GUIDELINES FOR MANAGEMENT OF ANAPHYLAXIS IN

EDUCATIONAL ESTABLISHMENTS

DOH /Education AuthorityRevised October 2019

CENTRALISED HEALTH RAISING AWARENESS

SESSIONThis is an awareness session.All the material included in this presentation can be accessed on the Education Authority web site.

LEARNING OUTCOMESBy the end of this session you will have: Updated your knowledge on anaphylaxis Developed a greater understanding of the

emergency treatment prescribed for children with this condition

Practised the correct technique for Adrenaline autoinjector administration

Increased your awareness of the roles and responsibilities of parents, school, pupils, and school health team

WHAT IS ANAPHYLAXIS?

Anaphylaxis is a severe and potentially life threatening allergic reaction. It should always be treated as a medical emergency. Symptoms need to be recognised early, and treated quickly with the medicine ‘adrenaline’. An ambulance should always be called for a person having anaphylaxis and the operator informed that it is anaphylaxis.

(AllergyUK 2019)

WHAT CAUSES ANAPHYLAXIS?

Certain substances can trigger the severe, rapid onset allergic reaction. These are called allergens and include:

SUBSTANCES THAT TRIGGER ANAPHYLAXIS

FOODS cows milk eggs peanuts tree nuts fish shellfishA number of other foods have the potential to cause anaphylaxis

SUBSTANCES THAT TRIGGER ANAPHYLAXIS

INSECT VENOM bee and wasp stingsMEDICATION antibiotics aspirin anaesthetic drugs chlorhexidine - present in some hand and mouth washesLATEX latex gloves balloons

CHILDREN AT INCREASED RISK

atopic children atopic parents atopic siblings mum smokes male born by caesarean formula fed late weaning

little contact with other young children

lack of vitamin D

WHAT INCREASES THE RISK OF A SEVERE REACTION?

delayed administration of adrenaline previous severe allergic reaction eating outside of the home travelling and flying abroad peanut allergy exercise heat

WHAT INCREASES THE RISK OF A SEVERE REACTION?

poorly controlled asthma the amount of allergen taken and how exposure

occurs - ingested / inhaled / touched infection / high temperature female hormones stress and emotional upset consuming alcohol

TYPES OF REACTION

Uni-phasic – rapidly developing severe reaction involving the airway or circulation.

Bi-phasic – early oral and abdominal symptoms, then a symptom-free period of 1 – 2 hours, then increasing symptoms involving breathing and circulation.

MILD / MODERATE REACTION swollen lips, face or eyes Itchy / tingling mouth hives or itchy skin rash abdominal pain or vomiting sudden change in behaviour

ACTION TO TAKE stay with the child, call for help if necessary locate adrenaline autoinjector(s) give antihistamine (if vomiting can be

repeated) give inhaler if prescribed phone parent or emergency contact to

attend school and assess child’s condition

SEVERE REACTION

AAIRWAY persistent cough hoarse voice difficulty swallowing swollen tongue

SEVERE REACTION

BBREATHING difficult or noisy breathing wheeze or persistent cough

SEVERE REACTION

CCONSCIOUSNESS persistent dizziness pale or floppy suddenly sleepy collapse / unconscious

TREATMENT OF SEVERE REACTION lie child flat with legs raised (if breathing is difficult, allow child to sit) use adrenaline autoinjector without delay dial 999 for ambulance and say

ANAPHYLAXIS the operator may decide to send a rapid

response vehicle to your location

AFTER GIVING ADRENALINE

stay with child until ambulance arrives, do NOT stand child up

commence CPR if there are no signs of life phone parent / emergency contact if no improvement after 5 minutes, give a

further adrenaline dose using a second autoinjector device if available

pictures

ADRENALINE AUTOINJECTOR

Adrenaline is the emergency medicine used to treat a severe allergic reaction. It works quickly to reverse the symptoms of anaphylaxis by: helping to reduce swelling opening up the airway improving the blood pressure(AllergyUK 2019)

STORAGE OF EMERGENCY BOX

accessible at all times during the school day –NOT in a locked room or cupboard.

contains original completed care plan with medication in date.

clearly labelled with child’s name and passport photo for clear identification.

avoid extremes of temperature

ROLES AND RESPONSIBILITIES

School Health Team will provide centralised Health Raising Awareness

on the recognition and treatment of anaphylaxis. will offer and arrange a suitable date with the

school, parent and young person, to complete the allergy action plan for children new into school or newly diagnosed with anaphylaxis

will participate in a debriefing session following an anaphylactic incident

The Child’s Parent

will notify the school if their child requires an Adrenaline auto-injector

will notify school of any changes to child’s allergy action plan

will attend school meeting with School Nurse, Principal / designated teacher and young person, to complete the allergy action plan

will ensure in date, autoinjectors are available in school will return out of date autoinjectors to local pharmacy.

will discuss with the school arrangements for lunch and snacks.

will regularly remind the child of the need to refuse any food items offered by others.

will take home the emergency box, including all contents, at the end of the school year and return to school in September.

