Managing Severe AllergiesManaging Severe Allergies

within Schoolswithin Schools

What is Anaphylaxis?What is Anaphylaxis?

Anaphylaxis is a severe systemic Anaphylaxis is a severe systemic allergic reaction.allergic reaction.

At the extreme end of the allergic At the extreme end of the allergic spectrum.spectrum.

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

It can take seconds or several hours.It can take seconds or several hours.

Definition of AnaphylaxisDefinition of Anaphylaxis

Anaphylaxis involves one or both of Anaphylaxis involves one or both of two features: -two features: -

Respiratory difficulty (swelling of the Respiratory difficulty (swelling of the airway or asthma).airway or asthma).

Hypotension (fainting, collapse or Hypotension (fainting, collapse or unconsciousness).unconsciousness).

What are the symptoms?What are the symptoms?Swelling of the mouth or throat.Swelling of the mouth or throat.Difficulty in swallowing or speaking.Difficulty in swallowing or speaking.Alterations in the heart rate.Alterations in the heart rate.Hives anywhere on the body.Hives anywhere on the body.Abdominal cramps and nausea.Abdominal cramps and nausea.Sudden feeling of weakness.Sudden feeling of weakness.Difficulty breathing.Difficulty breathing.Collapse and unconsciousness.Collapse and unconsciousness.

What exactly is going on?What exactly is going on?• An anaphylaxis reaction is caused by An anaphylaxis reaction is caused by

the sudden release of chemical the sudden release of chemical substances, including histamine, substances, including histamine, from cells in the blood and tissues from cells in the blood and tissues where they are stored.where they are stored.

• The release is triggered by the The release is triggered by the reaction between allergic antibodies reaction between allergic antibodies (IgE) and the allergen.(IgE) and the allergen.

Types of ReactionTypes of ReactionUni-phasic – rapidly developing Uni-phasic – rapidly developing severe reaction involving the airway severe reaction involving the airway or circulation.or circulation.

Bi-phasic – early oral and abdominal Bi-phasic – early oral and abdominal symptoms, then a symptom-free symptoms, then a symptom-free period of 1-2 hours, then increasing period of 1-2 hours, then increasing symptoms involving breathing and symptoms involving breathing and circulation.circulation.

Common causesCommon causesPeanutsPeanuts

Tree nutsTree nuts

MilkMilk

EggEgg

SesameSesame

Fish Fish

ShellfishShellfish

WaspWasp

BeeBee

LatexLatex

PenicillinPenicillin

Blood productsBlood products

DrugsDrugs

KiwiKiwi

TreatmentsTreatmentsAdrenaline is the mainstay of Adrenaline is the mainstay of

treatment:-treatment:-Reverses swelling.Reverses swelling.Relieves asthma.Relieves asthma.Constricts the blood vessels.Constricts the blood vessels.Stimulates the heartbeats.Stimulates the heartbeats.

Antihistamines and asthma inhalersAntihistamines and asthma inhalers

DevicesDevices

Epipen Auto injector: -Epipen Auto injector: -

Adult dose 0.3mgsAdult dose 0.3mgs

Child dose 0.15mgsChild dose 0.15mgs

2year shelf life2year shelf life

DevicesDevices

Anapen auto injector: -Anapen auto injector: -

Adult dose 0.3mgsAdult dose 0.3mgs

Child dose 0.15mgsChild dose 0.15mgs

18 – 24 month shelf life18 – 24 month shelf life

StorageStorage

Accessible.Accessible.

Avoid extremes of temperature.Avoid extremes of temperature.

Clearly labelled.Clearly labelled.

In date.In date.

Management in schoolsManagement in schools

Allergen avoidance.Allergen avoidance.

Early recognition of symptoms.Early recognition of symptoms.

Crisis management.Crisis management.

Allergen avoidanceAllergen avoidance

Know the child, and their allergies.Know the child, and their allergies.

Be allergy aware and risk assess.Be allergy aware and risk assess.

Special occasions.Special occasions.

School trips.School trips.

Cookery lessons, science Cookery lessons, science experiments.experiments.

School pets, bird tables.School pets, bird tables.

Crisis ManagementCrisis Management

Alleviating fearAlleviating fear

Indemnity insurance.Indemnity insurance.

Individual protocols.Individual protocols.

What to do in an allergic reaction?What to do in an allergic reaction?

Stay calm.Stay calm.

Call for help.Call for help.

Using protocol assess the reaction.Using protocol assess the reaction.

Give emergency treatment.Give emergency treatment.

Make a note of the time.Make a note of the time.

Monitor closely until ambulance Monitor closely until ambulance arrives.arrives.

How to use an Auto InjectorHow to use an Auto Injector

If asthmaticIf asthmatic•give reliever via spacer (2 puffs) another give reliever via spacer (2 puffs) another 8 puffs 8 puffs•1 puff per minute can be given be1 puff per minute can be given be

Additional Medication

Anti-histamine medication can be given, if Anti-histamine medication can be given, if prescribed. See Childs Health Care Planprescribed. See Childs Health Care Plan

Draft 3 18/04/07

Symptom Flowchart for Severe Allergic Reaction (Anaphylaxis)

She is allergic to nuts

Refer to individual Healthcare Plan and medication container for dosages

Photograph of pupil, with parental consent

Name Date of Birth Class

Administer EpiPen 1. Hold EpiPen firmly 2. Remove grey safety cap 3. Place black end on upper, outer

thigh 4. Push firmly until you hear it click 5. Hold in place for 10 seconds 6. Remove EpiPen from leg 7. Place in recovery position

Dial 999 Contact parents

Stay with child Give EpiPen to ambulance

service for disposal

Lie down, raising feet

IF CONDITION WORSENS

Contact Parents.

Contact GP If parents are unavailable and follow advice.

Give Antihistamine

Mild/Moderate Reaction Swollen Lips Flushed, itchy, blotchy skin Abdominal pain and nausea Swelling round eyes Fast Breathing

Severe Reaction Swollen tongue Hoarse voice, difficulty

swallowing Cough, difficulty breathing,

noisy, laboured Change in colour, pale. Clammy Feeling faint Deteriorating consciousness Collapse

If asthmatic, give reliever via spacer (2 puffs) Another 8 puffs, 1 puff per minute can be given

Supervise Closely

Who’s responsible for what?Who’s responsible for what?

Written consent.Written consent.

Provide school with full information.Provide school with full information.

Ensure medicine is in date.Ensure medicine is in date.

A few things to think about!A few things to think about!“ “ Will a supply teacher know who I am?”Will a supply teacher know who I am?”

Kissing can seriously damage your health!Kissing can seriously damage your health!

Other training needs? e.g. Breakfast and Other training needs? e.g. Breakfast and after school clubs, school discos, sports after school clubs, school discos, sports clubs. School visitors, bus drivers/escorts. clubs. School visitors, bus drivers/escorts. Mid-day supervisors, catering staff.Mid-day supervisors, catering staff.

Want more information?Want more information?Contact the Anaphylaxis CampaignContact the Anaphylaxis Campaign

Tel: 01252 542029Tel: 01252 542029www.anaphylaxis.org.ukwww.anaphylaxis.org.ukwww.www.allergyinschoolsallergyinschools.org..org.ukukSchools packSchools packVideo/DVDVideo/DVD

Managing Medicines in Schools and Early Managing Medicines in Schools and Early Years Settings. DH/DfES. Years Settings. DH/DfES.