1. GUIDELINES FOR MANAGEMENT OF ANAPHYLAXIS IN EDUCATIONAL ESTABLISHMENTS DHSSPS /Education Authority Revised May 2017

2. OBJECTIVES OF SESSION Update your knowledge on anaphylaxis
Be aware of the emergency treatment prescribed for children with this condition
Practise the correct technique for Adrenaline autoinjector administration
Be aware of the roles and responsibilities of parents, school, pupils, and school health team

3. WHAT IS ANAPHYLAXIS?
Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction. It is characterised by rapidly developing life-threating problems involving the airway and /or breathing and /or circulation. In most cases, there are associated skin and mucosal changes

4. Why does anaphylaxis occur?
The body’s immune system reacts inappropriately in response to the presence of a food or substance that it wrongly perceives to be a threat. (Anaphylaxis Campaign 2016)

5. COMMON CAUSES Peanuts Milk (2nd most common) Kiwi Tree nuts Bee Wasp
Egg
Sesame
Fish
Shellfish
Soya beans
Milk (2nd most common)
Latex
Penicillin
Blood Products
Aeroallergens
Non steroidal anti-inflammatory
Kiwi
Bee
Drugs
Peach

6. Children at increased risk
Atopic parents
Atopic siblings
Mum smokes
Male
Born by caesarean
Formula fed
Early / late weaning
Little contact with other young children
Link with lack of vitamin D

7. What increases the risk of a severe reaction?
Exercise
Heat
Poorly controlled asthma
The amount of allergen taken
Infection
Emotional stress
Alcohol
Suffering from aeroallergens e.g. hay fever

8. TYPES OF REACTION
Uni-phasic – rapidly developing severe reaction involving the airway or circulation.
Bi-phasic – early oral and abdominal symptoms, then a symptom-free period of 1 – 2 hours, then increasing symptoms involving breathing and circulation.

9. MINOR REACTION Feeling hot or generalised flushing of the skin
Intense itching and rapid development of a nettle like rash
Burning sensation of lip and /or metallic taste in mouth
Red, itchy, watery, swollen eyes or swollen lips or face
Vomiting and diarrhoea with abdominal pain
Itchy, runny or congested nose and / or sneezing
Dizziness and feeling faint/pallor – may indicate severe reaction in the very young.

10. TREATMENT FOR MINOR REACTION
ANTIHISTAMINE AND INHALERS
Follow the child’s individual care plan. Administer the prescribed antihistamine and/or inhaler
Sit/lie child down to avoid injury if they faint, if wheezy raise head and shoulders slightly
Record the time given and stay with the child
Contact parent.

11. SEVERE REACTION
Difficulty in breathing / noisy breathing, wheeze or stridor
Swelling of mouth / tongue or feeling of tightness or lump in throat
Decreased level of consciousness
Collapse, lack of breathing
Absent or very weak pulse

12. TREATMENT OF SEVERE REACTION
Give prescribed Adrenaline autoinjector & record time
If unconscious but breathing place in recovery position
Call paramedic ambulance 999 and state clearly person suffering from anaphylaxis
Contact parent / carer (contact numbers given over)
If no improvement within 5 minutes give second Adrenaline auto-injector & record time
If no signs of life commence CPR (cardiopulmonary resuscitation) and continue until professional help arrives
IF IN DOUBT GIVE ADRENALINE AUTO-INJECTOR
If Adrenaline autoinjector is given the child MUST go to hospital for observation even if they have made a full recovery

13. pictures

17. Adrenaline autoinjector
Adrenaline is life saving and must be used promptly in anaphylaxis. Delaying the giving of adrenaline can result in sudden deterioration and death .

