The First-Aid Room

Allergic reactions and anaphylactic shock in school: what you need to know

Written by Alex Oselton | Mar 17, 2026 6:00:00 AM

Anyone who’s seen it or experienced it knows how fast an allergic reaction can escalate. 

For many pupils, allergy symptoms are mild, such as itching, watery eyes, or sneezing. In some cases, however, reactions can intensify within minutes and become severe and potentially life-threatening, a condition called anaphylaxis (or anaphylactic shock) that requires immediate medical attention.

Recognising early symptoms can significantly impact a child's safety, as anaphylaxis occurs more frequently in schools than in any other setting outside the home

Last week, we covered Benedict’s Law, the new school allergy safety bill that is expected to come into effect in September 2026.

With 40% of children in the UK diagnosed with an allergy, and almost 1 in 12 young children affected by a food allergy, it’s more important than ever to understand and recognise the symptoms of an allergic reaction and to know how to respond when one occurs.

 

What causes allergic reactions?

 

An allergy is the response of the body’s immune system to a normally harmless substance. These substances, known as allergens, are mistakenly identified by the immune system as a threat.

 

How allergic reactions develop


1. First exposure to the allergen: A person first comes into contact with a substance that their immune system may later react to. Typically, there may not be an allergic reaction to the substance at this stage, but the immune system identifies it as a potential threat.

2. Antibody production: Because it identifies the substance as a potential threat, the immune system produces antibodies, such as immunoglobulins (IgE).

3. Sensitisation: The immune system “remembers” the allergen, a process called sensitisation. This is why someone may not experience an allergic reaction the first time they are exposed to an allergen, but they may have one if exposed to it again.

4. Repeat exposure: When encountering the allergen again, the immune system recognises it and responds. The antibodies trigger the body’s defence system, which mistakenly treats the allergen as a threat.

5. Chemical release and symptoms: This immune response causes chemicals, such as histamine, to be released by blood cells. This causes a range of symptoms affecting the skin, airways, stomach, and/or circulation.


Ultimately,
it is this immune response to a perceived threat that can sometimes lead to a life-threatening reaction.

 

💡 Good to know

  • People with allergies typically do not have an allergic reaction upon first exposure to the allergen, because their immune system has not yet been sensitised to it.

  • Allergies can appear at any age, and tolerance can change over time.

  • While some childhood allergies, especially to cow’s milk, hen’s egg, wheat, and soya can be outgrown, allergies to peanuts, tree nuts, fish, shellfish, and sesame are more likely to continue into adulthood (Anaphylaxis UK).

For many pupils, allergies are already known and documented through medical records, and under Benedict's Law, schools will be required to have an Individual Healthcare Plan (ICP) in place for pupils with allergies. However, a child may experience their first allergic reaction at school, even if no allergy has previously been diagnosed.

 

What are common allergy triggers in schools?

 

Schools can expose pupils to a variety of allergens:

  • Food allergens, such as peanuts, tree nuts, milk, eggs, sesame, wheat, fish, or shellfish
  • Insect stings, particularly from bees or wasps during outdoor activities
  • Pollen, especially during spring and summer months
  • Animal dander, sometimes present on clothing
  • Medications, including antibiotics
  • Latex, sometimes found in gloves or sports equipment

 

What are the most common symptoms of an allergic reaction?

 

Schools are not expected to diagnose allergies, but teachers and staff play an important role in noticing symptoms and responding quickly. Symptoms can appear within minutes of exposure but may also develop gradually.

 

Mild to moderate allergic reaction symptoms

 

Symptoms of a mild allergic reaction may include:

  • Itchy skin or a raised rash (hives)
  • Swelling around the lips, eyes, or face
  • Sneezing or a runny nose
  • Watery or itchy eyes
  • Tingling in the mouth
  • Complaints that their throat feels “scratchy”
  • Mild stomach discomfort, nausea, or vomiting

Younger children may struggle to describe what they are feeling and may instead appear distressed, agitated, itchy, or uncomfortable.

