A Unique Child Health: A guide to ... Anaphylaxis

The WellChild Helpline provides information and advice

What is anaphylaxis?

Anaphylaxis is a severe allergic reaction which can be life-threatening. The whole body - the airway, breathing and circulation - can become affected very quickly (usually within minutes) after the person has come into contact with an allergen. An allergen is any substance that causes an allergy.

What causes anaphylaxis?

It is not known why some children develop anaphylaxis and others do not. The immune system usually fights off things that cause the body harm, such as diseases. When someone has an allergy, the body sees the allergen as a threat and this leads to a release of chemical substances from cells in the blood and tissues. The chemicals that are released act on blood vessels, which then causes swelling in the body. Even the tiniest amount of the allergen can cause a severe reaction.

Triggers

There are many different allergens that can cause anaphylaxis. The most common allergens are:

- Foods:
- nuts (such as peanuts, brazil nuts, hazel nuts)
- seeds (sesame, poppy)
- eggs
- milk/dairy products
- fish and shellfish
- fruit (such as kiwi)
- Insect stings - bee and wasp stings
- Latex (a type of rubber found in everyday objects such as rubber
gloves, rubber toys, balloons)
- Medicines (such as antibiotics, vaccines)

Occasionally, some children will have anaphylaxis but their trigger will not be known. This is called idiopathic anaphylaxis.

What are the signs and symptoms?

These will differ between children and not every child will experience all of the following symptoms:

- swelling of the face, mouth, tongue and throat
- difficulty swallowing or talking
- nettle-type rash anywhere on body, usually raised and itchy
- tummy ache, nausea and vomiting
- difficulty breathing and wheezing
- feeling weak
- loss of consciousness.

While many children develop symptoms within ten minutes of coming into contact with the allergen, for the majority it will be within two minutes.

How is anaphylaxis treated?

Anaphylaxis needs to be treated immediately with an injection of a drug called adrenaline (also called epinephrine). Every child who is at risk of anaphylaxis should be prescribed adrenaline. This injection will be with an instrument called either an EpiPen or an Anapen. It should be accessible at all times and should be carried when the child is out and about.

When a child starts to have an anaphylactic reaction, they must be given the adrenaline immediately (see further information). It is also important to dial 999. The instrument is easy to use and the injection is given at the top of the leg in the thigh. It can also be given through clothing (but not through thick material such as denim).

This drug helps reduce the swelling, raise the blood pressure and relieve the breathing difficulties. Other drugs such as antihistamines and asthma inhalers may also be prescribed to help with the symptoms.

Once this injection has been given, the child should start to recover quite quickly. They will, however, still need to be taken to hospital for monitoring. Bracelets can be worn by children with anaphylaxis to alert people.

Caring for a child with anaphylaxis in a childcare setting

Parents/carers can often spend a lot of time deciding on the right childcare for their child. For those who have a child with anaphylaxis, it is important that they feel safe in the knowledge that their chosen childcare provider has a good basic knowledge of anaphylaxis.

Anaphylaxis can be preventable. Knowing the triggers is the first step. Early years staff need to be educated on how to avoid these allergens and triggers. Staff should also be able to recognise the symptoms of anaphylaxis and be prepared to administer adrenaline according to a plan.

A detailed management plan, drawn up by the parents and staff, will ensure that the child receives proper care. The Anaphylaxis Campaign has examples of management plans for pre-school children on their Allergy in Schools website (www.allergyinschools.org.uk) which can be downloaded.

Further information:

- The Anaphylaxis Campaign, tel: 01252 542029, website: www.anaphylaxis.org.uk

- There is guidance on how to administer adrenaline via the EpiPen at www.epipen.co.uk and Anapen at www.anapen.co.uk

- You can also contact WellChild Helpline on 0808 801 0330, e-mail helpline@wellchild.org.uk or text 0778 147 2599.