28 june 2024
Our eHealth team advised us yesterday of an international vulnerability relating to polyfill.io . This domain has become compromised and is spreading malware through a widespread supply chain attack, estimated to affect over 110,000 websites including major websites such as the BBC. The Polyfill site offered widely used bits of code for older browsers that allowed the use of modern Javascript features. Such code makes the work for web developers easier and allows compatibility with a broader range of browsers.
Websites that have used the Javascript code from Polyfill have been urged to remove such code immediately. The change occurred after a suspected Chinese firm purchased the domain in early 2024.
Tactuum have identified and are now testing a fix to remove all Polyfill code from the RDS site.. They will be deploying the fix on Monday 1 July along with other planned fixes and amendments. I will notify you of the timing of the deployment as soon as possible.
In the meantime, please ensure that you have up-to-date anti-virus software installed on your machines and personal devices.
Anaphylaxis is a life-threatening allergic reaction due to the rapid onset of airway/breathing and/or circulatory problems. The early signs & symptoms of anaphylaxis may be mild such as flushing, itchy rash or swelling of the face and abdominal pain/vomiting but they are not always present. It can be triggered by: Foods (e.g. nuts), Medicines (e.g. antibiotics), Venom (e.g. bee and wasp venom), Latex (e.g. balloons, rubber gloves)
Airway and Breathing Problems:
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Low Blood Pressure affecting the Consciousness Level:
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If any one (or more) of these signs above are present follow the Emergency Response to Anaphylaxis. The symptoms of anaphylaxis may be different depending on the individual. The allergic reaction may also start as mild and progress rapidly to severe.
Anaphylaxis should ALWAYS be treated with an adrenaline autoinjector (e.g. EpiPen) and an ambulance must be called for further treatment and observation in hospital.
Symptoms of anaphylaxis can return hours after the initial reaction. This is known as a biphasic reaction.
Adrenaline is the first line treatment and should be administered without delay if signs of a severe allergic reaction (anaphylaxis) are suspected. The adrenaline treats both the symptoms of the reaction and also stops the reaction by preventing the further release of chemicals causing anaphylaxis.
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Relieves breathing problems by relaxing restricted airways |
Increases blood pressure by improving heart function (blood output and circulation) |
Anyone in the community can administer adrenaline via an AAI (e.g. EpiPen) if the intention is to save a life.
If in doubt of the allergic reaction’s severity, it should be treated as severe and adrenaline administered via an AAI. 
Human Medicines Regulations 2017
A pre-loaded injection device containing adrenaline called adrenaline auto-injector (AAI) is used. The devices are available in two strengths; junior and adult. They can be administered through clothes and should be injected into the upper outer thigh muscle, in line with the instructions issued for each brand of injector.
Brands of auto-injectors prescribed in the UK include EpiPen, Jext and Emerade. Each brand has been built differently requiring a slightly different administration technique, but all will have the same effect in the body – deliver adrenaline.
Positioning a younger child to administer an AAI:
Positioning an older child presenting with anaphylaxis symptoms:
a. Lying down with legs elevated where possible
b. If patient is struggling to breathe, sit up, but this should be for as short a time as possible
Follow the links below to watch how to use each brand:
One type of AAI is recommended in all settings to avoid confusion over the administration technique. However, over the last 2-3 years, there has been a shortage of AAI’s. In light of this, at times different brands were offered to patients for school use and to carry in their emergency bags.
Updates on the AAI shortage can be found at on the MHRA or BSACI web pages.
Food allergy affects up to 8% of school age children. Approximately 25% of school age allergy patients will have their first allergic reaction in school. The majority of the allergic reactions present with mild to moderate symptoms and they do not progress to anaphylaxis (even in children with history of anaphylaxis).
Fatal allergic reactions are rare but they are very unpredictable. In the UK, 17% of fatal allergic reactions in school-aged children happen while at school.
The factors that can increase the severity of a reaction include:
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| Delay in Adrenaline administration | Standing or Walking during Anaphylaxis | Asthma |
Not all patients with allergies are issued an AAI; allergic patients undergo a risk assessment by the healthcare professional to identify the risk of anaphylaxis that they run. A number of factors are assessed; such as additional health conditions (i.e. asthma), previous episodes of severe allergic reactions/anaphylaxis, reactions to very small amounts (traces) of allergens or remoteness to hospitals/ambulance access.
It is paramount that all staff know the school’s emergency response protocol to anaphylaxis. They should receive training in the management of allergy and anaphylaxis to stay prepared for such emergencies.
School allergy care