1. Allergies and Anaphylaxis awareness for Schools & Early Years settings - 2018
Welcome and introductions

2. Big 8 account for over 90% of food allergies in children
Milk
Egg
Shellfish
Wheat
Fish
Soya
Tree Nuts
Peanuts

3. Other common causes of allergies
Aeroallergens e.g. pollens, dust and animal hair, mould.
Injectable e.g. Wasp/Bee stings.
Contact e.g. Latex
Medicines e.g. Antibiotics
Spontaneous urticaria – child gets rashes without external triggers
You can be allergic to anything!

4. What is anaphylaxis?
Anaphylaxis is a severe systemic allergic reaction.
It is at the extreme end of the allergic spectrum
The whole body is affected usually within minutes of exposure to the allergen
It can occur within minutes of exposure to an allergen, although it can take several hours

5. What is the difference between an asthma attack and anaphylaxis
While a severe allergic reaction could include asthma, there would probably be other symptoms present, These may include:
swelling in the throat and mouth,
nettle rash anywhere on the body,
generalised flushing of the skin,
abdominal cramps,
nausea or vomiting.
If the symptoms look particularly severe – for example, if the allergic child is going floppy – then this is very likely to be a severe allergic reaction requiring immediate treatment.

6. Signs and Symptoms – Mild - Moderate
Swollen lips, face or eyes
Itchy / tingling mouth
Hives or itchy skin rash
Abdominal pain
Sudden change in behaviour

7. Signs and Symptoms - Anaphylaxis
Airway: Persistent cough, hoarse voice, difficulty swallowing, swollen tongue.
Breathing: Difficulty or noisy breathing, wheeze or persistent cough.
Consciousness: Persistent dizziness / pale or floppy, suddenly sleepy, collapse, unconscious.

8. Example symptoms of Allergic reaction
Hives / Nettle Rash
Swelling of the Mouth

9. Managing the condition
Allergen avoidance
Risk assessment
Kitchen and dining areas kept clean of food allergens
Knowledge of food ingredients at meal times – reading labels
Discouragement of food sharing
Easy access to emergency treatment
Annual staff training

10. Emergency allergy kit ‘Allergy kit’ may include:
Oral anti-histamine e.g. Piriton®, Cetirizine®
Reliever Inhaler (e.g. Salbutamol) and ideally spacer device
Adrenaline Auto Injector (AAI) Device e.g. Epi-Pen, Emerade or Jext
Allergy action plan

11. Treatments – Mild to Moderate
Stay with the child, call for help if necessary
Locate emergency allergy kit
Locate allergy action plan
Give anti-histamine (If vomited, can repeat dose)
Phone parent / emergency contact

12. Treatments – Anaphylaxis
Stay with the child, call for help
Locate emergency allergy kit
Locate allergy action plan
If possible, give anti-histamine (If vomited, can repeat dose)
Administer Adrenaline Auto Injector (AAI)
Call 999 and say Anaphylaxis (ANA-FIL-AX-IS)
Phone parent / emergency contact
If in doubt give Administer Adrenaline Auto Injector (AAI)
Additional Instructions – As per the Allergy Action Plan.
If Wheezy, give adrenaline FIRST, then asthma reliever puffer (blue inhaler) via spacer.
After giving adrenaline
If no improvement after 5 minutes, give a second adrenaline dose using a second device, if available.

13. Adrenaline Auto Injectors (AAI)
Clothes do not need to be removed, AAI can be administered through clothing

14. Instructions for Administrations – Epi-Pen
Reduced injection time from 10 to 3 seconds – this is based on research confirming delivery of adrenaline for 3 seconds is sufficient.
Removal of the massage step after the injection – this step has been removed to simplify the process of administering EpiPen or EpiPen Junior.
After administration, a needle guard will shield the needle, preventing injury

15. Instructions for Administrations – Emerade
Remove needle shield
Press against the OUTER THIGH (Without swinging the device)
Hold for 5 seconds - Massage the injection site gently, then call 999, ask for an ambulance stating "Anaphylaxis“
After administration, a needle guard will shield the needle, preventing injury

16. Instructions for Administrations – Jext
Jext should be pushed firmly against the outer portion of the thigh into the largest part of the thigh muscle, for 10 seconds. When you push Jext firmly against your thigh, a spring activated plunger will be released, which pushes the hidden needle through the seal at the end of the black needle shield, into the thigh muscle and injects a dose of adrenaline. Massage the area for 10 seconds after administration After administration, a needle guard will shield the needle, preventing injury

17. Guidance for Administer Adrenaline Auto Injector’s in schools
All children prescribed a Adrenaline Auto Injector should have 2 in school.
Infant / Junior Schools
Allergy kit should be stored in a central, safe location which is accessible at all times.
Secondary Schools
It is expected that the pupil carries the allergy kit on their person with one Adrenaline Auto Injector being stored in a central, safe location which is accessible at all times.
At the end of each school term, the Adrenaline Auto Injector expiry date should be checked and arrangements made for a new Adrenaline Auto Injector, if required.

18. New policy re AAI’s in schools
New policy October 2017 – schools can purchase spare AAI’s
The spare device is aimed at children;
Already at risk of anaphylaxis without access to their device at the time of need.
Those with a mild allergy then having an unexpected severe allergy. The new allergy plans will ask for parental permission to administer the pen.
A child with unexpected anaphylaxis not known to have an allergy (on the advice of the emergency services via a 999 call).

19. Adrenaline Auto Injectors (AAI)
Website Information: Epi-Pen Emerade Jext Demonstration pens can be ordered from the above websites.

20. Further Information Anaphylaxis Campaign
Allergy UK
Spare Pens in Schools