Children and Anaphylaxis: everything you need to know

An anaphylactic reaction can be terrifying for any parent. Knowing what to do in the event of a severe allergic reaction will equip parents and caregivers to recognise when anaphylaxis is occurring and therefore seek help quickly.

Introduction to Children and Anaphylaxis

Children and Anaphylaxis
It’s so important to monitor a child’s symptoms carefully if they are having an allergic reaction and respond QUICKLY if their symptoms indicate they may be having an anaphylactic reaction

Allergies are not uncommon. Most people would have experienced some kind of allergic reaction within their lifetime. In most cases, these reactions will be relatively mild and will either resolve on their own or can be treated with a simple antihistamine. For some people, an allergic reaction can become far more severe – this is known as anaphylaxis. Since many allergies are discovered during childhood, it is a good idea for parents and caregivers to have good understandings of anaphylaxis to support them to recognise an anaphylactic reaction and to seek help quickly.

What is anaphylaxis?

The Australasian Society of Clinical Immunology and Allergy defines anaphylaxis as ‘a potentially life-threatening severe allergic reaction’ Anaphylaxis – Australasian Society of Clinical Immunology and Allergy (ASCIA) . Anaphylaxis occurs when the immune system overreacts to a particular trigger and the most common allergens that can cause anaphylaxis are foods, insects and medicines. Since anaphylaxis must be treated quickly, all allergic reactions of this kind should be treated as a significant medical emergency.

How do I know if my child has anaphylaxis?

The initial symptoms of an anaphylactic reaction can often look like a typical allergic reaction. A skin rash, itchy skin or a runny nose might be the first signs that a reaction is occurring. In cases of anaphylaxis, more severe signs will begin to appear – and these can progress quite rapidly. The most common symptoms of anaphylaxis include:

·      Coughing, wheezing and chest tightness.

·      Pain and itching skin

·      Dizziness or confusion

·      A rash such as hives or red, swollen areas on the skin

·      A runny or congested nose

·      Sneezing

·      Trouble breathing and a rapid heartrate

·      Swollen or itchy lips or tongue

·      Swollen or itchy throat

·      A hoarse voice or difficulty swallowing

·      Vomiting or diarrhoea

·      A weak pulse and pale skin

In many cases, the casualty will likely have at least two or more of the symptoms listed above. Here, you can find detailed information about recognising anaphylaxis – including some images that some may find upsetting, Signs & Symptoms – Allergy & Anaphylaxis Australia (allergyfacts.org.au).

How is an anaphylactic reaction treated?

Anaphylactic reactions must be treated with a shot of adrenaline. In Australia, when a person is diagnosed with anaphylaxis, they are prescribed an adrenaline autoinjector – commonly known as an EpiPen. Staff in care settings and schools are now required to undergo training in the administration of an EpiPen, however the instructions are clearly labelled on the medication for those who may not be familiar with this process.

Children and Anaphylaxis
Epipen TRAINER device on the LEFT (used for practicing how to use an Epipen), REAL Epipen on the RIGHT

When a casualty is experiencing an anaphylactic reaction, the first aider must not allow the person to stand or walk around. They should sit the casualty down or if unconscious and breathing, place them in the recovery position. If the person has an adrenaline autoinjector, this should be administered immediately and then medical help sought by phoning 000. If an autoinjector is unavailable, call 000 immediately and commence CPR if the person becomes unresponsive and stops breathing.

What do you do if a child has anaphylaxis?

If your child has never had an anaphylactic reaction before, getting help quickly will be essential as you may not have access to an Epipen. Calling 000 as soon as you suspect that an anaphylactic reaction is occurring will allow for help to arrive as soon as possible. Most ambulances will carry an Epipen within their vehicle. If your child has had a previous anaphylactic reaction, you or the child will likely have an Epipen which can be administered immediately. In these cases, it is important to still call 000 for help as an additional Epipen may need to be administered and the child will need to be closely monitored in hospital as they recover from the reaction.

Children and Anaphylaxis
An action plan may suggest giving an antihistamine such as Claratyne, before administering an Epipen, but if a reaction is worsening quickly, it is vital to go straight for the Epipen

If your child has been diagnosed with anaphylaxis, it is very important for them to have a medical management plan prescribed by a doctor. Care settings such as child care and schools will require documentation to ensure that they know exactly what to do if a child has a reaction whilst in their care. Each state will have specific information on their website about what is needed – just like this one from the South Australia Education Department: Supporting children and students with anaphylaxis and severe allergies (education.sa.gov.au).

Finally, if your child has a diagnosed medical condition, it is a great idea to fit them with a Medic Alert bracelet or necklace so that others can easily identify the issue in an emergency. You can browse the range of Medic Alert jewellery here:  Products (medicalert.org.au)

Children and Anaphylaxis
ASCIA Anaphylaxis Action Plan. This is a necessary piece of documentation that must accompany the child to a child care service or school. It must be completed and signed by a Doctor, usually updated annually.

What is a common cause of allergic anaphylactic shock in children?

There are a great many allergens that can cause an anaphylactic reaction. Below is a list of the most common triggers that adults and children can react to.

Foods

–       Nuts

–       Milk

–       Fish

–       Shellfish

–       Eggs

–       Some fruits

Medicines

–       Antibiotics

–       Anti-inflammatory drugs (eg asprin).

