Taking control

A quarter of a million pre-school children across the UK have nut allergy, according to a House of Commons report published in November 2004. In addition to this, research published in March 2005 showed that families caring for a child with a life-threatening allergy find life even more stressful than those who have been told their child has cancer.

Viewed together, these two reports paint a bleak picture. They show that large numbers of ordinary families across the country are carrying a daily burden of uncertainty, living with the possibility that their allergic child might die before reaching adulthood.

However, the high levels of fear and depression that families experience are not justified and do not have to be permanent. They can be helped to cope.

The facts, in proportion, are:

* The number of young children who actually die from allergy is small. The Anaphylaxis Campaign's record of fatalities contains just two deaths of a child under ten during the past decade. Unmanaged risks are real, but road fatalities, for example, far outnumber the deaths from allergy.

* Severe allergy is manageable. Once strategies are put in place for avoiding harmful allergens, such as milk, egg and peanuts, the chances of an accidental exposure are minimised. A Cambridge study team confirmed this, showing that the risks for allergic children are reduced if the family receives expert advice and assessment in a specialist allergy clinic and participates in a management plan.

* Accidental exposures to allergens do occur, and occasionally children suffer severe reactions. But prescribed treatments - such as easy-to-use adrenaline injection kits - provide reassurance that symptoms can be successfully treated while medical assistance is on the way.

* The key to successfully managing a life-threatening allergy is information, plus a commitment to carrying prescribed treatments everywhere. There is, however, a problem. Allergy services across the UK are generally poor and GPs receive very little training in allergy. There is little wonder that many families, devoid of high-quality information, find that life is driven by anxiety and tend to over-protect their children. Little wonder, too, that families turn to support organisations like the Anaphylaxis Campaign for help.

Staff at pre-schools and nurseries are understandably anxious when a child is identified as having a potentially severe allergy, such as to peanuts, nuts, milk, egg, fish or kiwi fruit. The first rule for parents is to be calm and provide all the known facts: what the child is allergic to, what symptoms may occur, and how they are treated. Then a management plan can be devised with the help of the local surgery or the child's consultant.

The plan should cover strategies for avoiding the allergens that cause the problem and for dealing with symptoms. A mild reaction can be treated with oral antihistamines, supplied by the parents, but a more severe reaction will probably require an injection of adrenaline (also known as epinephrine). Those at risk are prescribed an injection kit - an EpiPen or Anapen.

The question of what symptoms require emergency treatment must form an important part of this training.

A rash or an itchy feeling in the mouth are not serious in themselves, but the child must be watched carefully to ensure that a more serious reaction isn't developing.

Serious symptoms requiring emergency action include any swelling in the airways, asthma, or indeed any marked deterioration. If the child is going floppy or dizzy this could mean that anaphylactic shock - the most extreme form of allergy - is developing, and time is of the essence. Fortunately anaphylactic shock among pre-school children is rare. A serious reaction is more likely to involve breathing difficulties. For all of these symptoms, an injection of adrenaline is likely to be needed and an ambulance must be called.

All this sounds alarming, but the fact is that serious reactions in the pre-school setting can be prevented by good communication, vigilance, common sense, and a commitment to learning basic facts about treatment.

Children with potentially severe allergies are not sick or ill in the normal sense and can quite easily enjoy the same challenges as other children. If nurseries and pre-schools can do their bit, some of the burden that parents face can be lifted.

Further information

* Full information can be obtained from the Anaphylaxis Campaign helpline (01252 542029) and from its website for schools, pre-schools and nurseries: www.allergyinschools.org.uk