 

Severe allergic reactions and anaphylactic shock

 

In some cases, an allergic reaction can develop into anaphylaxis, a severe and potentially life-threatening condition.

Symptoms of anaphylactic shock include:

  • Sudden swelling of the lips, mouth, throat or tongue
  • A rash that is swollen, raised or itchy (hives)
  • Coughing, wheezing, very fast breathing or struggling to breathe – they may feel like they are choking or gasp for air
  • Tightening throat and struggling to swallow
  •  Blue, grey or pale skin, tongue or lips – for black or brown skin, this may be easier to see on the palms of the hands or soles of the feet
  • Skin that feels cold to the touch
  • Confusion, tiredness, drowsiness or dizziness
  • Fainting, losing consciousness
  • Becoming limp, floppy or unresponsive – their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face

What school staff can do if a pupil has an allergic reaction

 

Clear procedures and coordinated responses can help ensure that pupils receive appropriate care quickly.

1. Stay calm and reassure

Allergic reactions can be frightening. Reassure the child and keep them comfortable while assessing symptoms. If they have a known allergy, follow their Individual Healthcare Plan.

2. Administer medication if required


If a pupil’s healthcare plan indicates that medication should be given, follow the school’s procedures and the instructions provided.


3. Monitor the pupil closely and inform parents


Keep the pupil under observation and record:

  • When symptoms started
  • Possible triggers (if known)
  • What symptoms were reported or observed
  • Actions taken and any medication administered
  • Whether symptoms improved or worsened

Symptoms can change quickly during an allergic reaction. Clear and accurate documentation ensures families are aware of what happened and supports continuity of care, as healthcare professionals may use incident records to diagnose an allergy.

 

When to call emergency services

 

If a severe allergic reaction is suspected, 999 should be contacted immediately, and the pupil’s emergency medication should be administered according to their care plan.

If you suspect a pupil is experiencing an anaphylactic reaction:

  1. Use an adrenaline auto-injector. Do not wait to see if things improve, as anaphylaxis can progress quickly.

  2. Call 999 for an ambulance and say that you think a pupil is experiencing an anaphylactic reaction.

  3. Allow the pupil to lie down in a quiet area. Raise their legs, and if they are struggling to breathe, raise their shoulders or sit them up slowly.

  4. If they have been stung by an insect, try to remove the sting if it's still in the skin.

  5. Use a second adrenaline auto-injector if symptoms do not improve after 5 minutes.

 

By September 2026, schools will be required to stock adrenaline auto-injectors for emergency situations. Schools can access these through providers such as our partner, Kitt Medical, which offers subscription supplies of adrenaline pens.

 

❗ Always contact emergency services after using an adrenaline auto-injector.

❗Do not offer food or drinks as this could potentially make the condition worse.

Do not ask or allow them to stand or walk, even if they seem to feel better. Standing up can cause a sudden, severe drop in blood pressure (cardiovascular collapse). Even after receiving adrenaline, they must remain resting. Standing up too soon can cause symptoms to return or worsen.

 

Communicating with parents about allergic reactions


While schools are not expected to diagnose medical conditions, parents rely on them to share observations and concerns about their child’s health.

When discussing allergic reactions:

  • Share factual observations rather than assumptions about causes
  • Avoid placing blame around food choices or exposure
  • Explain what symptoms were noticed and what action was taken
  • Encourage families to seek medical advice and get in touch with their GP or an allergy specialist

Using neutral, supportive language helps ensure conversations remain collaborative and focused on the child’s wellbeing.

 

Supporting resources

We’ve carefully crafted these resources to help you, your colleagues, and parents recognise allergic reactions early and respond quickly and confidently. 

  1. Allergic Reactions: Know the signs and how to respond (poster for school staff)
  2. Childhood allergies: Parent guidance brochure
  3. What to do: anaphylaxis