In the United Kingdom, approximately 2 million people live with at least one type of food allergy. While many experience only mild symptoms, a significant number are at risk of severe, life-threatening reactions, including anaphylaxis.

Any food can trigger anaphylaxis, but some are more likely to do so, particularly in school settings. For this reason, food allergy training and anaphylaxis protection should be a priority.

This article covers food allergy statistics in children, the top 14 food allergens, and how schools can prepare for anaphylactic emergencies with spare adrenaline pens.

What is a Food Allergy, and What are Its Symptoms?

A food allergy, also called food hypersensitivity, is our immune system’s unusual reaction to specific foods. Note that food allergy is different from food intolerance. The latter is often less serious and does not involve the immune system. Even small amounts of the allergy-causing food (allergen) can trigger symptoms, such as:

Lightheadedness or dizziness
Rash
Swelling of the eyes, lips, and face
Runny, itchy, or blocked nose
Sneezing
Diarrhoea
Tummy ache
Feeling or being sick

People with food allergy may also experience anaphylaxis, a severe, life-threatening allergic reaction. Anaphylaxis escalates quickly, often in a matter of minutes. Symptoms include:

Airway: Tightening of the throat, swelling of the tongue, difficulty swallowing
Breathing: Sudden onset wheezing, difficulty breathing, and noisy breathing
Circulation: Feeling faint, pale, clammy skin, confusion, and loss of consciousness

Generally, anaphylaxis causes narrowed airways, difficulty breathing, and sudden drop in blood pressure. Immediate treatment with an adrenaline auto-injector is crucial as these symptoms are fatal.

The 14 Major Food Allergens in the UK

Did you know that food allergy occurs in 2 to 5% of children in the UK? Approximately 7.1% of breast-fed infants in the country have a food allergy, with 1 in 40 developing peanut allergy and 1 in 20 developing egg allergy.

Peanut and tree nut allergies are two of the most common allergies in the UK, with peanut allergy affecting 1 in 55 children. There are also studies pointing to cow’s milk as the “most common single cause” of anaphylaxis in school-age children.

Knowing the most common food allergens becomes even more important in school settings where 20% of severe food allergic reactions happen. This isn’t surprising as kids can be careless with food, share snacks, and have little concept of anaphylaxis prevention. Hence, it’s up to the school staff to manage risks.

As part of food allergy training for staff and students, the school can prepare an allergen checklist. In the UK, the most common ingredients that cause food allergies are as follows:

Celery

There’s little information about the prevalence of celery allergy, but Allergy UK states that in Europe, it’s about 2.8 - 11.1%.

And, although it might seem simple to avoid, celery may actually be hidden in many food products and ingredients, such as soups, salads, seasonings, and even some processed meat.

Gluten

Another common food allergen in the UK is cereals containing gluten. Gluten is one of the proteins found in wheat; for this reason, gluten-containing cereals are particularly associated with wheat allergy.

In Europe, the self-reported prevalence of wheat allergy is at 3.6%. It is also more common in children, but most outgrow it by the age of 16. Some, however, develop life-threatening anaphylaxis.

It may seem straightforward to switch to other breakfast options for allergy protection, but remember that wheat can be found in many foods, including bread, pasta, sauces, soups, and even some medications.

Eggs

Despite being a staple in household pantries, many develop egg allergy, especially babies and young children. In most cases, kids outgrow egg allergy by the time they enter school, but there are occasions when it persists through teenage years and even well into adulthood. For this reason, schools must still include eggs in their allergen checklist.

Loosely cooked eggs, such as poached eggs, omelette, fried egg, and scrambled eggs are more likely to cause a reaction. Loosely cooked eggs can also be hidden in some foods, such as egg fried rice, homemade batter and pancakes, and fresh egg pasta.

Molluscs, Fish, and Crustaceans

Allergy to crustaceans, a group of shellfish, is often associated with other seafood. The other group, molluscs, include oysters, clams, scallops, and mussels.

According to Anaphylaxis.org.uk, if someone reacts to one group of shellfish, there's a high chance they will react to others within the group. Hence, if a child is allergic to one crustacean, chances are, they are also allergic to other types. Examples of crustaceans include prawns, lobsters, shrimps, and crab.

Cross-contamination is also a concern in seafood allergy, considering how fish and shellfish often come in contact with each other in fish markets.

Milk

Cow’s milk is a common allergen in the UK, particularly affecting young children. Approximately 2-3 out of every 100 babies have a cow’s milk allergy, but most outgrow it by the age of five. However, some individuals continue to experience this allergy into adulthood, where symptoms often become more severe.

Given that milk is a staple in both households and schools, caution is necessary for allergy protection, especially since older children and adults with persistent cow’s milk allergy can experience serious symptoms, including anaphylaxis.

Foods to avoid include those containing cow’s milk or milk proteins like whey and casein, such as cheese, sour cream, and yoghurt.

Reminder: Cow’s milk allergy is different from lactose intolerance; the former involves an immune reaction, while the latter is a digestive issue. Considering this, remember that lactose-free products are not safe for individuals with cow’s milk allergy since they still contain milk proteins.

Mustard

Although rare, mustard allergy can cause serious symptoms, including anaphylaxis, in those affected.

Mustard belongs to the Brassica family, which also includes Brussels sprouts, broccoli, and cabbage. The mustard products found in supermarkets are made from mustard seeds, which are ground and mixed with other ingredients.

Children allergic to mustard must avoid not only the mustard in jars but also any foods containing mustard. Additionally, they may react to other parts of the mustard plant, such as the flower, mustard oil, and leaves, which can also be used in food.

Peanuts & Tree Nuts

Peanut and tree nut allergies are very common in the UK. In fact, they are the most commonly known food to cause anaphylaxis. A school’s food allergy training must highlight nut allergies, for this reason.

