Allergies and Anaphylaxis awareness for Schools & Early Years settings - 2018 Welcome and introductions

Big 8 account for over 90% of food allergies in children Milk Egg Shellfish Wheat Fish Soya Tree Nuts Peanuts

Other common causes of allergies Aeroallergens e.g. pollens, dust and animal hair, mould. Injectable e.g. Wasp/Bee stings. Contact e.g. Latex Medicines e.g. Antibiotics Spontaneous urticaria – child gets rashes without external triggers You can be allergic to anything!

What is anaphylaxis? Anaphylaxis is a severe systemic allergic reaction. It is at the extreme end of the allergic spectrum The whole body is affected usually within minutes of exposure to the allergen It can occur within minutes of exposure to an allergen, although it can take several hours

What is the difference between an asthma attack and anaphylaxis While a severe allergic reaction could include asthma, there would probably be other symptoms present, These may include: swelling in the throat and mouth, nettle rash anywhere on the body, generalised flushing of the skin, abdominal cramps, nausea or vomiting. If the symptoms look particularly severe – for example, if the allergic child is going floppy – then this is very likely to be a severe allergic reaction requiring immediate treatment.

Signs and Symptoms – Mild - Moderate Swollen lips, face or eyes Itchy / tingling mouth Hives or itchy skin rash Abdominal pain Sudden change in behaviour

Signs and Symptoms - Anaphylaxis Airway: Persistent cough, hoarse voice, difficulty swallowing, swollen tongue. Breathing: Difficulty or noisy breathing, wheeze or persistent cough. Consciousness: Persistent dizziness / pale or floppy, suddenly sleepy, collapse, unconscious.

Example symptoms of Allergic reaction Hives / Nettle Rash Swelling of the Mouth

Managing the condition Allergen avoidance Risk assessment Kitchen and dining areas kept clean of food allergens Knowledge of food ingredients at meal times – reading labels Discouragement of food sharing Easy access to emergency treatment Annual staff training

Emergency allergy kit ‘Allergy kit’ may include: Oral anti-histamine e.g. Piriton®, Cetirizine® Reliever Inhaler (e.g. Salbutamol) and ideally spacer device Adrenaline Auto Injector (AAI) Device e.g. Epi-Pen, Emerade or Jext Allergy action plan

Treatments – Mild to Moderate Stay with the child, call for help if necessary Locate emergency allergy kit Locate allergy action plan Give anti-histamine (If vomited, can repeat dose) Phone parent / emergency contact

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) Additional Instructions – As per the Allergy Action Plan. If Wheezy, give adrenaline FIRST, then asthma reliever puffer (blue inhaler) via spacer. After giving adrenaline If no improvement after 5 minutes, give a second adrenaline dose using a second device, if available.

Adrenaline Auto Injectors (AAI) Clothes do not need to be removed, AAI can be administered through clothing

Instructions for Administrations – Epi-Pen Reduced injection time from 10 to 3 seconds – this is based on research confirming delivery of adrenaline for 3 seconds is sufficient. Removal of the massage step after the injection – this step has been removed to simplify the process of administering EpiPen or EpiPen Junior. After administration, a needle guard will shield the needle, preventing injury

Instructions for Administrations – Emerade Remove needle shield Press against the OUTER THIGH (Without swinging the device) Hold for 5 seconds - Massage the injection site gently, then call 999, ask for an ambulance stating "Anaphylaxis“ After administration, a needle guard will shield the needle, preventing injury

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. 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. Massage the area for 10 seconds after administration After administration, a needle guard will shield the needle, preventing injury

Guidance for Administer Adrenaline Auto Injector’s in schools All children prescribed a Adrenaline Auto Injector should have 2 in school. Infant / Junior Schools Allergy kit should be stored in a central, safe location which is accessible at all times. 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 a new Adrenaline Auto Injector, if required.

New policy re AAI’s in schools New policy October 2017 – schools can purchase spare AAI’s 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 then having an unexpected severe allergy. 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 via a 999 call). https://www.gov.uk/government/publications/using-emergency-adrenaline-auto-injectors-in-schools

Adrenaline Auto Injectors (AAI) Website Information: Epi-Pen www.epipen.co.uk Emerade www.emerade.co.uk Jext www.jext.co.uk Demonstration pens can be ordered from the above websites.

Further Information Anaphylaxis Campaign https://www.anaphylaxis.org.uk/ Allergy UK https://www.allergyuk.org/ Spare Pens in Schools http://sparepens.wpengine.com/