18. The effects of Adrenaline
An adrenaline autoinjector is prescribed according to the child’s weight to deliver a single dose of adrenaline to reverse the symptoms of anaphylaxis
Acts quickly to reduce swelling
Relieves wheeziness
Improves blood pressure
The only medicine which stops the production of the chemicals which make symptoms worse

19. Reasons given for failing to use the Adrenaline autoinjector
Thought unnecessary (54%)
Unsure if it was necessary (19%)
Already called an ambulance (8%)
Device not available (5%)
Too scared to use it (2.5%)
Not trained (2.5%)
Attended A&E (1.5%)
Device was out of date (1%)

20. STORAGE OF EMERGENCY BOX
Accessible at all times during the school day – NOT in a locked room or cupboard.
Contains completed care plan with medication in date.
Clearly labelled with child’s name and passport photo for clear identification.
Avoid extremes of temperature

21. ROLES AND RESPONSIBILITIES
The Child’s Parent
Will ensure the school are notified if their child requires an Adrenaline autoinjector and when no longer allergic to particular foods or substances
Parent will attend school meeting with School Nurse and Principal, young person if age appropriate, to complete Adrenaline autoinjector care plan.
Will accept responsibility for maintaining and replacing, in school, two up to date Adrenaline autoinjectors.
The parent should inform the school and school nurse if any change in child’s prescription .

22. It is the duty of the parent to check the expiry date of the Adrenaline autoinjectors. The parent should return out of date Adrenaline autoinjectors to pharmacy for disposal
Will discuss with the school arrangements for lunch and snacks.
Will regularly remind the child of the need to refuse any food items offered by others.
Will remove all medication at the end of the school year and return to school in September.
Adrenaline autoinjectors can be registered “on-line” to receive expiry date alert

23. The school
The school principal/or designated teacher will notify the school nurse on becoming aware of a pupil requiring an Adrenaline autoinjector device in school with no care plan is in place in school.
The principal or designated teacher will create awareness of pupils allergic condition ensure all staff are aware of trained staff in management of anaphylaxis.
The principal or designated teacher will identify adequate numbers of appropriate staff to attend training.
School should raise awareness with all staff regarding any activities which can place the child at risk.
School should make arrangements for safe handling and availability of Adrenaline autoinjector for pupils leaving the school building on school trips/swimming/sports activities etc

24. Principal/designated teacher to attend the school meeting with school nurse, parent and young person, if age appropriate, to devise and complete the care plan.
Will agree with the parents and if necessary school meals staff on the provision of school meals/snacks etc in attempting to minimise risk.
Will ensure safe storage of, and easy access to, the two autoinjectors devices. All school staff must be aware of where these are stored.
It is the duty of the parent to check the expiry date of Adrenaline autoinjectors, however schools must be aware of autoinjector expiry dates to ensure they are in date at all times in school.
Following an anaphylactic incident, a review/debriefing with school staff and school nurse must take place within one week of the incident.

25. The Pupil (depending on age of child)
Post primary pupils may be responsible for carrying their own Adrenaline autoinjectors WITH THEM AT ALL TIMES especially when away from main building e.g. sports fields/school trips
Pupils should be advised to ensure they are safe and responsible at all times with their Adrenaline autoinjector.
Will be aware of the risk of food sharing
Advised to wear medical identifier
Report the onset of symptoms to a responsible member of staff

26. School Health Team
Provide centralised awareness training on the recognition and treatment of anaphylaxis in partnership with Education Authority and give advice and support to school staff.
School Nurse will arrange with school, parents and young person, if age appropriate, to attend meeting in the school to devise and complete the Adrenaline autoinjector care plan.
School Nurse will outline the responsibilities within this presentation. A copy of this presentation can be obtained on line from Education Authority’s website.
Participate in any debriefing session/follow up of major or minor incident

31. Frequently asked questions
In an emergency can I use another pupil’s Adrenaline autoinjector?
Who/how many should attend Anaphylaxis Awareness?
How often should we have this training?
What do we do with used Adrenaline autoinjector?
Can we be a ‘nut free’ school?
What will happen if I give Adrenaline and the child is not having a reaction?

32. And finally Updated your knowledge and skills
Be aware of the emergency treatment prescribed for children with this condition
Practised the correct technique for Adrenaline autoinjector administration
Be clear of roles and responsibilities' of all involved.

33. WANT MORE INFORMATION? www.anaphylaxis.org.uk
Schools pack
Video/DVD
Supporting pupils with medication needs DHSSPS/DOE (2008)

34. Contact telephone numbers for school nursing
Armagh
Banbridge & Dromore
Dungannon
Kilkeel
Newry
Portadown, Brownlow & Lurgan

35. Thank you for your time.