For children with a known food allergy, the key to preventing a potentially serious reaction is avoiding exposure to the relevant allergen (the food that causes the allergy).
It is important for centres to develop and implement an allergy policy to reduce the risk of allergen exposure as much as possible and practicable. The allergy policy should also include requirements for staff training regarding anaphylaxis and use of adrenaline injectors.
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To prevent accidental exposure to an allergenic food, some children’s services have developed policies to exclude certain foods from the centre. However, many of these foods make up an important part of the diet, and excluding these foods without appropriate replacements can lead to nutritional deficiencies. It is not recommended that foods be excluded from the service unless under health professional supervision (e.g. GP, paediatrician, allergist or dietitian).
If it is necessary for certain foods to be excluded from the service, parents of all children should be asked not to send these foods in lunchboxes or for celebrations and other occasions when food might be shared.
It should be made clear to parents and staff that although allergen avoidance policies are designed to reduce the risk of exposure, it is never possible to achieve a completely allergen-free environment in any service that is open to the general community.
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The Australasian Society of Clinical Immunology and Allergy (ASCIA) outlines four steps to prevent anaphylaxis in preschool and childcare services.
Centres should request information about allergies from parents upon enrolment. Documentation from a health professional (e.g. paediatrician) should be provided to support this.
All children with food allergy should have a current ASCIA Action Plan for Anaphylaxis or an ASCIA Action Plan for Allergic Reactions (see below). These should be updated by the child’s medical practitioner every 12 months.
Staff should meet with parents/guardians of children with allergies to discuss risk minimisation strategies.
All staff should be trained in identifying, managing and preventing allergic responses every 1–2 years.
If face-to-face training is unavailable, or if refresher training is required, staff can access the e-training from the Australasian Society of Clinical Immunology and Allergy. This training program provides ready access to accurate and consistent education about the recognition, emergency treatment and risk minimisation of anaphylaxis.
The course is free and each session takes approximately 1 hour to complete. A certificate can be printed upon successful completion of the course. For more information and to access the training program visit http://www.allergy.org.au/patients/anaphylaxis-e-training-schools-and-childcare.
Note: e-training should be completed in conjunction with regular practice using adrenaline autoinjector training devices (with no needle and no adrenaline). To order EpiPen® trainers email alphapharmss@alphapharm.com.au and to order Anapen® trainers email info@analert.com.
Strategies should be put in place to reduce the risk of exposure to allergens. This is at the discretion of the centre.
This should include measures such as:
More detail about the importance of these strategies is provided on each web page for the specific allergens – please see links at right.
It is primarily the responsibility of parents/guardians to teach allergic children to care for themselves. However, in childcare services and pre-schools, children are dependent on carers for providing a safe environment. It is important for all children to be educated about allergies and anaphylaxis and suitable risk minimisation strategies (e.g. washing hands after eating, not sharing food.).
On enrolment, centres should request written documentation of confirmed allergies from the child’s treating team (doctor, allergist, paediatrician). An ASCIA Action Plan should be provided by the parent/carer along with appropriate medication and an adrenaline autoinjector, if required.
The ASCIA Action Plan is a medical management document that is developed in collaboration with the child’s parents and prepared and signed by a medical practitioner. It includes the child’s name and photograph, confirmed allergies, symptoms of mild, moderate and severe reactions and clear instructions of action to take when an allergic reaction occurs.
The Australian Society of Clinical Immunology and Allergy (ASCIA) has developed the following action plan templates for individual use:
These are medical documents that can only be completed and signed by the patient’s treating medical doctor and cannot be altered without their permission. The templates are available from http://www.allergy.org.au/health-professionals/anaphylaxis-resources/ascia-action-plan-for-anaphylaxis.
ASCIA Action Plans must be placed in an area that can be easily and quickly accessed when an emergency response is required. However, displaying the ASCIA Action Plan containing personal health information where it is readily visible may raise concerns about privacy. The location where allergy action plans will be displayed should be discussed with parents of identified children, and any concerns about privacy should be addressed.
A copy of an ASCIA Action Plan for anaphylaxis should also be kept with the EpiPen® or Anapen® at all times so that the plan is always at the scene of an emergency along with the medication.
Australasian Society of Clinical Immunology and Allergy http://www.allergy.org.au/
For more information please phone 1300 22 52 88 or email heas@nnf.org.au
Except where otherwise indicated, the images in this document show models and illustrative settings only, and do not necessarily depict actual services, facilities or recipients of services. This document may contain images of deceased Aboriginal and Torres Strait Islander peoples. In this document, ‘Aboriginal’ refers to both Aboriginal and Torres Strait Islander people. ‘Indigenous’ or ‘Koori/Koorie’ is retained when part of the title of a report, program or quotation. Copyright © State of Victoria 2016
Written and reviewed by dietitians and nutritionists at National Nutrition Foundation, with support from the Victorian Government.
