Diagnosis and Management Plan

The healthcare professional will take a detailed allergy patient focused history. This is the most important step in making the diagnosis; possible allergens will be identified and following allergy testing (where necessary) the allergy is usually confirmed .

Allergy testing includes:

Skin Prick Testing

A small drop of allergen is placed on the patient's arm and lightly pricked to push it just below the surface of the skin. After a few minutes, if the person is allergic to the particular allergen a local skin reaction will be observed. A positive result is where a raised white bump on the skin develops. This means that the allergen has stimulated the immune cells under the skin to release inflammatory substances, such as histamine. Skin prick tests should always be interpreted in conjunction with the patient history of reactions.

Blood Testing

This test measures the levels of specific antibodies (immunoglobulin E) in the blood. For example if peanut allergy is suspected the specific antibodies against peanut protein can be measured.

Oral Food Challenge

This is the gold standard test for confirming or ruling out a food allergy. It is used when there is a diagnostic uncertainty or when assessment of the tolerance level to a specific food is required. This takes place in hospital where a specific food is given to the patient in an incremental dose under observation.

Upon diagnosis of an allergy, the patient will be issued with a personalised allergy action plan (PAAP). This plan will state the allergen(s) to avoid and how to manage a mild-moderate or severe allergic reaction.

An example of a PAAP is the BSACI Allergy Action Plan.  Different health boards may use a different design or style of plan, but they should all include the same information.

The EAACI advise that the risk of an allergic reaction can be reduced when an individual health care plan is in place

Where pupils with allergy are identified by the school, the senior management team, or designated staff member should draw up an individualised healthcare plan to identify the level of support the pupil requires, as stipulated by the Scottish government statutory guidance. This should be developed with input from the child’s healthcare professional, school health team (where available), senior management team, parents / carer(s) and the individual pupil.

The BSACI allergy action plan can function as an individualised healthcare plan.

 The Scottish Government’s guidance states that the policy for pupils with medical conditions including allergy should be provided by the local council’s education services.

An allergy management policy should therefore be in place across all schools. It may be incorporated into a wider medical conditions policy but schools should always have specific arrangements related to management of children with severe allergies.

This policy should reflect the main goal of the school, as outlined by the European Academy of Allergy and Clinical Immunology (EAACI, 2014), which is to:

“Create a network of support and self-sustaining environment of awareness which will in turn decrease the likelihood of reactions and enable staff to recognise and treat emergencies”

Schools can stay prepared with an Allergy Management Policy:

The Allergy Management Policy should cover the school’s approach for identifying pupils with allergy, developing healthcare plans, storing emergency medication/spare AAI’s, preventing allergic reactions and responding to emergencies. It should also set clear roles and responsibilities of school staff, parents and pupils.

It is important to have a policy in place even if there are no pupils with allergies currently registered. 
“Approximately 25% of severe allergic reactions which happen in school occur in pupils with no history of allergies”