Airway and Breathing Problems:

Persistent Cough Hoarse voice/high pitched sound (stridor) Difficulty swallowing, swollen tongue Difficulty or noisy breathing Wheeze

Low Blood Pressure affecting the Consciousness Level:

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.

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:

 EpiPen

 Jext

Emerade

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:

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.