Anaphylaxis is an extreme and severe allergic reaction. The whole body is affected, often within minutes of exposure to the substance which causes the allergic reaction (allergen). It is also known as anaphylactic shock. Any allergic reaction, including the most extreme form, anaphylactic shock, occurs because the body’s immune system reacts inappropriately in response to the presence of a substance that it wrongly perceives as a threat.
The symptoms are caused by the sudden release of chemical substances, including histamine, from cells in the blood and tissues where they are stored. The release is triggered by the interaction between an allergic antibody called Immunoglobulin E (IgE) and the substance (allergen) causing the anaphylactic reaction.
This article is focused towards the pupil in a school environment and provides guidance for teachers and healthcare providers who are expected to deal with an anaphylactic reaction.
Frequently asked questions for Schools
How common are severe food allergies among children?
Every school is likely to have at least one pupil who is severely food-allergic, and many schools will have more. Peanut allergy is particularly common – with one in 70 children nationwide thought to be affected.
What are the symptoms of food allergy?
For many children, the symptoms of food allergy are mild. In severe cases, symptoms may include generalised flushing of the skin, nettle rash (hives) anywhere on the body, swelling of the throat and mouth, severe asthma, abdominal cramps, nausea and vomiting. In very severe cases there may be collapse and unconsciousness, although this is rare.
What is the treatment?
The treatment for a severe allergic reaction is an injection of adrenaline (also called epinephrine), delivered into the muscle in the side of the thigh. The adrenaline injections most commonly prescribed are the EpiPen and Jext. These are extremely user-friendly.
How can I ensure that the allergic child’s development is not impaired?
Children who are at risk of severe allergic reactions are not ill in the usual sense. They are normal children in every respect – except that if they come into contact with a certain food or substance, they may become unwell. It is important that these children are allowed to develop in the normal way and are not stigmatised or made to feel strange. All efforts should be made to ensure that the allergic child has the opportunity to participate in all school activities.
School trips may need a little planning and preparation, together with a meeting with the parents and/or the child to ensure they are satisfied with plans. At least one person trained in administering adrenaline must accompany the party. From the child’s point of view, it is inadvisable for a parent to accompany them on school trips, although in some cases this may be unavoidable.
There is no need to exclude an allergic child from cooking lessons, but care is needed with foods that any child is allergic to. The cooking area should be cleaned thoroughly before use and recipes thought out carefully.
Allergic children should have every opportunity to attend sports trips to other schools. Many schools have now had to handle at least one child with food allergy or allergy to insect stings. Ensure your P.E. Teacher is fully aware of the situation and notifies the schools to be visited that a member of the team has an allergy when arranging the fixtures. A member of staff trained in administering adrenaline should accompany the team. Should another school feel they are not equipped to cater for any food-allergic child arrange for the child to take their own food.
If I have to administer adrenaline, how quickly will it work?
Signs of improvement should be seen fairly rapidly. If there is no improvement, or the symptoms are getting worse, then a second injection may be administered after five – ten minutes.
How many injectors should an allergic pupil have at school?
The answer depends on many factors including the size of the school and the layout of the buildings. Many allergy specialists believe every allergic child should have at least four in total – two for home and two for school. In a particularly large school, it may be sensible to have more than two, kept in various locations.
There is no national agreement about how many injectors an allergic child should carry, and in the end it will be up to the prescribing doctor. If the first injector is administered promptly and correctly, and an ambulance is minutes away, then the chances of a second being needed before the ambulance arrives will be much reduced.
Why is more than one injector recommended?
Usually one is sufficient to treat a reaction, but if the symptoms persist or get worse, and the ambulance has not arrived, a second may be administered. The question of when to administer a second to an individual child should be discussed with the child’s doctor. In rare cases it may be needed after five minutes. There would also be a need to use a second injector if the first had been wrongly administered and therefore wasted (although this is extremely unlikely if training has been adequate).
What will happen if I give adrenaline and the child is not having a reaction?
The heartbeat could increase and the child may have palpitations for a few minutes. There should be no serious side effects unless the child has coexisting heart problems.
Once the injector has been used how do I dispose of it?
Place it in a rigid box and take it to the hospital with you to show the A&E staff what has been used. The hospital will then dispose of it for you.
What is the difference between an asthma attack and an allergic reaction?
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.
Can school pets be a problem for the allergic child?
Some food-allergic children may also be allergic to pets; this needs careful thought and discussion with an allergic child’s parents.
Should parents insist on a school being a peanut-free zone?
Generally speaking the Anaphylaxis Campaign would not necessarily support ‘peanut bans’ in all schools. Schools do however have a duty of care to all pupils, so need to have procedures in place to minimise the risk of a reaction occurring in a food-allergic child. Schools may wish to write to parents asking for their cooperation in making life safe for allergic children.
What are the family’s responsibilities?
Tips on how the family can help the allergic child include:
- Notify the school of the child’s allergies. Ensure there is clear communication.
- Work with the school to develop a plan that accommodates the child’s needs throughout the school including in the classroom, in dining areas, in after-school programmes, during school sponsored activities and on the school bus. Ask your doctor, allergy specialist or paediatrician to help.
- Provide written medical documentation, instructions and medications as directed by a doctor. Replace medications after use or upon expiry.
- Educate the child in allergy self-management, including what foods are safe and unsafe, strategies for avoiding allergens, how to spot symptoms of allergy, how and when to tell an adult of any reaction, and how to read food labels.
- Provide a “stash” of safe snacks for special school events and periodically check its supply and freshness.
- Review policies and procedures with the school staff, the child’s doctor and the child (if age appropriate) after a reaction has occurred.
What are the school’s responsibilities?
Tips that might help the school to ensure the safety of an allergic child include:
- Ensure that catering supervisors are aware of an allergic child’s requirements. Review health records submitted by parents.
- Include food-allergic children in school activities. Pupils should not be excluded based on their allergy.
- Ensure the staff have received high-quality training in managing severe allergies in schools, including how to use an adrenaline auto injector.
- Identify a core team to work with parents to establish prevention and treatment strategies. Arrange staff training. Ensure all staff can recognise symptoms; know what to do in an emergency, and work to eliminate the use of allergens in the allergic pupil’s meals, educational tools, arts and crafts projects.
- Ensure that medications are appropriately stored, and easily accessible in a secure location (but not locked away) central to designated staff members.
- Review policies after a reaction has occurred.
What are the pupil’s responsibilities?
- Be sure not to exchange food with others.
- Avoid eating anything with unknown ingredients.
- Be proactive in the care and management of your food allergies and reactions (based on the age level).
- Notify an adult immediately if you eat something you believe may contain the food to which you are allergic.
- Notify an adult immediately if you believe you are having a reaction, even if the cause is unknown. Always wear your medical alert bracelet or some other form of medical identification.
- Steps that may be taken for keeping the allergic child safe at break and lunch time:
- Tables should be cleaned thoroughly before and after eating. Remind children to wash their hands.
- Ensure the cooks and lunch time staff all know the allergic child.
- Educate the school pupils about food allergy, maybe in the form of an awareness day or as a fundraising event – the Anaphylaxis Campaign can help with fundraising and ideas please visit their website at: http://www.anaphylaxis.org.uk/
Anaphylaxis is a severe and potentially life-threatening reaction to a trigger such as an allergy. For further information please visit the NHS website Symptoms of anaphylaxis