1. Anaphylaxis awareness training for providers of non-education activities, pre-school, Primary and Secondary schools.

2. #TakeTheKit
Please watch a short YouTube film from The Anaphylaxis Campaign.
This film is particularly suitable for anyone with responsibility for older children and young people.
It highlights the particular risks young people face.
Adolescents and young adults are more likely to have episodes of anaphylaxis and less likely to have their medication with them for a variety of reasons.

3. YouTube – ‘Take the kit anaphylaxis’ #TakeTheKit from The Anaphylaxis Campaign.
Highlights

4. Anaphylaxis awareness
Aim
To have an understanding of allergic reactions and anaphylaxis
To be aware of the variety of signs and symptoms that may be seen in anaphylaxis
To be able to support a child having an anaphylactic reaction
To feel confident to safely administer an adrenaline auto-injector
This training is specifically designed for allergy and anaphylaxis information with more detailed information for those who may need to use an adrenaline auto injector. Opportunity to use practice devices is included.

5. Administration of Medicines in Non Health Care Settings
Please ensure that you have read the appropriate policy concerning medicines in your area of work.
Available on LEA Intranet.
Also on LEA website. Recent letter sent to all LEA schools: need to ensure an audit of all medicines in school is completed at the beginning of each term to ensure there are no expired medications in schools. An amendment has been made to the LEA schools medicines policy.

6. What is an allergy?
Reaction to foreign substances called allergens which trigger an exaggerated immune response
Mild reaction
e.g. hay fever, rashes
Severe reaction
e.g. anaphylaxis
Grass pollen
Mild reaction examples: hay fever, skin rashes and swelling
Severe reaction involves respiratory and circulatory system as well as skin or gut symptoms

7. What is Anaphylaxis?
An acute, severe, often life threatening, allergic reaction needing immediate treatment. Usually occurs within seconds or minutes of exposure to certain triggers
Signs of Airway and/or Breathing and/or Circulation problems
On rare occasions may happen after a few hours
Food is the most common trigger in children.
Exercise-induced anaphylaxis can also occur in susceptible individuals.

8. Common allergens Cows milk Eggs Shellfish Fish Peanuts
Tree nuts e.g. Brazil, cashew, almond, pecan, pistachio, hazelnut, walnut
More common with adults:
Latex
Medicines e.g. Penicillin
Wasp & Bee stings
Peanut is a legume and grows under ground like potatoes.
Tree nuts grow on trees.
Coconut and pine nuts are seeds, Nutmeg has nothing whatsoever to do with nuts!

9. ABCDE Recognition of Anaphylaxis
The whole body is affected, usually within minutes of exposure to the trigger. Symptoms can vary in severity.
Airway
Breathing
Circulation
Disability
Exposure
The most important treatment for a severe, life threatening anaphylactic reaction is the early use of an adrenaline auto injector.
A mild allergic reaction still needs close observation as more serious symptoms may develop.
An allergic reaction can be regarded as mild when it only involves the skin or gastrointestinal tract. In these cases it will respond to treatment with antihistamines

10. Recognition of Anaphylaxis A-B-C
Airway problems
Throat and tongue swelling
Difficulty swallowing and breathing
Hoarse voice
Barking cough
Breathing problems
Shortness of breath with increased rate of breathing
Wheeze / noisy breathing
Unable to talk in sentences
Severe reaction may stop breathing
Circulation problems
Pale, clammy and complain of feeling faint and dizzy
May appear confused, agitated and may express a feeling of impending doom (feeling scared)
Possible loss of consciousness

11. Recognition of Anaphylaxis D-E
Disability problems
Abdominal pain, vomiting
Incontinence
Exposure
Skin changes – hives, nettle rash,
Redness and swelling commonly of the eyelids, lips and sometimes mouth and throat
Disability and Exposure symptoms are classed as mild symptoms. Treat with antihistamines if available and the only symptoms. Observe.
See Emergency Care Plan. Also Emergency Care Plan for Antihistamine (Cetirizine)

12. Recognition of anaphylaxis - Hives
Examples of hives. Also called urticaria or nettle rash. Usually extremely itchy!

13. Recognition of anaphylaxis - Swelling
Skin swelling is a common reaction seen with allergy. The swelling is in the deeper tissues of the skin. Swelling that comes outwards i.e. visible is classed as a mild allergic symptom. Antihistamines should be used to provide relief.
Swelling that occurs inwards i.e. within the throat can be life threatening and can produce Airway and/or Breathing problems.

