Guidelines and Treatment of Anaphylaxis

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1 Guidelines and Treatment of Anaphylaxis This leaflet explains anaphylaxis and what to do if your child suffers from this severe form of allergic reaction. Anaphylaxis Anaphylaxis is a dangerous type of allergic reaction which is most likely to be caused by particular foods, insect bites or medicines. In anaphylaxis, cells release histamine in large amounts. This caused blood vessels to become leaky causing swelling in the surrounding tissues. It is characterised by the following features: Early signs of allergic reaction Swelling and itching; the face may be flushed and wheals or hives may erupt on the skin Lip or facial swelling Acute vomiting or abdominal pain Anaphylaxis or severe reactions Difficulty breathing, coughing and/or wheezing due to swelling of the air passages. Loss of colour; cold and clammy as the blood pressure falls. Collapse / loss of consciousness (the child may appear asleep). Antihistamines For a mild reaction a dose of antihistamine such as Chlorpheniramine (Piriton) can be given as soon as possible. Syrup is absorbed more quickly than tablets. Chlorpheniram 2mg in 5ml syrup ine doses 0 2 years 1mg = 2.5 ml syrup 2-5 years 2mg = 5 ml syrup 5-8 years 3mg = 7.5 ml syrup 8> years 4 mg = 10ml syrup (1 tablet)

2 Cetirizine doses (once a day only) 6 months 2 years 2.5mg = 2.5ml syrup 2 4 years 5mg = 5ml syrup 5 > years 10mg = 10ml syrup (1 tablet) Inhalers Asthma medications will improve breathing symptoms if the child normally takes them. Epinephrine (formally known as adrenaline) Epinephrine works by constricting the small blood vessels and relaxing muscles. This helps to reduce the swelling and improve the breathing. For a more severe reaction (see above) or if there is no improvement following the antihistamine, an injection of epinephrine in a pre-loaded syringe (e.g. EpiPen or Anapen ), will need to be given into the thigh muscle. Epinephrine must never be given into the blood supply as it may cause very high blood pressure and serious bleeding in the brain. Any child with Epinephrine should have a written management plan. It is important that your child wears a Medic-alert/SOS bracelet or necklace. These are pieces of jewellery containing a telephone number a doctor can ring to find out about your child s medical condition. EpiPen doses Less than 25kg More than 25kg 0.15mg 0.3mg

3 How to use your EpiPen The allergy nurse will demonstrate how to use the EpiPen. There are also dummy EpiPens on which you can practice. 1. Remove the EpiPen from the packaging. 2. Remove the grey safety cap. 3. Hold the EpiPen placing the black tip at right angles to the middle of the outer surface of the thigh and press hard until a click is heard. After hearing the click, hold in place for 10 seconds. 4. Remove the EpiPen. 5. For children more than 12kg a 2nd EpiPen can be given after 5-10 minutes if there has been no improvement. If you had to use the EpiPen for an allergic reaction always call for help without leaving your child by dialling 999, or go immediately to the nearest casualty, whichever is quicker. This is important even if your child has got better with the EpiPen. General Points EpiPen can be given over clothing, however if your child is wearing a thick cloth, e.g. a jean, it is advisable to remove it before using the EpiPen. If you are not sure whether your child's allergic reaction needs EpiPen, it is safer to use the EpiPen and then seek help. Remember there are minimal side effects of using the EpiPen, whereas an untreated allergic reaction can make your child very unwell. The Adrenaline in EpiPen is light sensitive and should be stored in the tube provided at room temperature. Do not keep EpiPen in the refrigerator. EpiPen should only be given in the outer surface of thigh. If you inject in any other part of the body there may be serious side effects. Accidental use Keep the epinephrine pen away from small children. If epinephrine is accidentally injected into the wrong place, particularly the hand, seek medical attention immediately. It will reduce the blood supply to the area and may make the area go blue.

4 After Use The needle remains out so it needs to be carefully disposed of. Although there is fluid left it cannot be re-used. Get a replacement auto injector from your GP. Looking after your Autoinjector (Pen) Carry the pen with you at all times. Protect the pen from heat and light Check the expiry date and get a replacement from your GP in plenty of time. Children need to have all their asthma and allergy medication with them. Going to School School age children may need to have epinephrine pens at school. The school will need to have two epinephrine pens. This needs to be discussed with the school and there must be someone trained to administer it. A contract to administer the epinephrine pen with your consent needs to be drawn up. Further information is available for school. We recommend children wear an emergency bracelet such as MedicAlert or SOS. You may find it useful to go through the following checklist: When to use an epinephrine injection How to use an epinephrine injection When to carry an epinephrine injection Storage/disposal of an epinephrine injection Expiry date of epinephrine injection Friends/babysitters aware School aware of risk School trained and have 2 epinephrine injections MedicAlert information

5 Useful contact Addresses Anaphylaxis Campaign PO Box 275, Farnborough, Hants., GU14 6SX Tel: British Allergy Foundation Deepdene House, 30 Bellegrove Road, Welling, DA16 3PY Tel: Fax: MedicAlert 1 Bridge Whart 156 Caledonian Road London N1 9UU Tel: Trainer EpiPens can be obtained free from: Or from: ALK-Abelló (UK) 2 Tealgate, Hungerford Berks. RG17 0YT Tel:

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