Anaphylaxis fact sheet

Produced in consultation with the Anaphylaxis Working Party Clinical Governance Committee

Food allergies and the canteen

School canteens can play an important role in ensuring the health and wellbeing of students in your school. Minimising the risks associated with severe allergies in a school canteen environment must be part of a whole school risk management plan.

What is a food allergy and what are some of the symptoms of an allergic reaction?

A food allergy occurs when the body’s immune system overreacts to a food, which is normally harmless for most people. While a mild food allergy may cause skin irritation on the face and arms, a more marked reaction may cause swelling of lips, face, eyes, hives or welts, abdominal pain or vomiting.

What is anaphylaxis?

Anaphylaxis is a severe and sudden allergic reaction that occurs when an allergic person is exposed to an allergen such as a food or an insect sting. Reactions usually begin within minutes of exposure and can progress rapidly. Anaphylaxis is potentially life threatening and always requires an emergency response.

What are the most common foods that can cause anaphylaxis?

  • Milk
  • Eggs
  • Peanuts
  • Tree nuts (walnuts, almonds, cashews, pistachios, pecans etc)
  • Sesame
  • Fish
  • Shellfish
  • Soy

Life threatening reactions are most often a result of eating a particular food, even in trace amounts. Skin contact with the trigger food might cause hives or swelling, while smelling the trigger food is a highly unlikely to cause anaphylaxis. Food labelling rules in Australia state that the most common allergens (crustaceans, eggs, fish, milk, peanuts, soybeans, tree nuts, sesame seeds and their products, gluten and its products, plus sulphite preservatives) must be declared on packaging or in connection with the display. These allergens are not always easy to find on labels. Other words may also refer to the allergen e.g. a milk product may be referred to as casein. Anaphylaxis Australia, in association with the NSW Food Authority and Food Standards Australia New Zealand (FSANZ), has produced some allergen ingredient cards that list ingredients you should avoid if you are allergic to milk, peanut, egg, fish, tree nut, sesame, soy or shellfish.

If there is a student in the school with severe allergies to some foods what does the canteen need to do?

  • Government schools are required to develop an individual health care plan for each student at risk of anaphylaxis.
  • Canteen staff and volunteer helpers need to be made aware of children at risk of anaphylaxis. However, canteen staff should deal with personal and health information sensitively and confidentially.
  • Encourage parents of students with severe allergies to visit your canteen to check which food products may be safe for their child.
  • Set up a procedure for responsibility for serving the child including who is responsible for checking the product ingredient list and who is responsible for serving the child.
  • Include the needs of children who are severely allergic when planning your stock purchases.

What can the school canteen do to minimise risk?

  • Review the canteen menu and provide healthy alternatives for students with allergies.
  • Ensure food handling and hygiene procedures are in place and are practised by all canteen staff including volunteers.
  • Inform all staff and volunteers of food allergic children in the school and ensure they have awareness of food allergies and cross contamination issues.
  • Ensure that the promotion and encouragement of new foods, including any taste testing, is properly supervised to avoid pressure on students to try foods known to contain common food allergens.

Food handling and hygiene procedures:

  • Thoroughly wash hands before and after handling foods that are known to be highly allergenic.
  • Take care when using gloves. Use new gloves when handling foods that are known to be highly allergenic or when making the lunch of a child who is at risk of anaphylaxis.
  • Use different utensils and equipment for preparing highly allergenic foods.
  • Wash contaminated kitchen utensils in hot soapy water or in the dishwasher.
  • Use hot soapy disposable paper towels to wipe surfaces that have had the highly allergic food on them, i.e. do not use a dishcloth.
  • Avoid cross contamination. Take care not to contaminate margarine and other spreads.
  • Store highly allergenic foods in sealed, well labelled containers.
  • Some canteens place a sticker on the child’s bag when the order is placed to alert the person preparing the food and filling the order.

Does the school canteen need to ban peanuts and peanut products?

Whole peanut and nut products and products containing nut pieces:

For schools where there are children with severe allergies to nuts (peanuts and tree nuts) a risk minimization policy for school canteens should be implemented. This involves removal of items with the relevant nut as an ingredient, but does not apply to those foods labelled “may contain traces of nuts”. (ASCIA Guidelines for prevention of food anaphylactic reactions in schools, preschools and childcare centres.)

Peanut butter and nut spreads:

For schools where there are children with severe allergies to nuts (peanuts and tree nuts) these items are best removed from the canteen due to the risk of cross contamination during food preparation. One needs to consider that parent volunteers with no formal training in food service may assist in canteens.

Does the canteen need to ban other products if there is a child in the school with anaphylaxis to that product or what procedures need to be in place?

