Identify Patients at Risk

All healthcare professionals involved in the care of school age patients should have an overall understanding of allergic disease, the risk factors for anaphylaxis and when to refer to an allergy specialist.

A detailed, patient allergy focused history is the most important step for an allergy diagnosis. Allergy testing should be conducted where necessary to confirm the allergy.

Skin prick testing

A small drop of allergen is placed on the patient's arm and lightly pricked to push it just below the surface of the skin. After a few minutes, if the person is allergic to the particular allergen a local skin reaction will be observed. A positive result is where a raised white bump (hive) on the skin develops. This means the allergen has stimulated the immune cells under the skin to release inflammatory substances such as histamine (responsiveness to the allergen).

Skin prick tests should always be interpreted in conjunction with the patient history of reactions.

Blood testing

Specific antibodies against allergens, immunoglobulin E (IgE): this test measures the level of specific IgE antibodies in the blood for example peanut protein, if peanut allergy is suspected.

Oral food challenge

This is the gold standard test for confirming or ruling out an allergy. It is used when there is a diagnostic uncertainty and when assessment of the tolerance level to specific food is required. This usually takes place in hospital where a food is given to the patient in an incremental dose.

Criteria for prescribing an adrenaline autoinjector

Most patients will be prescribed anantihistamine to treat the signs and symptoms of a mild-moderate reaction, such as swelling of the lips and eyes, itching or sneezing.

Not all patients with allergies will require an Adrenaline Auto-Injector (AAI).

The healthcare professional should complete a risk assessment to identify children at higher risk of anaphylaxis.

A detailed, patient focused history is paramount.

The BSACI has published criteria for healthcare professionals to prescribe an adrenaline autoinjector. The criteria include:

	Patients who have experienced anaphylaxis and the allergen is hard to avoid.
	Patients who have an allergy to high risk foods (e.g. peanut) and have other risk factors such as asthma – even if past reactions were mild.
	Patients who react to trace amounts of the allergen.
	Patients who cannot easily avoid the allergen.
	Patients with a continuous risk of anaphylaxis.
	Patients with idiopathic anaphylaxis (unknown trigger).
	Patients with significant co-factors such as asthma or raised baseline serum tryptase.
	Patients in their teenage years are at increased risk.
	Patients living remotely, with reduced access to medical help.

The guidance from the MHRA states that all patients prescribed an AAI should carry two at all times.

It is common for schools to request pupils’ AAIs are stored in school as part of an emergency kit to avoid the situation where a pupil or their family forget to bring the AAIs.

Therefore, patients are usually prescribed four AAI’s – a set for the school and a set for the pupil; to be carried on the pupil or with the pupil as per primary and secondary policies.