1. Anaphylaxis awareness

2. Anaphylaxis awareness
Aim
To have an understanding of Anaphylaxis
To be aware of the variety of anaphylaxis signs and symptoms
To be able to support a child having an anaphylactic reaction
To feel confident to safely administer an adrenaline auto-injector

3. 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

4. Asthma and Anaphylaxis
Poorly controlled asthma increases the potential severity of an allergic reaction and anaphylaxis.
If asthma symptoms occur during an allergic reaction, give the prescribed adrenaline auto injector then give reliever (blue) inhaler.
10 puffs salbutamol (blue) inhaler may be given. Use a spacer if available.
If asthma symptoms occur without allergy, treat as asthma.
Good asthma control is very important for anyone at risk of anaphylaxis.
There is a statement on the autoinjector Emergency Action Plans relating to asthma symptoms.

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

6. 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
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.

7. Common allergens Cows milk Eggs Latex Medicines e.g. Penicillin
Peanuts
Shell fish
Tree nuts e.g. Brazil, cashew, almond, pecan, pistachio, hazelnut, walnut
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!

8. 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 }

9. 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
Breathing: If breathing stops, perform Basic Life Support.
Circulation: If unconscious but breathing, place in recovery position. If pregnant, ensure they are lying on their left-hand side (to avoid compression of the superior vena cava which would cut off the supply to the baby).

10. 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)
Remember, symptoms can change and may become more serious (see A, B, C on last slide)

11. Recognition of anaphylaxis - Hives
Examples of hives. Also called urticaria or nettle rash. Usually extremely itchy!
Hives can occur for reasons other than allergy! E.g. infection, changes in temperature, pressure or touch.

12. 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.

13. Antihistamines
Mild allergic reactions (skin and/or gut symptoms) usually respond to antihistamines
Continue to observe the child for improvement or deterioration.
Follow Emergency Action Plan for Cetirizine
Inform parent/carer
Cetirizine is the preferred antihistamine. Usually given once daily if required regularly, but extra dose can also be give as per Emergency Action Plan.
Fexofenidine may be prescribed instead.
Cetirizine is a 2nd generation antihistamine so less sedating and preferred to Piriton (Chlorphenamine).

15. Treatment for Anaphylaxis
Adrenaline is the ONLY drug for the treatment of an anaphylactic reaction
Give prescribed adrenaline auto injector into thigh muscle, one dose only (unless otherwise specified on Emergency Care Plan)
Dial 999
Tell call handler child has anaphylaxis.
Contact child’s parents or guardian

16. Treatment for Anaphylaxis
Position child
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 or along a couch)
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.

17. Adrenaline auto injectors
Two commonly used devices
Jext (Jext 300, Jext 150)
Epipen (Epipen, Epipen Jr)
Expiry date is 18months from date of manufacture
Dosage according to weight
300 microgrammes (mcg) for children over 30kg (usually years)
150 microgrammes (mcg) for children 15 – 30kg

18. Jext
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.

19. How to give 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
‘Window’ on the trainer has a red rod which changes to a green rod when used. Coloured rod can be seen in the window after use in actual Jext.
Important to remember to hold in place for 10 seconds to allow adrenaline to go into the muscle.

21. Epipen
Window (next to clock on image) for checking adrenaline is clear. Epipen advice: “blue to sky, orange to thigh”.

22. 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. 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!
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.

25. 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.

26. After the injection
Position child in recovery/comfortable position and observe
Place used device in appropriate container and give to paramedic/ ambulance staff
Complete appropriate report form.
Fax completed report form (in school medical policy) to
(as per Emergency Action Plan)

27. Storage and access to the adrenaline auto injector
The device should always be with the child, young person OR stored safely but easily accessible
Device should accompany student on sports field
Kept in its original container at room temperature
(DO NOT store in the fridge)
Parent’s responsibility to ensure device is within expiry date
If you accidentally inject yourself seek medical advice immediately
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 school meals
Packed lunches
Discourage sharing food
Do Not segregate children from peers
Careful disposal of food 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.
Supply teachers, temporary staff, staff new to provider, students, apprentices, volunteer staff
After school clubs, breakfast clubs
School events e.g. School disco with tuck shop
Food technology in school (Cookery)
Sports events
Day/ residential trips
Kissing!
Anything out of the ordinary increases the risk!
Consider relationships: peanut protein will remain in the mouth for up to 2 hours after ingestion.
Skin reactions are likely with skin contact (from another person)

30. Things to consider ………. Celebrations Lunchtime cover Food tasting
Craft activities e.g. bird feeders, food collage
Cooking or food decorating activities
Discourage using food as treats eg 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.
Remember icing may contain raw egg white so unsuitable for egg allergic children.

31. give adrenaline. If in doubt,
The child or young person will not come to permanent harm from an adrenaline injection given when it may not have been required. It is, however, extremely important and potentially life-saving for anyone with anaphylaxis.

32. Useful organisations Anaphylaxis Campaign Helpline 01252 542029
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. It has information on allergic skin conditions and eczema (‘itchy’), allergic rhinitis (‘sneezy’) and asthma (‘wheezy’) and more.

33. Further information: School Nurse for your school
Kerrie Kirk, Children’s Allergy Specialist Nurse, UHL
Leicester Children’s Allergy Service