Safety Advice Note – SAN(M) 2
ANAPHYLAXIS (SEVERE ALLERGIC REACTION)
** For further Medical Safety Guidance and Advice please also refer to the Schools’ Portal – Reference
library /health and safety/medication and medical devices. This updated advice has been compiled using
information from NHS Choices and the Anaphylaxis Campaign
Contents
Introduction .......................................................................................................................... 1
Common triggers of Anaphylaxis ......................................................................................... 1
Signs and symptoms............................................................................................................ 2
Medication and storage........................................................................................................ 2
Administering medication ..................................................................................................... 3
General advice on administering Intramuscular Adrenalin ................................................... 3
Training and insurance for staff ........................................................................................... 4
Individual Health Care Plans (IHCPs) .................................................................................. 4
Notifying the Local Authority of pupils with Anaphylaxis ...................................................... 4
Day-to-day measures........................................................................................................... 5
Storage of and access to medication ................................................................................... 5
Further information .............................................................................................................. 6
Internet links ........................................................................................................................ 6
Introduction
Anaphylaxis can affect both children and adults. It is a severe and potentially lifethreatening allergic reaction at the extreme end of the allergic spectrum. Anaphylaxis may
occur within minutes of exposure to the allergen, although sometimes it can take hours. It
can be life-threatening if not treated quickly with adrenalin. Any allergic reaction, including
anaphylaxis, occurs when the body’s immune system reacts inappropriately in response to
the presence of a substance that it perceives as a threat. Anaphylaxis can be
accompanied by shock (known as anaphylactic shock): this is the most extreme form of an
allergic reaction.
Common triggers of Anaphylaxis
Schools should give consideration not only to provided food but also to activities
undertaken in school that may inadvertently introduce allergens to affected pupils or staff,
such as feeding animals and birds, first aid treatment – use of latex gloves etc.
Common triggers are:
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peanuts and tree nuts – peanut allergy and tree nut allergy frequently cause severe
reactions and for that reason have received widespread publicity. Some small
animal and wild bird foods also contain potential allergens so you could buy
separate ingredients and mix your own;
other foods (e.g. dairy products, egg, fish, shellfish, sesame and soya);
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insect stings – most commonly wasps and bees;
latex allergy;
medications (e.g. allergy to penicillin);
birthday and end-of-term treats - have a ‘swap box’ in the classroom that is supplied
with ‘safe’ food by the pupil’s parents. The pupil can then swap their treat for
something safe. Older pupils may choose to simply go without;
contaminated materials - (e.g. cereal boxes, egg cartons). If there is a pupil with
severe allergies in your class do not use containers or boxes that may have been in
contact with their particular allergen during lessons (e.g. craft or technology);
snacks in tuck shops and vending machines – avoid selling packets of nuts and
seeds as a snack. This is because the allergen can be easily carried on the hands
of the person eating them and contaminate work surfaces, computers, books etc.
While this type of cross-contamination reaction is not likely to be life threatening, it
can be serious enough to cause disruption to the school and increase anxiety in the
pupil, their parents and school staff;
Trees – conkers. A few pupils with allergies report that they break out in a localised
skin rash when they handle conkers. We are not aware of any severe reactions.
On rare occasions there may be no obvious trigger. Allergies are increasingly common
and it is likely that there will be pupils in your school with allergies and some may be at risk
of anaphylaxis.
Signs and symptoms
Anaphylaxis has a whole range of symptoms. Even when mild symptoms are present, the
child should be watched carefully. They may be heralding the start of a more serious
reaction. Any of the following may be present, although most pupils with anaphylaxis
would not necessarily experience all of these:
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generalised flushing of the skin anywhere on the body;
nettle rash or hives anywhere on the body;
difficulty in swallowing or speaking;
swelling of throat and mouth;
alterations in heart rate;
severe asthma symptoms;
abdominal pain, nausea and vomiting;
sense of impending doom;
sudden feeling of weakness (due to a drop in blood pressure);
collapse and unconsciousness.
Medication and storage
Diagnosis is usually made by the child’s GP or Consultant. Sometimes skin tests can
further confirm the diagnosis. Treatment is urgent and essential to prevent progression of
a severe anaphylactic reaction. Two main types of medication are available for treatment
of a severe allergic reaction:
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Antihistamines (Piriton/Zirtec)
Preloaded Adrenalin injection ( such as Epi-pen or Anapen)
EPI-PEN ADRENALINE AUTO-INJECTOR
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www.epipen.co.uk
ANAPEN AUTO-INJECTOR
www.anapen.co.uk
Schools should ask parents to provide two ‘pens’ for each affected pupil. The
reasons for this are in case one may misfire or fail to operate properly, or a second dose
may be required whilst awaiting medical assistance.
Where possible, instructions for administration of medication from the pupil’s GP and/or
the school health service must be followed. These advised arrangements should be
included on the pupil’s Individual Treatment Plan (see Appendix A). A suitable container
(lidded plastic box) should be used and clearly marked on the outside with the pupil’s
name, a green cross indicating its medical content, and possibly a photograph of the pupil.