Adrenaline autoinjectors can be registered “on-line” to receive expiry date alert.

The School will notify the school nurse on becoming aware of a pupil

requiring an Adrenaline autoinjector device in school, where no care plan is in place.

will create awareness of the pupil’s allergic condition. staff should be aware of those who have attended the Health

Raising Awareness Session will identify adequate numbers of appropriate staff to attend

awareness sessions as dictated by their indemnity insurance will make arrangements for the safe handling and availability of

Adrenaline autoinjector for pupils leaving the school building or any activities that can place the child at risk.

will attend the meeting with the school nurse, parent and young person, to devise and complete the allergy action plan.

will agree with the parents and school catering staff on the provision of school meals.

will ensure safe storage and easy access to the autoinjector devices. All school staff must be aware of where these are stored.

it is the duty of the parent to check the expiry date of Adrenaline autoinjectors, however schools must be aware of autoinjector expiry dates to ensure they are in date at all times in school.

will attend a meeting with the school nurse within one week following an anaphylactic incident.

DOH Guidance on the use of Adrenaline Auto-injectors (AAIs) in schools

From 1 October 2017 the Human Medicines (Amendment) Regulations 2017 will allow all schools in the UK to buy adrenaline autoinjectors (AAI) devices without a prescription, for emergency use in children who are at risk of anaphylaxis but whose own device is not available or not working.

Schools are not required to hold spare AAI(s) – this is a discretionary change enabling schools to do this if they wish.

The school’s spare AAI(s) should only be used on pupils: where both medical authorisation and written parental consent have

been provided for the spare AAI to be used on them, and whose own prescribed AAI(s) cannot be administered correctly and

without delay.

THE PUPIL post primary pupils will always carry or have

available their recommended allergy medication.

will know their triggers and how to avoid them

will be able to recognise the symptoms of an allergic reaction

will report the onset of symptoms to a responsible member of staff

FREQUENTLY ASKED QUESTIONS

In an emergency can I use another pupil’s Adrenaline autoinjector?Adrenaline injectors should only be used on the patient for whom they have been prescribed. If you have attended the Centralised Health Raising awareness session and can spot the signs early, call 999 for immediate assistance. You should only consider using a device prescribed for another person if there is likely to be a delay to the arrival of paramedics, and the emergency service operator agrees with this course of action.

FREQUENTLY ASKED QUESTIONS

In a school population, who should attend Centralised Health Raising Awareness

Sessions?The regularity and how many staff attend theawareness session should be dictated in theschools professional indemnity insurance.

FREQUENTLY ASKED QUESTIONS

What do we do with used Adrenaline autoinjector?

Send to Emergency Department with child in theambulance. School must follow up replacementautoinjector with parents.

FREQUENTLY ASKED QUESTIONS

Can we be a ‘nut free’ school?Nut bans cannot be enforced and may lull staff and the pupil into a false sense of security. Nuts are only one of many allergens that could affect pupils, and it would be impossible to ban them all. However, in nurseries and infant classes it is reasonable to ask parents not to allow children to take nuts into school, in order to reduce the risk of young and vulnerable children.

FREQUENTLY ASKED QUESTIONS

What will happen if I give adrenaline and the child isn’t having an anaphylactic reaction?

Adrenaline is a very safe drug if given in the thigh . There will be no danger to the child if they didn’t really need it.(allergywise.org.uk)

WANT MORE INFORMATION? www.anaphylaxis.org.uk www.allergyinschools.org.uk www.allergyuk.org www.allergywise.org.uk www.cateringforallergy.org.uk Supporting pupils with medication needs

DHSSPS/DOE (2008) www.health-ni.gov.uk ref HSS(MD) 21/2017

Guidance on the use of Adrenaline auto-injectors (AAIs) in schools

CONTACT TELEPHONE NUMBERS FOR SCHOOL NURSING

Armagh 028 3756 5098 Banbridge & Dromore 028 4066 2866 Dungannon 028 3756 5725 Kilkeel 028 3756 7830 Newry 028 3756 6362 Craigavon Area 028 3756 1025

Thank you for your time.Any questions?