Grundy J (2002) Rising prevalence of allergy to peanut in children: Data from 2 sequential cohorts.  Journal of Allergy and Clinical Immunology. 110; 784-789.

Harvey J (1999) Managing medicines in Schools. Folens Limited, Dunstable. www.healthedtrust.com/pdf/Managing-Medicines-in-Schools-complete.pdf

Harvey J (2004) Vending healthy drinks. A guide for schools. HET, FSA, Dairy Council. www.healthedtrust.com/pages/Vendingnews1.html

Harvey J (2005a) Food in School – Healthier Vending. Crown. www.foodinschools.org

Harvey J (2005b) Think Healthy Vending. Guidance on vending machines in schools. Crown. www.healthedtrust.com/pages/Vendingnews1.html

Heller L (2007) Allergens: no room for mistakes www.foodnavigator.com/news/ng.asp?n=74116-allergens-contamination-recalls [accessed 28/03/07]

Higgs J, Styles K (2006) Principles and practical aspects of healthful school vending. Nutrition Bulletin. 31; 225-232. 

Nelson M et al (2004a) School meals in secondary schools in England. Research report RR557. Department for Education and Skills, London.

Nelson M et al (2004b) School meals in Primary schools in England. Research report RR753. Department for Education and Skills, London.

School Food Trust (2006a) A guide to introducing the Government’s new food-based standards for school lunches. www.schoolfoodtrust.org.uk

School Food Trust (2006b) Transforming School Food. A report on the development and implementation of food standards for school foods other than lunch. www.schoolfoodtrust.org.uk

School Food Trust (2007) A fresh look at vending. www.schoolfoodtrust.org.uk/vending

School Meals Review Panel (2005) Turning the tables: transforming school food. A report on the development and implementation of nutritional standards for school lunches. www.schoolfoodtrust.org.uk/food.php

The Anaphylaxis campaign (2007) Managing Severely Allergic Pupils in Schools: a training resource for school nurses. Details from www.anaphylaxis.org.uk.

The Information Centre (2006) Statistics on Obesity, Physical Activity and Diet: England. The Information Centre, Lifestyles Statistics  www.ic.nhs.uk/webfiles/publications/opan06/OPAN%20bulletin%20finalv2.pdf

Westminster Education Forum (2006) Healthy eating in school: preparing for implementation. Westminster forum projects limited.

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