14. Treatment of mild to moderate allergic reactions with antihistamines.
Suitable for when allergic symptoms appear mild to moderate:
Itchy (skin, mouth, throat, ears)
Redness and/or swelling
Rashes
Hay fever symptoms (nose and eyes)
Abdominal pain and vomiting (due to allergy)
Symptoms usually respond well with antihistamines.
Follow Emergency Action Plan section on mild to moderate reactions.
Continue to observe after giving antihistamines
Cetirizine is the preferred antihistamine. Usually given once daily if required regularly, but extra dose can also be give as per Emergency Action Plan.
Cetirizine is a 2nd generation antihistamine so less sedating and preferred to Piriton (Chlorphenamine).

15. When should you use the adrenaline auto injector?
Definite anaphylaxis
Throat swelling or breathing is difficult
Feeling faint or losing consciousness
Dangerous reaction
Deterioration/getting worse
If in doubt, use the adrenaline auto injector!
Adrenaline is the ONLY drug for the treatment of anaphylaxis. It works fast!
Do not worry if adrenaline auto injector has been used when maybe not needed. Action following administration = dial 999. Medical staff to assess need for further treatment.

16. Treatment for Anaphylaxis (or suspected anaphylaxis)
Use the adrenaline auto injector.
Give into the thigh muscle, one dose only (unless otherwise specified on Emergency Action Plan)
Dial 999
Tell call handler child has anaphylaxis.
Contact child’s parents or guardian
If more than 1 adult available, several stages of help can occur at the same time

17. Treatment for Anaphylaxis
Position child in a safe position:
If child is experiencing breathing difficulties, support in a sitting position
If feeling faint, lie down and raise legs
If breathing difficult and feeling faint, sit supported on floor with feet at 90° to body. (E.g. Against a wall)
If unconscious, but breathing, use the recovery position
Child to remain in this position until help arrives
Keep calm. Reassure the child
Position of child should be relevant to their symptoms and needs. DO NOT let the child walk around.
Ensure child is supervised until help arrives.

18. Asthma and Anaphylaxis
Poorly controlled asthma increases the potential severity of any allergic reaction and anaphylaxis.
If a child has serious allergy symptoms and seems wheezy, treat as anaphylaxis.
Give prescribed adrenaline auto injector
Call 999
Then give reliever – salbutamol - (blue) inhaler.
10 puffs salbutamol (blue) inhaler may be given.
Use a spacer (Volumatic) if available.
Good asthma control is very important for anyone at risk of anaphylaxis.
There is a statement on the auto injector Emergency Action Plans relating to asthma symptoms. 10 puffs of reliever may be given if there appears to be any asthma symptoms but only after the adrenaline auto injector has been used and ambulance service has been called. Each puffs should be given separately, shaking the inhaler between each actuation breaths in and out of spacer (if used).
Adrenaline will help any asthma symptoms anyway.

19. After the injection Continue to observe the child’s condition
Place used device in appropriate container and give to paramedic/ambulance staff (to check what’s been given and dispose of safely)
Complete appropriate report form.
Fax or scanned copy of completed report form as per Emergency Action Plan (in school medical policy)
Fax number

20. Adrenaline auto injectors
Two commonly used devices
Jext (Jext 300, Jext 150)
Epipen (Epipen, Epipen Jr)
Expiry date is18 months from date of manufacture
A third device exists which is uncommonly prescribed
Emerade (Emerade 150, Emerade 300, Emerade 500). Expiry 18 months
Dosage according to weight
300 microgrammes (mcg) for children over 30kg (usually years)
150 microgrammes (mcg) for children 15 – 30kg
The prescriber decides the dose to be issued. All devices should be prescribed as device specific. Brands should only be changed if there are manufacture problems.
If GP changes the brand prescribed then the GP should issued an appropriate Emergency Action Plan. All EAPs are available through
Emerade now has an expiry date of 18 months from manufacture.

21. Jext Epipen
Different colour for the different strengths. There is a ‘window’ (not shown on image) to check the adrenaline is clear. DO NOT use if cloudy. Get replacement ASAP.

22. How to administer Jext
Make a fist around the Jext with your thumb closest to the yellow cap
Remove the yellow cap with your other hand
Push the black tip firmly on the outer aspect of the thigh
Hold in place for 10 seconds
Massage the thigh for 10 seconds

23. How to give the Epipen
Grasp Epipen with thumb closest to blue safety cap.
Pull off safety cap with other hand.
Hold Epipen about 10cm away from outer thigh. The orange tip should be facing the outer thigh.
Jab firmly into outer thigh holding the Epipen at a 90 degree angle to the outer thigh.
Hold for 10 seconds before removing the Epipen.
Massage site for 10 seconds.

