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Allergy

What is an allergic reaction?

An allergy develops when the immune system recognises and responds to something in the environment that is normally harmless: e.g. food proteins, pollens or dust mite.  An allergic reaction occurs when a child is exposed to that substance and the body's immune system reacts to that substance.  Symptoms may be localised or generalised, and range from mild to severe.

The most common causes of allergic reactions in young children are:

• Egg
• Cow's milk
• Peanut
• Tree nut
• Soy
• Wheat
• Fish
• Shellfish

Other causes are bee or other insect stings, medication and latex (rubber).

What is anaphylaxis?

This term is used to describe a severe allergic reaction that involves the respiratory and/or cardiovascular systems.  Anaphylaxis is the most severe form of an allergic reaction and is life threatening.

A reaction can develop within minutes of exposure to the allergen, but with planning and training, a reaction can be treated effectively by using an adrenaline injection (EpiPen®/EpiPen® Jr).  An important aspect of anaphylaxis management is prevention and avoidance of the cause.

The most common causes of anaphylaxis are peanut, tree nuts, egg and cow's milk.  Other causes include antibiotics, bee and insect stings.

Signs and symptoms of an allergic reaction:

Mild to moderate allergic reaction 

A mild to moderate reaction will include one or more of these symptoms, and it is possible that a number of them will occur simultaneously:

• Hives or welts
• A tingling feeling in or around the mouth
• Abdominal pain, vomiting and /or diarrhoea
• Facial swelling

Anaphylaxis (Severe allergic reaction)

Anaphylaxis is the term used to describe a severe systemic allergic reaction that involves the respiratory and/or cardiovascular system. Presentation of any of the symptoms below, in addition to one or more of symptoms of a mild-moderate allergic reaction, indicates anaphylaxis:

• Difficulty breathing
• Noisy breathing
• Swelling of the tongue
• Swelling/tightness in throat
• Difficulty talking and/or hoarse voice
• Loss of consciousness and/or collapse
• Pale and floppy (infants/young children)

Management of anaphylaxis

• Each child who has been prescribed an EpiPen®/EpiPen® Jr require an Anaphylaxis Action Plan, completed by a doctor.  The Anaphylaxis Action Plan should be provided by the parents, together with the EpiPen®/EpiPen® Jr
• Employers should support staff training so that all staff can recognise an allergic reaction and be able to administer an EpiPen®/EpiPen® Jr appropriately
• If a reaction is suspected, the Anaphylaxis Action Plan must be followed
• If an EpiPen®/EpiPen® Jr is given, an ambulance must be requested by phoning 000

Treatment of anaphylaxis

The first line treatment for anaphylaxis is adrenaline, which may be given as an EpiPen® Jr for children weighing less than 20 kgs or and EpiPen® injection for children weighing 20 kgs or more.  An EpiPen®/EpiPen® Jr is a single dose of auto-injector of adrenaline, which is prescribed by a doctor.

Care of the EpiPen®/EpiPen® Jr

• Clearly label storage container with child's name
• Check expiry date regularly
• Store at room temperature
• Store in a safe, easily accessible location
• A copy of the Anaphylaxis Action Plan should be stored with the EpiPen®/EpiPen® Jr.  This contains contact details for parents/guardian, and medical services

Prevention of subsequent allergic reactions:

• Know and avoid the causes
• Do not allow food sharing or swapping
• Only give foods approved by the child's parents
• Use non-food treats where possible, but if food treats are used, give only those provided by the parents ( encourage parents to provide a container of safe treats from home)
• Practise routine hygiene and good food safety practices.  Children and staff should always wash their hands after play and before and after eating.

Banning of products

Banning of products that contain the allergen is NOT recommended.

Banning will not succeed in creating an "allergy free zone".  It is difficult to achieve a 100% ban, for a variety of reasons.  For example, product labels can be confusing, parents of non-allergic children may not comply with the ban, and lastly, staff and students become complacent.

Food sharing

The child at risk of food allergies should not share food.  These children must only have food provided from home or given with the parent's permission.

Food preparation

Any staff, including relief staff, who are responsible for cooking or delivering food to children should know about the child's allergies.  They should be aware of alternative words used to describe the particular allergy food.  For example, cow's milk may be called casein, and egg may be called ovalbumin.  They should also be aware of potential contamination of other foods when preparing, handling or displaying food.

Art/craft

Food containers or packages that contain the allergy food should not be used.  Parents of children with anaphylaxis can help by checking art/craft products for hidden ingredients, as they are often more aware of terms used.

Separate tables should be used for art/craft and food.  Where this is not possible, tables must be cleaned thoroughly between uses.

Excursions

The EpiPen®/EpiPen® Jr must be taken on all excursions and a staff member trained to use the EpiPen®/EpiPen® Jr must always be present.  The EpiPen®/EpiPen® Jr must be readily available.