Anaphylaxis is a generalised allergic reaction, which often involves more than one body system (e.g. skin, respiratory, gastro-intestinal and cardiovascular). A severe allergic reaction usually occurs within 20 minutes of exposure to the trigger and can rapidly become life threatening.

According to the Anaphylaxis Australia peanut allergies are the most common, followed by egg, cow’s milk and tree nuts, such as cashew.

The fact is that anaphylaxis is frightening enough for parents who know what their child reacts to, what to avoid, how to treat their child, and the signs to look out for, but the leap into the unknown in terms of what will happen to your little one in an un-regulated environment is often too much for parents to deal with.

Most child care centres will have some sort of experience of children with allergies, and are often “nut free” environments, but there are many other triggers for anaphylaxis and carers aren’t trained in what to look out for or how to deal with an anaphylactic reaction.

This is deeply frustrating for mums and dads who desperately want their children to be able to lead a ‘normal’ life and develop social skills and friendships acquired in a group situation. It also means that early child care is generally home-based and therefore more costly (nannies and au pairs are not ‘approved child care’ in terms of Child Care Benefit or tax rebate). Or those parents do not have the ability to return to work at all. Most child care centres now have at least one child at risk of anaphylaxis, so national guidelines for management in child care are NOT too big an ask.

Radio presenter and author, Jo Abi (see our VIP mum interview) knows all about the difficulties of anaphylaxis as the mother of a three year old, Phillip, with anaphylaxis brought on by nuts and egg.  “I was very scared about sending Phillip to child care. I desperately wanted him to go – for both his benefit and mine, but without any regulations in child care facilities in terms of dealing with anaphylaxis, I really thought it was impossible”.

Jo sought advice from Anaphylaxis Australia, which publishes guidelines through www.allergyfacts.org.au (for child care and schools in each state and territory) on how to manage allergies in a school environment.

“I rang every child care centre in my area (Waverley, NSW), said Jo, and couldn't find any with an adequate allergy program for anaphylactic children. Most could deal with food intolerances, but not more severe food allergies. All of the child care centres were nut free, but none were egg free. (Egg is now the second most common food allergy is pre-schoolers after peanuts)”.

Jo visited a centre she felt sounded most willing to adapt to her son's needs. Junction Juniors at Westfield Bondi Junction was dealing with some food intolerances and some staff had received “EpiPen®¹” training, although it had been a while ago.

Together with the centre director, Jo organised a nurse from Randwick Children's hospital to give a talk to the staff as well as update their EpiPen training. The child care centre manager organised for pre-school meals to be egg free on the days he is there.

“The carers have been brilliant, said Jo. I know it was hard for them, but each morning when I drop Phillip off we go over the menu to check it. The centre manager also held a staff meeting for all carers where they had to learn Philip's name, face and food allergies. For a few weeks we'd be greeted with, "Hi Philip, egg and nuts!" It was very comforting”.

Jo continues to work with the current staff to make the environment safe for Philip and any other children who join the centre with a severe food allergy.

“We keep the lines of communication open and they ring whenever they are unsure of a particular food or if Philip develops a rash due to contact with a child who has eaten egg. But so far, it’s been great. Phillip absolutely loves going to “school” and I feel as confident as I can that he’s in the best hands”.

Maria Said, President of Anaphylaxis Australia said that even though deaths are rare, food induced anaphylaxis is not uncommon. “The best way to protect children is to ensure they are promptly and properly diagnosed. We encourage all child care facilities to access training by dedicated anaphylaxis educators and ensure that all staff receive annual training on preventing an anaphylactic reaction; recognising symptoms of a reaction and practise how to administer the lifesaving EpiPen adrenaline auto-injector.

Said continued: “Management of those at risk of severe allergic reactions is about implementation of many strategies to reduce risk and then training on recognition and emergency treatment of an allergic reaction as no body can ever guarantee any environment is free of an allergen.”

For school anaphylaxis guidelines for individual states and territories call anaphylaxis Australia on 1300 728 000 or go to www.allergyfacts.org.au.

ANAPHYLAXIS – THE FACTS
Anaphylaxis is the most severe form of allergic reaction and potentially life threatening. It must be treated as a medical emergency, requiring immediate treatment and urgent medical attention.

Common triggers of anaphylaxis include:

• Food
  Milk, eggs, peanuts, tree nuts, sesame, fish, crustaceans and soy are the most common food triggers, which cause 90% of allergic reactions, however, any food can trigger anaphylaxis. It is important to understand that even trace amounts of food can cause a life-threatening reaction. Some extremely sensitive individuals can react to even the smell of a food (e.g.fish)
• Insect Venom
  Bee, wasp and jumper ant stings are the most common causes of anaphylaxis to insect stings. Ticks and fire ants also cause anaphylaxis in susceptible individuals.
• Medication
  Medications, both over the counter and prescribed, can cause life threatening allergic reactions. Individuals can also have anaphylactic reactions to herbal or ‘alternative’ medicines.
• Other - triggers such as latex or exercise induced anaphylaxis are less common and occasionally the trigger cannot be identified despite extensive investigation.

Signs and Symptoms:
The signs and symptoms of anaphylaxis may occur almost immediately after exposure or within the first 20 minutes after exposure. Rapid onset and development of potentially life threatening symptoms are characteristic markers of anaphylaxis.

Allergic symptoms may initially appear mild or moderate but can progress rapidly. The most dangerous allergic reactions involve the respiratory system (breathing) and/or cardiovascular system (heart and blood pressure).

• Mild to moderate allergic reaction
• Tingling of the mouth
• Hives, welts or body redness
• Swelling of the face, lips, eyes
• Vomiting, abdominal pain

• Severe allergic reaction- ANAPHYLAXIS
• Difficulty and/or noisy breathing
• Swelling of the tongue
• Swelling or tightness in the throat
• Difficulty talking or hoarse voice
• Wheeze or persistent cough
• Loss of consciousness and/or collapse
• Pale and floppy (young children)
• CPR instructions: St John Ambulance - A quick guide to first aid - CPR

Diagnosis:
A person who is suspected of having a food allergy should obtain a referral to see an allergy specialist for correct diagnosis, advice on preventative management and emergency treatment. Those diagnosed with severe allergy must carry emergency medication as prescribed as well as an Anaphylaxis Action Plan signed by their doctor. Food allergic children who have a history of eczema and/or asthma are at higher risk of anaphylaxis. Administration of adrenaline is first line treatment of anaphylaxis.

Management & Treatment:
Anaphylaxis is a preventable and treatable event. Knowing the triggers is the first step in prevention. Children and caregivers need to be educated on how to avoid food allergens and/or other triggers.

However, because accidental exposure is a reality, children and caregivers need to be able to recognise symptoms of an anaphylaxis and be prepared to administer adrenaline according to the individuals Anaphylaxis Action Plan.

Research shows that fatalities more often occur away from home and are associated with either not using or a delay in the use of adrenaline.

In Australia, adrenaline can be purchased on the PBS in the form of an auto-injector known as the EpiPen®. More information also available from ASCIA.