Kids Health Info

Allergic and anaphylactic reactions

  • Allergic reactions are common. They happen when the immune system reacts to something in the environment that is normally harmless, e.g. food proteins, pollens or dust mites. They can be triggered by an allergen coming into contact with the skin, eyes, nose, lungs, stomach or bowel.

    Many allergic reactions are mild, but some can be severe and even life threatening.

    The most common causes of allergy in children are eggs, peanuts, tree nuts, cow's milk, soy, wheat, fish and shellfish. Other causes are bee or other insect bites (e.g. wasp, jumper jack ant), some medications such as antibiotics or anaesthetics, and latex (rubber).

    What is anaphylaxis?

    Anaphylaxisis is the most severe form of an allergic reaction and is life threatening. Rates of anaphylaxis are not well documented, but are estimated at approximately 10 in every 1000 school children.

    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 or Anapen®/Anapen® Jr). An important aspect of anaphylaxis management is prevention by avoiding the cause.

    Signs and symptoms

    Mild to moderate allergic reaction

    A reaction will include one or more of these symptoms, and it is possible that a number of them will happen at the same time:

    • Hives or welts (a red, lumpy rash, like mosquito bites).
    • A tingling feeling in or around the mouth.
    • Stomach pain, vomiting and/or diarrhoea.
    • Facial swelling.

    Severe allergic reaction (Anaphylaxis)

    This term is used to describe a severe allergic reaction that involves a person's breathing and/or circulation (heart and blood). Any of these symptoms, as well as one or more of the above symptoms of a mild-moderate allergic reaction, indicates anaphylaxis:

    • Difficulty with breathing and/or noisy breathing.
    • Swelling of the tongue.
    • Swelling and/or tightness in throat.
    • Difficulty talking and/or hoarse voice.
    • Loss of consciousness and/or collapse.
    • Becoming pale and floppy (infants/young children).

    Prevention

    Preventing an allergic reaction or anaphylaxis is very important. Ways you can prevent an allergic reaction or anaphylaxis include:

    • Knowing and avoiding the causes.
    • Not allowing food sharing or swapping.
    • For teachers: only giving foods approved by the parents or foods you have witnessed the child eating before.
    • For teachers: using non-food treats where possible, but if food treats are used in class give only those provided by the parents. (Encourage parents to provide a container of safe treats from home).
    • Practising routine hygiene and good food safety practices. Children and staff should always wash their hands after play and before eating, and tables should be wiped down 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 staff and students can become complacent. Rather than banning foods, it is recommened that people become aware of allergy causing foods.

    Food sharing:

    Food sharing between children at risk of anaphylaxis should be completely avoided. These children must only consume food provided from home or given with the parent's permission.

    Food preparation:

    Any staff who are responsible for cooking or delivering food to children, including relief/casual staff, 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 contamination of other foods when preparing, handling or displaying food.

    Art/craft:

    Food containers or packages that contained the allergy food should not be used. Parents of children with anaphylaxis can help by checking art/craft products for hidden ingredients, because they are often more aware of the 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 adrenalin auto-injector must be taken on all excursions and a staff member trained in its use must always be present. The EpiPen®/EpiPen®Jr or Anapen® Anapen® Jr must always be readily accessible.

    Treatment

    The first line treatment for anaphylaxis is adrenaline, which may be given as an EpiPen® /Anapen® injection. Please read the Kids Health Info factsheet:  Auto-injectors (epi-pens) for anaphylaxis - an overview

    If a child has had a history of anaphylaxis, an adrenaline auto-injector should be prescribed for the treatment or future episodes. Indications for prescribing an  adrenaline auto-injector can be found at the Australasian Society of Clinical Immunology and Allergy (ASCIA). The following recommendations should be considered:

    • Each child who has been prescribed an adrenaline auto-injector needs an Anaphylaxis Action Plan, completed by a doctor.
    • If an adrenalin auto-injector is used, always call an ambulance by phoning 000.

    More information:

    • Kids Health Info factsheet:  Auto-injectors (eip-pens) for anaphylaxis - an overview.
    • Regular education sessions run by the RCH, parents and teachers.  See the Allergy department website for more details or telephone (03) 9345 5701.
    • The Department of Education's Anaphylaxis Guidelines for Victorian schools and the Department of Human Services model policy can also be downloaded from the Allergy department web site.

     

    Developed by the RCH Department of Allergy and Immunology. First published in June 2007. Last reviewed in September 2012.

Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts.