School Pupils with Allergies

Jon Cruddas Excerpts

Thursday 30th November 2023 Westminster Hall

[Jon Cruddas (Dagenham and Rainham) (Lab)]

It is a pleasure to follow the hon. Member for Rutland and Melton (Alicia Kearns); that was an excellent contribution and I associate myself with everything she said.

I congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate, as is customary in these proceedings. In this instance, my congratulations are about more than simply adhering to the parliamentary protocols, because this stuff really matters. Hopefully, actions that might follow from this debate could save the lives of scores of young people in this country, so the stakes are high. I therefore thank him both for securing this debate and for his detailed contribution. During my comments, I will echo many of the things that have been said. As the chair of the all-party group on allergy, I can say with some confidence that the allergy community, countless young people suffering from allergic diseases and their extended families will be grateful for his intervention.

This is our third or fourth debate on allergy over the past year or so, and that is great, because it marks real progress. For years, it has been difficult to get the scale of the allergic epidemic registered in Parliament and by Government policymakers. It is so frustrating that over the past couple of decades, a series of detailed, authoritative reports has consistently demonstrated the prevalence of allergic disease, patient needs and the lack of UK service provision, yet their policy recommendations have generally been ignored. Hopefully that is now changing, as is reflected in not just the number of debates we are having, but the changing dialogue secured over the past two years with Government.

A previous care and mental health Minister, the right hon. Member for Chichester (Gillian Keegan)—now the Secretary of State for Education—demonstrated real commitment in this area and began to grip questions of allergy, primarily from a public health perspective. Consequently, since 2021, we have established a work programme and an ongoing dialogue between civil servants and representatives from the National Allergy Strategy Group to support the development of a national plan. From a public health perspective, we are beginning to see real and, quite possibly, sustained progress. Hopefully, following today’s debate, we might complement those positive recent developments with progress for those suffering from allergic disease in our schools.

It is worth remembering what we are talking about. Allergy is a hypersensitivity reaction to substances or allergens that are normally tolerated. Examples include peanuts, milk, shellfish, cats, medicines and grass pollens. They can trigger harmful antibodies and the release of inflammatory chemicals, causing symptoms such as sneezing, itching, rashes and falls in blood pressure. However, they may also cause airway narrowing, shortness of breath, wheezing and swelling that, if in the mouth, throat or airway, cause severe difficulty in breathing and can be life-threatening.

About one in three people—more than 20 million people—in the UK have an allergic-related disorder, 5 million of whom have conditions severe enough to require specialist care. Fatal and near-fatal reactions occur regularly due to foods, drugs and insect stings, and they have been increasing over recent years. For example, hospital admissions due to allergy rose by 52% in the six years to 2017-18. Admissions from anaphylaxis, which is a rapid onset of life-threatening reactions, rose by 29%.

Prevalence rates for allergy in the UK are among the highest in the world, especially among young people. Each year’s new births add some 43,000 cases of child allergy to the population in need. This is not just happening here in the UK: the prevalence, severity and complexity of allergies have increased on a global scale over the last 60 years. Allergy UK has described allergy as

“the most common chronic disease in Europe.”

More and more children struggle with allergic conditions. Some 50% of British children may have an allergy, and those numbers are rising. However, this goes beyond the statistics: for the growing number of people living with allergic disease in the UK, their condition can have a significant and negative impact on their lives and those of their families.

As I mentioned, the lack of interest in allergy at national level has been frustrating. Over the past two decades, there has been a series of specialist reports recommending action. They have highlighted the poor management of allergy in the NHS and specialist services, as well as in primary care, and they have identified the negative impact of an allergic condition on a person’s life and the lives of their family members. It is frightening and restrictive to live with a condition that can cause a severe or life-threatening reaction at any time.

However, there has been no wide-scale change in how we protect people with allergic conditions and respond to anaphylactic reactions, and a change is therefore needed. I think we can all appreciate how parents of children with allergic conditions suffer. A child unexpectedly vomiting, struggling for breath or breaking out in a rash is terrifying. That is why this debate about allergy in schools is so important.

