2Anaphylaxis awareness AimTo have an understanding of AnaphylaxisTo be aware of the variety of anaphylaxis signs and symptomsTo be able to support a child having an anaphylactic reactionTo feel confident to safely administer an adrenaline auto-injector
3Administration 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
4Asthma 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.
5What is an allergy?Reaction to foreign substances called allergens which trigger an exaggerated immune responseMild reactionSevere reactionMild reaction examples: hay fever, skin rashes and swellingSevere reaction involves respiratory and circulatory system as well as skin or gut symptoms
6What is Anaphylaxis?An acute, severe, often life threatening, allergic reaction needing immediate treatment. Usually occurs within seconds or minutes of exposure to certain triggersOn rare occasions may happen after a few hoursFood is the most common trigger in children.Exercise-induced anaphylaxis can also occur in susceptible individuals.
7Common allergens Cows milk Eggs Latex Medicines e.g. Penicillin PeanutsShell fishTree nuts e.g. Brazil, cashew, almond, pecan, pistachio, hazelnut, walnutWasp & Bee stingsPeanut 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!
8ABCDE Recognition of Anaphylaxis The whole body is affected, usually within minutes of exposure to the trigger. Symptoms can vary in severity.AirwayBreathingCirculationDisabilityExposure}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}
9Recognition of Anaphylaxis A-B-C Airway problemsThroat and tongue swellingDifficulty swallowing and breathingHoarse voiceBarking coughBreathing problemsShortness of breath with increased rate of breathingWheeze / noisy breathingUnable to talk in sentencesSevere reaction may stop breathingCirculation problemsPale, clammy and complain of feeling faint and dizzyMay appear confused, agitated and may express a feeling of impending doom (feeling scared)Possible loss of consciousnessBreathing: 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).
10Recognition of Anaphylaxis D-E Disability problemsAbdominal pain, vomitingIncontinenceExposureSkin changes – hives, nettle rash,Redness and swelling commonly of the eyelids, lips and sometimes mouth and throatDisability 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)
11Recognition 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.
12Recognition 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.
13AntihistaminesMild allergic reactions (skin and/or gut symptoms) usually respond to antihistaminesContinue to observe the child for improvement or deterioration.Follow Emergency Action Plan for CetirizineInform parent/carerCetirizine 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).
15Treatment for Anaphylaxis Adrenaline is the ONLY drug for the treatment of an anaphylactic reactionGive prescribed adrenaline auto injector into thigh muscle, one dose only (unless otherwise specified on Emergency Care Plan)Dial 999Tell call handler child has anaphylaxis.Contact child’s parents or guardian
16Treatment for Anaphylaxis Position childIf child is experiencing breathing difficulties, support in a sitting positionIf feeling faint, lie down and raise legsIf 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 arrivesKeep calmReassure the childPosition of child should be relevant to their symptoms and needs. DO NOT let the child walk around.Ensure child is supervised until help arrives.
17Adrenaline auto injectors Two commonly used devicesJext (Jext 300, Jext 150)Epipen (Epipen, Epipen Jr)Expiry date is 18months from date of manufactureDosage according to weight300 microgrammes (mcg) for children over 30kg (usually years)150 microgrammes (mcg) for children 15 – 30kg
18JextDifferent 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.
19How to give JextMake a fist around the Jext with your thumb closest to the yellow capRemove the yellow cap with your other handPush the black tip firmly on the outer aspect of the thighHold in place for 10 secondsMassage 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.
21EpipenWindow (next to clock on image) for checking adrenaline is clear. Epipen advice: “blue to sky, orange to thigh”.
22How to give the EpipenGrasp 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.
24When should you use the adrenaline auto injector? Definite anaphylaxisThroat swelling or breathing is difficultFeeling faint or losing consciousnessDangerous reactionDeterioration/ getting worseIf 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.
25How adrenaline works First line treatment for anaphylaxis. Effective levels in 5-10 minutes.Relaxes the muscles of the airways helping breathingStimulates the heartbeatReverses swellingIncreases blood sugar levelAdrenaline 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.
26After the injectionPosition child in recovery/comfortable position and observePlace used device in appropriate container and give to paramedic/ ambulance staffComplete appropriate report form.Fax completed report form (in school medical policy) to(as per Emergency Action Plan)
27Storage and access to the adrenaline auto injector The device should always be with the child, young person OR stored safely but easily accessibleDevice should accompany student on sports fieldKept in its original container at room temperature(DO NOT store in the fridge)Parent’s responsibility to ensure device is within expiry dateIf you accidentally inject yourself seek medical advice immediatelyIf 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!
28Reducing risk at meal times Allergy free school mealsPacked lunchesDiscourage sharing foodDo Not segregate children from peersCareful disposal of food reduces risk of wasp / bee stingsDiscreet supervision at meal and break times is better than segregation.
29Things 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 staffAfter school clubs, breakfast clubsSchool events e.g. School disco with tuck shopFood technology in school (Cookery)Sports eventsDay/ residential tripsKissing!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)
30Things to consider ………. Celebrations Lunchtime cover Food tasting Craft activities e.g. bird feeders, food collageCooking or food decorating activitiesDiscourage 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.
31give 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.
32Useful 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.
33Further information: School Nurse for your school Kerrie Kirk, Children’s Allergy Specialist Nurse, UHLLeicester Children’s Allergy Service