–       General anaesthetic

Insect stings

–       Wasps

–       Bees

Other common triggers

–       Some dyes

–       Latex

–       Exercise

Whilst these triggers are the most common, there are many other things that can trigger a case of anaphylaxis and sometimes it can be difficult to determine what the actual trigger is. Allergy testing within a controlled environment may be necessary in cases where a known trigger has not been able to be identified. If you are wanting to get some allergy testing for your child, you will need to ask your GP for a referral to an allergy immunologist. The specialist can then perform a pin prick test and/or a blood test to determine any allergies that may be present, as well as your child’s likely allergy response level. It’s important to note however that these tests are not always 100% accurate. In my son’s first pin prick test, it came up that he was allergic to eggs, yet he had been eating eggs regularly with no reactions at all. I mentioned this to the Dr who suggested to simply keep eating the eggs on a fairly regular basis, as avoiding them could actually be worse than continuing to consume, as an allergy response could in fact develop.

Can you survive anaphylaxis without treatment?

If left untreated, anaphylaxis can certainly be deadly. Since an anaphylactic reaction can block the airways and prevent breathing – it can lead to a quick decrease in blood pressure and ultimately stop the heart. If not treated quickly, an anaphylactic reaction can lead to brain damage, kidney failure, cardiogenic shock, arrhythmias, heart attacks and death. In some cases, an anaphylactic reaction will worsen pre-existing medical conditions such as multiple sclerosis. Treating anaphylactic shock quickly is essential for minimising complications and giving the casualty the best chance of survival.

How quickly does anaphylaxis occur?

According to Better Health – anaphylaxis can occur within minutes, Anaphylaxis – Better Health Channel. In most cases, a reaction will occur within 20 minutes of exposure to an allergen but it is also possible for a delayed reaction to occur up to 2 hours after the initial exposure. Whilst the symptoms might first appear to be mild, they can worsen at a very rapid rate, so knowing what to look for will certainly increase the likelihood of getting help fast.

My personal experience with Anaphylaxis and my son

When my son Andy was 11 months old, I tried giving him some peanut butter on toast. Within 15 minutes, his whole body was covered in hives and he had a swollen groin, ears and face. After seeking medical attention, he was given a double dose of antihistamine and the hives and swelling eventually went down. We avoided giving him peanuts for the next few years until we had an official pin prick allergy test with an allergy immunologist at 4 years old. The results and process for pin prick allergy testing can be seen below in the photos of Andy’s arm at both 5 years old, and then 10 years old.

At both of these tests, results came back as anaphylactic to peanuts, cashews and pistachios, and he was prescribed an Epipen.

We take the Epipen with us everywhere we go, especially when eating out as you can never be too careful.

When Andy was 8 years old, he was accidentally given a peanut biscuit by a family member, took one bite and luckily didn’t like it so didn’t consume more than a bite. This one bite caused vomiting (3 times), as well as all over body hives and difficulty breathing. The family member called me in a panic and so I had to coach them over the phone on how to use an Epipen while telling another person in the household to call an ambulance immediately. I listened as my son screamed on the other end in response to the needle entering his leg. Fortunately the ambulance was very quick to arrive and Andy was taken to hospital and monitored. He didn’t require a second Epipen dose.

Andy is now very aware of how his body reacts when he has consumed peanuts. I have taught him HOW to use his own Epipen by practicing with the Epipen trainer device. He also knows to ASK when out at restaurants or at friend’s houses, what is in the food he is being offered, to ensure they are peanut free.

It’s SO important to raise awareness of Anaphylaxis so that more people understand the severity of this kind of allergy and how to respond to it. QUICKLY! It’s also vital that people have First Aid knowledge, such as how to administer an Epipen, when to call ‘000’ and how to do CPR if necessary.

Children and Anaphylaxis
Andy’s arm at 5 years old, after his first pin prick test. This shows a severe response to the peanut allergen and bad reactions also to cashew, pistachio and dustmite
Children and Anaphylaxis
Small samples of various allergens are placed on the arm and labelled, then the skin is pricked slightly to ensure the allergen enters the skin
Children and Anaphylaxis
The allergy response is measured by drawing a circle around the hive, pressing sticky tape to the pen circle, then placing the sticky onto paper for measuring and recording.

Some Quick Facts about Anaphylaxis

  • Epipens are SUPER easy to use and can even be administered through clothing! (Outer thigh is recommended)
  • Anaphylaxis can worsen over time, or improve. Allergies can change or develop suddenly without any known reason.
  • An expired Epipen CAN STILL WORK! Obviously an Epipen that is still in date is preferable but if an expired Epipen is the only one on hand, you can still use it!
  • Anaphylactic reactions can present differently person to person. There are a range of possible reactions, as listed above.
  • Sometimes ONE Epipen dose is not enough and a SECOND Epipen dose may be required.
  • For a child diagnosed with Anaphylaxis you can get TWO Epipens prescribed to you and they have been listed on the PBS (Pharmaceuticals Benefits Scheme) so the cost is usually around $40 for the two.

Summary of Children and Anaphylaxis

Having a child who has anaphylaxis can be worrying and stressful for parents. Whilst a diagnosis such as this can cause fear and concern for a child’s safety, education and support can certainly make the management just a little easier. Thankfully, as a society there has been a growing awareness of common conditions such as asthma and anaphylaxis and there are a wide range of first aid training courses available for educators, parents, caregivers and friends. As with most things – education is key. Ensuring that your child is surrounded by those who know what to do in an emergency will help them live their lives to the fullest and certainly reduce the worry. It is also crucial to educate your child. Your child will need to understand the severity of their allergy, without making them too fearful. They will also need to learn how to use an Epipen (when age appropriate) and get into the habit of asking about food ingredients when offered food by others.

If you are interested in completing some first aid training on anaphylaxis, check out the following link for a course near you: First Aid Training – St John Ambulance Australia. You can also complete some FREE e-training with ASCIA here.

Do you have a child with allergies or Anaphylaxis? It’s so important to learn from each other and create a community of allergy aware parents, caregivers and educators. Let me know in the comments!

TeachingBrave

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