Anyone prescribed adrenaline must carry or have immediate access to two of their own adrenaline auto-injectors. Two are needed in case one misfires, or a second dose is needed.

Younger children, who cannot be expected to carry their own medication, should have an emergency kit which is available to the child at all times, not locked away, and accessible to all staff.

Older children and teenagers should, whenever possible, assume responsibility for their emergency kit under the guidance of their parents. They should carry two adrenaline auto-injectors on them at all times and be supported to have the confidence to self administer in an emergency. However, symptoms of anaphylaxis can come on very quickly, so school staff need to be prepared to administer medication if they need assistance.

Spare adrenaline auto-injectors should be stored in a central location, not locked away, where they can be with the child within 5 minutes. All staff must know the location of the spare adrenaline auto-injectors.

Any member of staff may volunteer to provide first aid to support pupils with medical conditions. However, Regulation 238 of the Human Medicines Regulations 2012 allows for adrenaline to be administered by anyone for the purpose of saving a life in an emergency.

In many schools, it would be appropriate for there to be multiple designated members of staff who can administer adrenaline to avoid any delay in treatment and to ensure cover when staff are absent. Best practice would be for all school staff have anaphylaxis training, particularly all staff working closely with the allergic child.

The change in law applies to local authority-maintained nurseries, primary, secondary and special schools, academies, pupil referral units and independent schools in England, Scotland and Wales. In Northern Ireland this applies to grant aided schools and independent schools as defined in the Education and Libraries (NI) Order 1986. The ‘Human Medicines (Amendment) (No. 2) Regulations 2014’ defined what the term ‘school’ means. This definition can be found here.

Any other organisations or clubs outside of school, cannot purchase spare adrenaline auto-injectors. Children at risk of anaphylaxis must have their own prescribed adrenaline auto-injectors with them at all times.

The adrenaline auto-injectors prescribed in the UK are EpiPen® and Jext®. The decision as to how many and what brands to purchase will depend on the individual circumstances within your school. However, the Department of Health guidance advises:

“Where all pupils are prescribed the same device, the school should obtain the same brand for the spare adrenaline auto-injector. If two or more brands are currently held by the school, the school may wish to purchase the brand most commonly prescribed to its pupils.”

The place where the adrenaline auto-injector is administered is the same for EpiPen® and Jext®; they are injected into the upper, outer thigh. However, there is some variation in operating each one and training on each device should be given to all school staff who might be required to administer adrenaline in an emergency.

Schools can purchase adrenaline auto-injectors from any pharmacy, without a prescription. A template letter which must be complete on headed school paper can be downloaded here. It is also available on the website www.sparepensinschools.uk.

Pharmacies are not required to provide adrenaline auto-injectors free of charge to schools, your school must pay for them as a retail item. They cost around £35 each, but most pharmacies will add an additional handling charge of £10-£15 each.

Spare adrenaline auto-injectors are primarily for pupils known to be at risk of anaphylaxis and for who both medical authorisation and written parental consent for use of the spare auto-injector has been provided. The school’s spare auto-injector can be administered to a pupil whose own prescribed device cannot be administered correctly without delay.

A schools’ spare adrenaline auto-injector can also be used for any pupils or other person not known by the school to be at risk of anaphylaxis in an emergency. Written permission is not required in these exceptional circumstances where the reaction could not have been foreseen.

Further information on the use of spare adrenaline auto-injectors can be found in this Clarification of adrenaline autoinjector guidance for schools

We don’t typically recommend complete nut bans because they are very difficult to enforce and can lead to a false sense of security. Children can be allergic to other common food allergens, for example milk and egg, and it would be impossible to ban them all. We recommend a whole school allergy awareness approach of all allergens. Settings should carry out an individual risk assessment for any child with an allergy and put appropriate measures in place to reduce the risks as far as possible. Every setting is different, but this may include extra cleaning measures or adjustments of the timings and locations of meals and snacks if necessary.

See our ‘Should schools go nut-free?’ podcast with Dr Adrian Sie here.

We don’t recommend a complete ban of any foods, including foods with precautionary allergen labels. A large variety of foods have nuts as an ingredient or ‘may contain’ warnings for nuts. Nuts are also not the only allergen, and it would be impossible to ban them all.

See our ‘Should schools go nut-free?’ podcast with Dr Adrian Sie here.

Some cosmetics contain food ingredients, for example, some creams contain nut oils. It’s difficult to determine the level of risk posed by cosmetic products containing food ingredients, however, unless the allergic child accidentally ingests the cream it’s likely to be very low. Anaphylaxis from skin contact with the product alone is extremely unlikely, however, contact reactions such as a skin rash/hives could occur. Nut oils are made from the fats of the nut, so likely have very little amounts of nut protein in, reducing the risks further as the proteins cause allergic reactions.

Further information about food ingredients in cosmetics can be found in our factsheet.

Kissing can be risky if someone eats a food that the other person is allergic to. Allergens can remain in saliva for several hours – anywhere between 2 and 24 hours, and even brushing teeth may not get rid of them effectively. If, for example, a child eats something then kisses a child allergic to that food on the cheek, this is unlikely to cause anaphylaxis, but a contact reaction such as a skin rash/hives could occur.

Kissing on the lips is more risky for someone with a food allergy, and could cause anaphylaxis if they kiss someone who has eaten their allergen. Our ‘Take the Kit‘ video, aimed at older students, highlights the importance of always carrying your adrenaline auto-injectors with you and the potential risk from kissing.

Cake sales to raise money for charity are a common feature of school life. There’s no reason why these shouldn’t go ahead, provided the activity is risk assessed and food allergies are considered. The more information that can be provided about the ingredients in the food, the better it is, so that those with allergies can make safe choices. The Food Standards Agency has further information about providing food at community events, such as school fetes.