Allergies & Anaphylaxis in Schools and Early Years Settings

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Big 8 account for over 90% �of food allergies in children

• Milk
• Egg
• Tree Nuts
• Peanuts (part of the legume family – not nuts!)
• Shellfish
• Wheat
• Fish
• Soya
• (sesame also very common!)

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Non-food causes of allergies include:

• Aeroallergens e.g. pollens, dust, animal hair and moulds.
• Injectable e.g. Wasp/Bee stings.
• Contact e.g. Latex
• Medicines e.g. antibiotics and pain relief medication such as Ibuprofen
• Spontaneous urticaria – child gets rashes without external triggers

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You can be allergic to pretty much anything!

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Mild – Moderate symptoms include:

• Swollen lips, face or eyes
• Itchy / tingling mouth
• Hives or itchy skin rash
• Abdominal pain
• Sudden change in behaviour
• Vomiting

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Examples of allergic skin reactions

• Hives / Nettle Rash

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Swelling of the lips

What is anaphylaxis?

• Anaphylaxis is a severe systemic allergic reaction.

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• It is at the extreme end of the allergic reaction spectrum

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• The whole body is affected usually within minutes of exposure to the

allergen

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Signs and Symptoms - Anaphylaxis

• Airway: Persistent cough, hoarse voice, difficulty swallowing, swollen tongue.

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• Breathing: Difficulty or noisy breathing, wheeze or persistent cough.

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• Consciousness: Persistent dizziness / pale or floppy, suddenly sleepy, collapse, unconscious.

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�What is the difference between �an asthma attack and anaphylaxis ?�

• While a severe allergic reaction could include asthma type symptoms, there could (but not always) be other allergy symptoms present (see previous slide).

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If in doubt: administer adrenaline!

Delays in giving adrenaline are a common finding in fatal reactions.

Managing allergies

• Allergen avoidance
• Risk assessment
• Kitchen and dining areas kept clean of food allergens
• Knowledge of food ingredients at meal times including reading labels
• Discouragement of food sharing
• Contact allergy child’s family in advance if doing activities involving food
• Easy access to emergency treatment medications
• Annual staff training

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Emergency allergy kit

The child’s individual ‘Allergy Medication Kit’ may include:

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• Oral anti-histamine e.g. Piriton®, Cetirizine® and Loratadine in liquid or tablet form
• Reliever Inhaler (e.g. Salbutamol) and ideally spacer device
• Adrenaline Auto Injector (AAI) Device e.g. EpiPen, (Emerade) or Jext
• Allergy action plan – example on next slide

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Current issues with action plans

The following information has been added by Helen Smith (Clinical Nurse Specialist – Allergies) for your information

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• The local allergy team provide 500-1000 individual plans per year so cannot update these unless there is a significant change
• The plan may state one particular adrenaline pen make and when these expire they may be prescribed a different device by the GP due to current availability. Many of the plans state ‘any pen device of the same strength is okay as an alternative’ to cover this issue.
• September 2021 – there is currently a national shortage of the liquid version of anti-histamine Cetirizine (used instead of tablets in younger children) so alternatives are being advised e.g. Loratadine (same dose as Cetirizine). Again the allergy team cannot update all plans to reflect this.

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Treatments – Mild to Moderate

• Stay with the child and call for help if necessary
• Locate the child’s allergy kit
• Locate their allergy action plan
• Give anti-histamine medication (If vomited, can repeat dose as per action plan)
• Phone parent / emergency contact

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Treatments – Anaphylaxis

• Stay with the child, call for help
• Locate emergency allergy kit
• Locate allergy action plan
• If possible, give anti-histamine (If vomited, can repeat dose)
• Administer Adrenaline Auto Injector (AAI)
• Call 999 and say Anaphylaxis (ANA-FIL-AX-IS)
• Phone parent / emergency contact
• If in doubt give Administer Adrenaline Auto Injector (AAI)

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• Additional Instructions – (as per the Allergy Action Plan);
• If wheezy, give adrenaline FIRST, then asthma reliever puffer (blue inhaler) via spacer.

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After giving adrenaline

• If no improvement after 5 minutes and an ambulance hasn’t arrived give a second adrenaline dose using a second device, if available.

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Adrenaline Auto Injectors (AAI)�

Clothes do not need to be removed, AAI can be administered through clothing avoiding buttons, seams and pockets

Instructions for Administrations – Epi-Pen

• Reduced injection time from 10 to 3 seconds

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• Removal of the massage step after the injection – this step has been removed to simplify the process of administering EpiPen or EpiPen Junior.

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• After administration, a needle guard will shield the needle, preventing injury

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Epipen Administration

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http://www.epipen.co.uk/demonstrationvideo/

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Instructions for Administrations – Jext

Jext should be pushed firmly against the outer

portion of the thigh into the largest part of the thigh muscle, for 10 seconds.

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When you push Jext firmly against your thigh,

a spring activated plunger will be released, which

pushes the hidden needle through the seal at the end

of the black needle shield, into the thigh muscle and

injects a dose of adrenaline.

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Massage the area for 10 seconds after administration

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After administration, a needle guard will shield the

needle, preventing injury

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Jext Administration

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https://youtu.be/fydt1hgpcso

Instructions for Administrations Emerade

UPDATE November 2021 – Emerade devices are now being relaunched in the UK in 300mcg and 500mcg strengths. Devices stopped being prescribed in September 2021 due to potential fault.

• Remove needle shield
• Press against the OUTER THIGH (without swinging the device)
• Hold for 5 seconds - Massage the injection site gently.
• After administration, a needle guard will shield the needle, preventing injury

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Emerade Administration

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Instruction video for Emerade adrenaline auto-injector for anaphylaxis

Guidance for Administer Adrenaline �Auto Injector’s in schools

All children prescribed a Adrenaline Auto Injector should have 2 in school.

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Infant / Junior Schools

• Allergy kit should be stored in a central, safe location which is accessible at all times.

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Secondary Schools

• It is expected that the pupil carries the allergy kit on their person with one Adrenaline Auto Injector being stored in a central, safe location which is accessible at all times.
• At the end of each school term, the Adrenaline Auto Injector expiry date should be checked and arrangements made for the parents to provide a new Adrenaline Auto Injector, if required.

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New policy re AAI’s in schools

• October 2017 – schools can purchase spare AAI’s

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• The spare device is aimed at children;
• Already at risk of anaphylaxis without access to their device at the time of need.
• Those with a mild allergy not prescribed an AAI then having an unexpected severe allergic reaction. The new allergy plans will ask for parental permission to administer the pen.
• A child with unexpected anaphylaxis not known to have an allergy (on the advice of the emergency services only via a 999 call).

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• www.gov.uk/government/publications/using-emergency-adrenaline-auto-injectors-in-schools

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Adrenaline Auto Injectors (AAI)

Website Information

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Epi-Pen

www.epipen.co.uk

Emerade

www.emerade.co.uk

Jext

www.jext.co.uk

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Demonstration pens can be ordered from the above websites.

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Further Information

• Anaphylaxis Campaign
• www.anaphylaxis.org.uk

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• Allergy UK
• www.allergyuk.org

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• Spare Pens in Schools (including how to purchase AAI devices)
• www.sparepensinschools.uk

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• www.medicalconditions@school.org

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