A lack of legal clarity surrounding anaphylaxis management in schools and childcare settings could delay treatment and lead to “preventable death”, HSE Child Health-Public Health has warned.
A paper, titled Anaphylaxis in childcare and educational settings in Ireland – an overview of issues and concerns from a child health perspective, has been authored by the Clinical Lead for Child Health-Public Health Dr Abigail Collins, and clinical colleagues.
The paper reflects a need for clearer provisions and supports relating to the management of anaphylaxis in childcare and schools.
It advocates for the development of a national policy on the prevention, recognition, and management of anaphylaxis in these settings. This would involve provision of mandatory awareness and emergency response training for all staff; and the availability of wall-mounted adrenaline auto-injectors.
The HSE paper says children with anaphylaxis must be “protected from preventable death” by ensuring staff are “protected and obligated” to administer or assist in administering an adrenaline auto-injector. Legal clarity should be provided for staff “confirming” they are “permitted and protected” when administering adrenaline in suspected anaphylaxis. Children at risk of anaphylaxis must be able to participate “fully and safely in all aspects of educational and childcare life”.
Anaphylaxis is a serious allergic reaction. Potential triggers include foods, medicines, insect stings, and latex.
“Although most anaphylactic reactions are not fatal, symptoms can escalate rapidly, and delayed treatment significantly increases the risk of death,” states the paper.
The HSE confirmed to the Medical Independent that the use of adrenaline in a child with suspected anaphylaxis, even if it later transpires to be another diagnosis, is “very unlikely” to cause harm.
The HSE paper referenced an Irish study that enrolled over 500 children with known food allergies. Five cases of anaphylaxis occurred in schools/pre-schools during the study period, mainly in primary school children. In none of these cases was adrenaline administered by staff (adrenaline was administrated in three cases – by parents on their arrival or by hospital staff). The majority of children in the study had brought two adrenaline auto-injectors to the school/pre-school. However, over one-third of parents had not provided their child’s allergy action plan to their school/pre-school.
The HSE paper, developed in 2025 and released under Freedom of Information (FoI) law, has been shared with a number of departments/agencies, including the Department of Health (DoH).
Separate FoI records indicated that the DoH did not consider there was a lack of legal clarity surrounding the area.
According to the HSE paper, the relevant legal framework includes Statutory Instrument (SI) No 449/2015. This SI allows registered organisations to procure certain emergency medicines, including adrenaline, which can be administered by an individual who has undergone training. The person receiving the emergency medicine must previously have been prescribed the medicinal product or been diagnosed as having the condition for which it is to be administered, “provided that it is reasonable to expect this information to be obtained in the circumstances.”
As of early 2026, only 11 schools and childcare facilities were registered under this SI. The Pre-Hospital Emergency Care Council confirmed it “would support” a review of SI 449/2015.
The HSE paper also referenced ‘Good Samaritan’ provisions under the Civil Law (Miscellaneous Provisions) Act 2011; and Common Law, “which places an ‘in loco parentis’ duty of care on teachers, based on judicial decisions and precedents in previous cases.”
In practice, however, existing laws “have not provided sufficient clarity on how anaphylaxis should be managed in childcare and educational settings”.
When contacted, the DoH stated the Department of Children, Disability, and Equality (DCDE) would be “better placed to respond”.
According to the DCDE, the safety and wellbeing of children and young people is its primary concern. The HSE paper’s recommendations for a national policy and mandatory training would “need to be considered in light of Government policy”.
“The Department is happy to engage further with other departments and agencies on these recommendations and next steps for services under its remit.”
The DCDE outlined that childcare providers are legally required to ensure “all reasonable measures are taken to safeguard the health, safety, and welfare of a pre-school child attending the service”.
In a situation where there is no prior parental consent to administer an available adrenaline auto-injector (eg, a first-time presentation), the DCDE said it considered administration would be a reasonable measure if advised by emergency services in a life-threatening scenario. In cases of suspected anaphylaxis in children, the HSE website’s advice is to “use an adrenaline auto-injector if they have one”. The second step is phoning the emergency services.
According to the Department of Education and Youth, the board of management of each school is responsible for the care and safety of students.
“Where a school knows that a pupil or pupils may face difficulties because of a medical condition, the school can work together with parents, teachers, and the children to put plans in place. These plans can help prevent problems or make sure that, if a child needs something like medication, the right treatment is available.
“This Department cannot direct any member of the board of management or the teaching staff of the school to administer medical treatment to pupils, or to undertake action and procedures which are normally carried out by medical professionals.”
In England, new statutory measures will require schools to stock adrenaline auto-injectors for emergencies. Schools will be required to implement allergy awareness training for all staff and have a comprehensive policy for supporting children with medical conditions.
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