A nut allergy points to hypersensitivity to either peanuts or tree nuts.

1 in 50 children in the UK have peanut allergy, and reports say the numbers are increasing in recent decades. Also, 30 to 40% of kids with peanut allergy will also be allergic to at least one tree nut.

Here are more details about peanut and tree nut allergy:

Peanuts are technically not nuts; they are legumes grown underground. A child with an allergy to peanuts must avoid foods like peanut butter, peanut oil, and any products containing peanuts such as some baked goods.
Tree nuts are nuts that grow on trees, like walnuts, macadamia, pecans, pistachio and cashews.
A child or adult can be allergic to peanuts and be perfectly fine with tree nuts or vice versa.
Still, there are cases when a person is allergic to both peanuts and tree nuts
If you’re allergic to one tree nut, there’s a high chance that you’re allergic to other tree nuts as well.

Sesame

Sesame is among the top 10 causes of food allergies and is the most common type of seed allergy.

Foods to avoid include hummus, tahini, and halvah, as well as any foods containing these ingredients. Baked goods like breadsticks, bagels, and pies may also contain sesame seeds. It’s important to avoid food products with sesame, such as certain noodles, mixed spices, and salad dressings.

Finally, be cautious with sesame oil and foods containing or prepared with it.

Reminder: Some people who are allergic to sesame seeds may also have allergies to tree nuts and peanuts.

Soya

Soya, or soy, belongs to the legume family. While less common than nut allergies, precautions are crucial because soy is widespread - as many as 60% of manufactured foods contain soya.

Foods to avoid include soy oil, flour, and sauce, as well as soy milk, soy yoghurt, miso, and tofu. Additionally, avoid edamame beans, which are immature soybeans.

Sulphur Dioxide and Sulphites

Sulphur dioxide (E220) and sulphites (E221-E228) are used for their preservative effect in a wide range of foods, such as soft drinks, sausages, burgers, dried fruits and dried vegetables. While it is rare, some people develop an allergy to them that can lead to anaphylaxis. They release sulphur dioxide, which can irritate the airway and cause severe reactions.

Reading labels, a huge part of food allergy training, is crucial. Still, be aware that sulphites may not be listed as an ingredient if used as a bleaching agent in products like white flour, crisps, and frozen chips. Therefore, it's important to be vigilant and cautious about potential hidden sources of sulphites in food products.

Lupin

Lupin is a flower, and some species are grown for their seeds, which are used in various foods, including pasta, meat-based products, sauces, and beverages.

As lupin belongs to the legume family, the same family as peanuts, some individuals allergic to peanuts may also be allergic to lupin. This cross-reactivity means that those with peanut allergies may also need to be cautious about consuming lupin-containing products.

The Proactive Approach to Anaphylaxis Preparedness in school

Fatal food anaphylaxis symptoms develop rapidly, often within minutes, that’s why immediate intervention is a must.

The first-line treatment is epinephrine or adrenaline, a medication that can quickly reverse the symptoms of anaphylaxis, such as airway constriction, swelling, and low blood pressure.

Epinephrine is administered through adrenaline auto-injectors, which are easy-to-use devices pre-filled with epinephrine. In the UK, schools are allowed to have spare pens to ensure that the potentially life-saving medicine is available instantly for those who need it, but don’t have it at the moment.

However, despite being legally permitted to purchase adrenaline auto-injectors, schools still face several challenges such as ensuring correct storage and accessibility of pens, providing adequate staff training, managing inventory and expiration dates, and maintaining clear emergency protocols.

Kitt Medical can effectively address these challenges.

Kitt Medical offers comprehensive solutions to help schools overcome the challenges of purchasing and keeping spare pens. Here’s what Kitt Medical provides:

Epinephrine Medicine: Each Anaphylaxis Kitt for schools includes two 300 mcg and two 150 mcg adrenaline auto-injectors with clear usage instructions.
Visible and Accessible Storage: Kitts are designed to be seen and easily accessible, with four keys and a breakable emergency key box.
Portable: Once unlocked, the Anaphylaxis Kitt can be carried to the emergency location.
Automatic Resupply: Ensures that used or expired medications are automatically replenished at no extra charge beyond the annual subscription fee.
CPD-Accredited Training: Includes an online training course with six videos and multiple-choice questions, accessible to all school staff and only taking 30 minutes to complete.
Incident Reporting: Schools can report anaphylaxis incidents through the Kitt login portal, ensuring timely resupply and proper documentation.

All in all, Kitt Medical provides a reliable and efficient way for schools to manage spare adrenaline auto-injectors and be prepared for anaphylactic emergencies.

Find out more

References:

https://www.food.gov.uk/business-guidance/allergen-guidance-for-food-businesses#
https://www.allergyuk.org/living-with-an-allergy/at-school/for-schools/
https://www.food.gov.uk/research/food-hypersensitivity
https://www.gov.uk/government/publications/school-food-standards-resources-for-schools/allergy-guidance-for-schools
https://londonallergy.com/what-we-treat/nut-allergies/#:~:text=Peanut%20and%20tree%20nut%20allergies,mild%20to%20extremely%20severe%20symptoms.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885259/#:~:text=Conclusions,single%20cause%20of%20fatal%20anaphylaxis.
https://www.anaphylaxis.org.uk/about-anaphylaxis/14-major-food-allergens/
https://www.thermofisher.com/allergy/wo/en/allergen-fact-sheets/wheat.html
https://www.foodallergy.org/living-food-allergies/food-allergy-essentials/common-allergens/wheat
https://www.fda.gov/drugs/buying-using-medicine-safely/medications-and-gluten#
https://www.nhs.uk/conditions/food-allergy/