Schools are not required to ban any known food allergen or a food that “may contain” a known allergen. Anaphylaxis Guidelines for Schools, 2nd Edition, 2006 outlines procedures and requires schools to develop strategies to minimise exposure to known allergens. ASCIA Guidelines for prevention of food anaphylactic reactions in schools, preschools and childcare centres state:

Risk minimisation with regard to particular foods (peanuts and tree nuts) is indicated, however the implementation of blanket food bans or attempts to prohibit the entry of food substances into schools are not recommended.

There is no reason to ban cows milk and egg-containing foods from the canteen. Management of children and young people with allergies to such common foods relies on education of the child, the school and the canteen staff and provision of an appropriate plan of action.

What measures do other children in the school need to take to help avoid accidental exposure of an allergen?

Other children should be aware that some children have food allergies that can cause severe health problems and to get assistance if another child is unwell. They should know not to share food or trade food and not to encourage other children to eat food other than their own. They may still take their usual food to school as long as it is not shared with others. As stated above, there is no need to ban foods in schools or to prohibit the entry of specific foods in to schools. Although a ban on peanuts and peanut products or any foods in fact, is not required, in some schools this may occur after agreement by the community. If a school does decide to ban peanuts or peanut products, it should nevertheless not claim to be “peanut free” as such a claim can not reliably be made and, if made, may lead to a false sense of security about exposure to peanuts and peanut products.

Should canteens avoid stocking products with “may contain” statements?

Schools are not required to ban or to avoid stocking products with “may contain” statements. See above comment regarding a ban on food products. Manufacturers must declare allergens present as ingredients in their products in the ingredient list, as required under Standard 1.2.3 of the Australia New Zealand Food Standards Code. The use of the “may contain” statement is voluntary additional information provided by manufacturers and indicates a possibility of the inadvertent presence of allergenic substances beyond the control of the manufacturer. The products carrying these statements are plentiful and it would be unnecessary to remove all such products from the school canteen. These products may pose a risk to the allergic student if they consume them although some children who have known allergies eat these products regularly. Each child is individual so this is something that should only be decided by their treating doctor and discussed in the student’s health care plan. The risk of the allergic student having a reaction by sitting alongside a student who is consuming these products is very low if no food sharing occurs. Non-allergic children can consume foods that ‘may contain…’ in the vicinity of children who are allergic.

Should Canteen Managers receive training?

It is important that all Canteen Managers be involved in anaphylaxis training with other school staff. Canteen Managers should then seek to increase the awareness of their staff including their volunteers.

What are the main issues that Canteen staff need to be aware of to help avoid accidental exposure to an allergen?

Watch out for contaminated kitchen surfaces, chopping boards etc. Ensure there is no sharing of unwashed serving utensils and be aware that some children have severe allergies and must not be served the food they are allergic to.

DEC Recommendations

The Department of Education and Communities (DEC) does not recommend the banning of allergens in the school. However, these decisions in the end are not made by DEC but are made at the local level with the individual school. If you are a canteen manager, we encourage you to talk to your principal about what an allergen ban means for the canteen. Raise questions such as, what does it mean for the many products that contain traces of nuts, etc? It will help the school to see the great difficulty that a ban means and that banning something gives a false sense of security. Each school has a Student Welfare consultant and this person can be contacted to give further advice. In addition, DEC can be contacted at the state level at 02 9244 5861. However, it is best to talk to the principal and the Student Welfare Consultant before calling DEC. If a school is particularly concerned about legal issues, the school can contact DEC’s Legal Services team. However, only DEC employees can do this. If you are a canteen manager and are concerned about legal requirements or legal ramifications, you should talk to your principal who can contact legal service

What other information is available?

The Anaphylaxis Guidelines for Schools. 2nd Edition, 2006 Provides a step-by-step guide for Principals to assist them in providing a safe and supportive environment for students at risk of an anaphylactic reaction. This document can be accessed at www.schools.nsw.edu.au/studentsupport/studenthealth/conditions/anaphylaxis/index.php

ASCIA Guidelines for prevention of food anaphylactic reactions in schools, preschools and childcare centres: ../../../food-nutrition/food-intolerances/anaphylaxis-fact-sheet/allergy.org.au

Useful Websites

NSW Food Authority www.foodauthority.nsw.gov.au

Anaphylaxis Australia www.allergyfacts.org.au

Australasian Society of Clinical Immunology and Allergy www.allergy.org.au

References: P and C Journal Term 2 2006, Geraldine Batty (Anaphylaxis Aust) Fresh Tastes @ School Newsletter 5, August 2006