Prof. Nick Makwana
Consultant Paediatrician (Paediatric Allergy), Department of Child Health, Sandwell and West Birmingham Hospitals
Dr. Helen Evans-Howells
GP and Allergy Specialist, Dr Helen Allergy
Rebecca Batt
Paediatric Allergy Nurse Consultant, Guy’s and St Thomas’ NHS Foundation Trust
Children with severe allergies are at risk of life-threatening anaphylaxis. Parents and teachers should have robust action plans in place and know what to do in an emergency.
Adolescence is a high-risk period for severe or fatal anaphylaxis, driven by poor carriage, lack of confidence or delayed adrenaline use as they worry about over-reacting or not recognising symptoms.1
Anaphylaxis is a potentially life-threatening condition
If you’re worried that a child may be in the early stages of anaphylaxis, don’t wait for their symptoms to get worse. Take rapid action. “You might not know if a child is having a mild or severe allergic reaction,” says Professor Nick Makwana, Consultant Paediatrician (Paediatric Allergy), Department of Child Health, Sandwell and West Birmingham Hospitals. “Treat it as anaphylaxis, give them adrenaline straight away and then call 999. In an emergency, you don’t have time to make a perfect diagnosis.”
Symptoms that indicate anaphylaxis
It would help parents and teachers to understand the difference between mild and severe allergy symptoms, says Dr Helen Evans-Howells, GP and Allergy Specialist at Dr Helen Allergy clinic. Mild symptoms are usually visible and can include a rash, lip swelling and itchiness.
Severe symptoms can affect the airway, breathing and circulation. “Recognise ‘ABC’,” she says. “That’s Airway (a swollen tongue, throat, upper airway, trouble swallowing), Breathing (wheezing, fast breathing) and Circulation (looking pale, feeling drowsy, loss of consciousness). It’s about noticing those early signs, having the confidence to act — and administering adrenaline immediately.”
Every child deserves to learn in a safe environment
where staff are confident and prepared to act in an emergency
Adrenaline is the first-line treatment for anaphylaxis. “That’s because it opens up the airway,” explains Professor Makwana. “It also supports the blood pressure by tightening up the blood vessels and counteracts many of the body’s allergic responses that occur during a reaction.” Adrenaline is completely safe, so if given unnecessarily, it won’t cause harm. However, if given too late, symptoms may rapidly worsen and move to a point beyond reversal.
Collaborate effectively with schools and nurseries
This September, Benedict’s Law comes into force and requires all schools in England to demonstrably improve their allergy awareness, prevention and emergency response. “Every child deserves to learn in a safe environment where staff are confident and prepared to act in an emergency,” says Professor Makawana.
Every child with severe allergies should have an up-to-date action plan outlining their allergens, medication and emergency response steps. Parents should also check that their child’s school or nursery has its own robust, up-to-date allergy action plan. Even with Benedict’s Law coming into force, don’t assume they have one.
Dr Evans-Howell advises parents to show their child’s action plan to the class teacher (in the case of primary schools), school nurse and healthcare team (in the case of secondary schools). “Tell them: ‘These are my child’s allergies, and this is what it might look like if they have an allergic reaction’,” she says. “Have a conversation with them. Find out how they will keep your child safe in the classroom, cooking lessons, play times, on school trips, etc.”
Why children should carry two adrenaline devices
Rebecca Batt, Paediatric Allergy Nurse Consultant, Guy’s and St Thomas’ NHS Foundation Trust, also recommends asking where the school stores adrenaline. “Adrenaline devices need to be kept in a safe, unlocked storage area,” she says.
Parents should ensure their child is carrying two adrenaline devices with them at all times — and not just because there will be a back-up in case one fails. “It’s primarily because the effects of adrenaline can be short-lived,” says Batt. “A second dose may be needed. Also, don’t forget to check the expiry date of the medication because adrenaline devices can go out of date quickly.”
Some children, particularly teenagers, may feel self-conscious about carrying their adrenaline devices, which can be bulky. “I always emphasise how important it is for their health,” says Professor Makwana. “Their device gives them greater independence because if the worst happens, they’ll have the medicine to reverse symptoms.”
[1] Vazquez-Ortiz M.,et al. Allergy. 2020; 75(8):1850-1880; Kachru, R. J Food Allergy. 2020, 2(1):95