24. Emerade How to administer Emerade Remove the needle shield
Press against the thigh
Hold for 5 seconds
Massage the injection site gently

25. Emergency Action Plans
Adrenaline auto injectors should be brand specific. The Emergency Action Plan should match the type of device prescribed.
Types of Emergency Action Plans are:
For use with antihistamine (children at risk of mild reactions only such as. but not exclusively, resolving egg or milk allergy)
For use with Epipen
For use with Jext
For use with Emerade
All EAPs are available at
Check the device and Emergency Action Plan match

26. How adrenaline works First line treatment for anaphylaxis.
Effective levels in 5-10 minutes.
Relaxes the muscles of the airways helping breathing
Stimulates the heartbeat
Reverses swelling
Increases blood sugar level
Adrenaline is the only drug that gets into the blood stream at effective levels fast enough: therapeutic blood levels between 5-8 minutes.
It is also the only drug that will work on all the symptoms of anaphylaxis.
Humans need extra sugar for the body to cope with extreme situation such as emergencies and illness.

27. Storage and access to the adrenaline auto injector
The device should always be with the child OR stored safely but easily accessible
Keep in its original container at room temperature
(DO NOT store in the fridge or in direct sunlight)
It is parents’ responsibility to ensure device is within expiry date
Schools should audit all medicines in school termly.
The companies do provide text and reminders
If you accidentally inject yourself seek medical advice immediately. Put affected area in warm water.
If accidentally injected into the wrong person, they must seek urgent medical advice. Adrenaline constricts the blood vessels which could be detrimental if injected into an area with small blood vessels e.g. fingers!

28. Reducing risk at meal times
Allergy free meals
Packed lunches
Discourage sharing food
Do Not segregate children from peers
Careful disposal of food (sweet and savoury) reduces risk of wasp/bee stings
Discreet supervision at meal and break times is better than segregation.

29. Things to consider ……….
Communication between family and school/nursery setting is vital to child’s well being. Family may be able to provide alternative foods or recommend safe brands
Supply teachers, temporary staff, staff new to provider, students, apprentices, volunteer staff
Lunchtime cover. Also After School Clubs and Breakfast Clubs
Cooking or food decorating activities
Kissing!
Alcohol!!
Anything out of the ordinary increases the risk! Family may be able to give advice to reduce the risk of allergic reactions.
There will only be a skin reaction from being touched on the skin by someone who has handled the allergenic food. Similarly if a child is kissed on the cheek by another child who has eaten the allergic food. Antihistamines can be given for this.
If a child is kissed on the mouth by another who has eaten the allergenic food (where there is a potential of a mix of saliva), there is a potential risk of anaphylaxis. Give adrenaline if suspected anaphylaxis.
Alcohol reduces the ability to recognise and/or respond to symptoms. It can speed up the reaction. Young people may take risks they wouldn’t take if alcohol has not been consumed!

30. Things to consider ………. Celebrations and food tasting
Craft activities e.g. bird feeders, food collage
Day or residential trips
Sports events
Discourage using food as treats e.g. sweets (parents can provide swap boxes with safe treats)
Anywhere the child /young person goes their adrenaline auto injector should be accessible (even on a neighbourhood walk)
Remember food brought in from homes may contain ingredients you are not aware of.
Craft and cooking activities are still possible but discuss with family in advance and consider the ingredients to be used.

31. If in doubt,
give adrenaline

32. Useful organisations Anaphylaxis Campaign Helpline 01252 542029
Text and or alerts
Lots of information on asthma, eczema, hay fever, different adrenaline auto injectors and video clips
Various links via Anaphylaxis Campaign.
Food.gov is the website of the food standards agency who are currently involved in research relating to safe threshold levels. Instigate recall of products.
Itchysneezywheezy evolved from Imperial Hospital, London paediatric allergy service.

33. Useful websites www.jext.co.uk
Video clips on how to use. Children’s area with games.
App available which can talk through how to use Jext.
Video clip on how to use.
Canadian website for young people with allergies. Lots of advice from young people living with allergies.

34. Further information: School Nurse Kerrie Kirk, Ruth O’Dowd
Children’s Allergy Specialist Nurses, UHL NHS Trust
Leicester Children’s Allergy Service