Anaphylaxis awareness

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

Administration of Medicines in Non Health Care Settings

• Please ensure that you have read the appropriate policy concerning medicines in your area of work.

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.

What is an allergy?

• Reaction to foreign substances called allergens which trigger an exaggerated immune response

• Mild reaction

• Severe reaction

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

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

ABCDERecognition 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

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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

The most important treatment for a severe, life threatening anaphylactic reaction is the early use of an adrenaline auto injector.

Recognition of Anaphylaxis A-B-CAirway 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

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

Recognition of anaphylaxis - Hives

Recognition of anaphylaxis - Swelling

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

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

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

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 10-11 years)

• 150 microgrammes (mcg) for children 15 – 30kg

Jext

How to give Jext

1. Make a fist around the Jext with your thumb closest to the yellow cap

2. Remove the yellow cap with your other hand

3. Push the black tip firmly on the outer aspect of the thigh

4. Hold in place for 10 seconds

5. Massage the thigh for 10 seconds

Epipen

How to give the Epipen

1. Grasp Epipen with thumb closest to blue safety cap.

2. Pull off safety cap with other hand.

3. Hold Epipen about 10cm away from outer thigh. The orange tip should be facing the outer thigh.

4. Jab firmly into outer thigh holding the Epipen at a 90 degree angle to the outer thigh.

5. Hold for 10 seconds before removing the Epipen.

6. Massage site for 10 seconds.

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!

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

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

0116 225 3850 (as per Emergency Action Plan)

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

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

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!

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)

If in doubt,

give adrenaline.

Useful organisations

Anaphylaxis Campaign Helpline 01252 542029

www.anaphylaxis.org.uk

www.food.gov.uk

www.itchysneezywheezy.co.uk

www.jext.co.uk

www.epipen.org.uk

Further information:

• School Nurse for your school

• Kerrie Kirk, Children’s Allergy Specialist Nurse, UHL

• Leicester Children’s Allergy Service email:

• Childrensallergy@uhl-tr.nhs.uk