The box should contain the adrenalin injectors; it could also include antihistamines,
reliever inhaler (for asthma symptoms), the pupil’s Individual Treatment Plan, emergency
contact telephone numbers, gloves, sharps box and anything else prescribed by the pupil’s
doctor. The storage container should also contain a record of the medication being held
within it, the date and time the medication was administered, the dose given, and the
signature of the individual who administered the medication. This should be completed
each and every time the medication stored in the box is administered.
Administering medication
Any staff who volunteer to administer medication must be given suitable training. This
training must be undertaken by health professionals, e.g. the school health service or the
pupil’s General Practitioner. The training should cover the identification of symptoms, the
administration of the medication and details of the emergency treatment plan for the
individual pupil concerned. Occasionally, parents will offer to train staff in the school and
although this may seem a reasonable option, it should be avoided. Where children have
conditions that may require rapid intervention, all staff should be able to recognise the
onset of the condition and take appropriate action.
If the pupil diagnosed with having anaphylaxis is displaying any of the following symptoms,
then these are signs of a serious allergic reaction and adrenalin should be given without
delay:
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difficulty in breathing or swallowing;
weakness or floppiness;
steady deterioration;
collapse or unconsciousness.
General advice on administering Intramuscular Adrenalin
Adrenalin “pens” should be administered into the upper outer aspect of the thigh.
Both Epi-pen and Anapen injectors are pre-measured and contain a single dose. After use,
the injector should be made safe by placing in a rigid sharps container and then handed to
the paramedic or ambulance crew to be taken with the pupil to the hospital, both for their
information and safe disposal.
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Once the injection is given, signs of improvement should be seen fairly rapidly. If there is
no improvement or symptoms are getting worse, a second injection, if available, may be
administered. If adrenaline has been given, an ambulance must be called and the pupil
taken to hospital.
Relapse of a severe allergic reaction is possible after apparent recovery. Medical
attention must be sought in every case.
Training and insurance for staff
School staff have a professional duty to safeguard the health and safety of pupils. This
does not, however, imply a duty upon them to administer medication. Staff may voluntarily
undertake this duty and must receive the training enabling them to do so. They will be fully
supported by the Local Authority, and staff indemnity is provided for those schools using
the Local Authority’s insurance scheme. They will then be covered in the event of a claim
for negligence, as long as they have acted reasonably and within the scope of their
training and employment. Where Foundation and Voluntary Aided Schools buy insurance
outwith the LA system, staff should check with their own Governing Body that similar
insurance indemnity exists for those who volunteer to administer medication.
If staff are not willing to administer treatment, it is essential that appropriate emergency aid
is summoned urgently by telephoning for an ambulance on 999. You must give your exact
location and the message ‘Anaphylactic reaction’. The ambulance crew will then be
prepared to administer the medication en route to the nearest hospital. In any event they
will be able to radio for advice and give advance warning of the child’s condition before
arriving at the hospital. As a matter of routine, all schools must have a clear procedure for
summoning an ambulance in an emergency. However, in the unlikely event of a severe
allergic reaction occurring, immediate adrenalin treatment will be necessary while waiting
for the ambulance to arrive.
Individual Health Care Plans (IHCPs)
For the most severe medical conditions it is important to establish an Individual
Healthcare Plan for the pupil in consultation with parents and the School Health Service.
See Appendix 1 for an anaphylaxis specific template. It will be necessary to arrange for
periodic reviews of Individual Healthcare Plans to allow for the changing health needs of
the pupils concerned.
Schools should ensure that they have contingency plans in case for any reason the normal
routine for treatment breaks down, e.g. the trained staff members are absent. This should
be included in the ITP for the pupil and is likely to include calling for an ambulance.
It is important that all staff, particularly those on temporary or supply contracts can easily
recognise the pupils at risk of anaphylactic reaction. One way of achieving this is to
highlight the names of the pupils within the school register so that all are aware of the
possible needs of the pupil concerned.
Notifying the Local Authority of pupils with Anaphylaxis
It is no longer necessary for schools to complete a form and inform the Local Authority’s
Corporate Health and Safety Team when a pupil is identified as having Anaphylaxis. It is,
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however, necessary for you to implement good local arrangements based on this Safety
Advice Note, as your arrangements may be looked at as part of the safety audit process.
Day-to-day measures
It will be necessary to ensure that measures are in place for food management, awareness
of the child’s needs in relation to the lunch menu, individual meal requirements and snacks
in school.
Meal times
Where school kitchen staff are employed by a separate organisation
from the general school staff, it is important that the catering
supervisor is made aware of the needs of those individual pupils with
such extreme allergies so that they can put appropriate measures in
place and instruct their staff.
It is recommended that pupils with severe food allergies be supplied
with a home packed lunch, particularly in the case of nursery and
infant school age pupils as they are less likely to be aware of what
they can and cannot eat.
Educational visits Arrangements for outdoor activities and school trips should be
discussed with the parents in advance. