1. Mandy East Professional’s Conference November 10th 2016
Campaign to introduce Spare Adrenaline Auto Injectors (AAIs) into educational establishments in the UK
Mandy East
Professional’s Conference
November 10th 2016

2. NICE Definition
Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction.
Characterised by rapidly developing, life-threatening problems involving:
the airway (pharyngeal or laryngeal oedema) and/or
breathing (bronchospasm with tachypnoea) and/or
circulation (hypotension and/or tachycardia).

3. Is there a problem?
Up to 6% of school-aged children have IgE-mediated food allergy
1 anaphylaxis episode per 10,000 children p.a.
82% of food anaphylaxis occurs in school-age children
61% of schools have at least 1 child with prior anaphylaxis / AAI prescription
Bohlke et al. JACI 2004;113:536–542
Nwaru et al. Allergy 2014;69:62-75.

4. Anaphylaxis Anaphylaxis cannot be predicted
Most fatalities occur in people with previous mild reactions
Many children with prior anaphylaxis have mild reactions in the future
Fatal anaphylaxis is rare but unpredictable
17% of fatal reactions occur in schools / preschool settings
Adrenaline auto-injectors commonly prescribed as rescue medication to treat anaphylaxis

5. Adrenaline auto-injector devices
Data: NHS Prescription Cost Analysis for England,

7. AAI devices Most children respond to one AAI but
some may require a further dose
device may misfire due to user error or malfunction
Most children with AAI therefore prescribed 2 devices, consistent with MHRA and EMA guidance
Children and Families Act (2014) requires schools to make arrangements for supporting children with medical conditions
individual care plan

8. UK National Survey
April to June 2015

9. Methodology Bespoke online survey
Parents, HCPs and teachers were invited to complete the survey using patient group databases and social media
Surveys open for completion for 8 weeks from April 27th 2015

10. Results Responses were received from: 1609 parents
519 healthcare professionals
821 teachers

11. Research questions How common are AAIs in schools?
Are there situations where the AAI may not be correctly administered to children?
e.g. Lack of availability, misfiring or device out of date?
Is there support for the introduction of spare AAIs into educational establishments from parents, HCPs and teachers?

12. % of parents and teachers reporting AAIs in schools
93%
83%

13. How many devices are children prescribed?

18. Conclusions AAIs are very common in educational establishments
Misfiring, forgetting to carry and out of date devices are commons
This can place allergic children at risk
Spare AAIs would increase availability and help ensure an in-date device is available

19. Overall summary
There is a clear rationale for the introduction of spare AAIs
The majority of UK schools have at least one food allergic child
The introduction of spare AAIs addresses all current barriers which may prevent the correct use of AAIs in an emergency
…and facilitate improved awareness and training
Finally, there is overwhelming support from parents, healthcare professional and teachers

20. The campaign so far Initial meeting with DH Dec 2014
First half of 2015 evidence gathering
Evidence presented to DH July 2015
DH present to MHRA July/August 2015
Response and follow up questions and clarifications October 2015
Further follow up questions throughout early 2016
Update meeting with DH March 2016

21. The campaign so far Further discussions DH and MHRA
All Party Group prepare to lobby
MHRA agree to table for discussion at future meeting
DH ask us to prepare a draft guidance for teachers
MHRA meeting September 2016
Decision to begin process to change legislation made public October 2016
Awaiting date for public consultation

22. Observations Be patient!
DH prefer to work with coalitions via one central contact
Lobbying needs to be carefully considered
Decisions are made only at certain times of the year
Clinical input essential
As is patient support
Good, well planned and evidence based campaigning gets the result

23. Any questions? mandy@anaphylaxis.org.uk www.anaphylaxis.org.uk
@AllergyCampaign