At least a fifth of a child’s life is spent away from parents at school. More anaphylactic reactions occur in school than anywhere else, yet in a third of anaphylactic cases, teachers and staff did not know that the child had an allergic condition in the first place. That is a horrifying statistic: in a third of cases, they did not know that the child had an anaphylactic condition. It is against that backdrop that parents rightly worry that schools and teachers have inconsistent and vague guidelines on planning for anaphylactic reactions.

Although there are awkward gaps in the guidance, there is mandatory guidance on supporting children with medical conditions, but that does not provide details on specific conditions such as allergy. There is specific guidance on using adrenaline auto-injectors, but that is not mandatory. Teachers are often unaware of which pupils in their class have an allergic condition so strong that it might induce an anaphylactic reaction and may need an EpiPen response. Quite correctly, parents are therefore nervous about how schools manage their children’s allergic conditions. Moreover, pupils might forget what they are allergic to and need teachers to remember, but teachers may not know or may be unprepared to respond to a severe allergic reaction.

Things can go wrong because of no one’s fault. Let us take the case of Karanbir Cheema. When this 13-year-old boy was eating lunch at school in west London, a classmate flicked cheese at his face—the sort of behaviour that is common on most school dinner tables across the country—but Karanbir was allergic to milk. He had a severe anaphylactic reaction and was taken to hospital. Tragically, two weeks later, he died. Schools might well respond to tragic occasions such as that by introducing no-nut bans or creating special zones in dining halls for milk allergies. Those are well intentioned, but they tend to isolate children from their friends, so they might inadvertently increase the vulnerability of children to social exclusion and the type of teasing that we heard about.

The best response to improve the immediate reactions of staff is to improve their knowledge and capacity to act. The key point is that changing schools’ management of allergies is not complicated or expensive. Many countries and governments around the world have simple legislation. New York state, for example, requires daycare employees to recognise anaphylaxis and administer EpiPens properly. Virginia requires schools to stock auto-injectors, which teachers are trained on. That also protects the schools from liability. As we heard, almost 20 years ago, Canada required its state schools to create anaphylaxis plans reducing exposure to allergens and to communicate with parents and students about allergies, and it required individual plans to be made for all high-risk students. That approach seems sensible and pragmatic. It would not be expensive or complicated to develop a similar set of requirements for British schools.

I will repeat the request that has been made this afternoon. The Benedict Blythe Foundation suggests four mandatory requirements for all schools, which seem entirely sensible to me. First, it suggests that every school must have an allergy policy in place, and secondly, that parents and schools must co-create an individual healthcare plan for every pupil with allergy and anaphylaxis —similar special educational needs plans are currently created for students with disabilities. Thirdly, it suggests that schools must hold spare adrenaline auto-injector pens, and fourthly, that school staff and teachers must be trained in allergy awareness and allergy first aid. It is straightforward to learn how to use an EpiPen. As we have heard, those combined recommendations would cost less than £5 million a year to implement in England. They would end patchwork guidance and provide peace of mind for both parents and teachers.

One final point I would make is that it is important that we use such debates to put on record our appreciation for all the practitioners and healthcare professionals dealing with allergy—including Allergy UK, members of the National Allergy Strategy Group, Anaphylaxis UK, the Natasha Allergy Research Foundation and all the researchers seeking new remedies—and for the insights of all the families and campaigners fighting on behalf of those with allergic conditions. These people do a fantastic job, but they need help, because lives depend on it.

It should be the right of every allergy sufferer to receive a quality standard of care. Every sufferer should be able to feel confident about the food they consume, and every young person should remain safe at school. Allergy conditions are becoming more prevalent and commonplace, which makes it extremely important that we make schools safe and protect children with allergic conditions.

I urge the Government to respond favourably to the debate and the recommendations that have been outlined this afternoon by Members from parties on both sides of this House, because the lives of many of our young people may well depend on it.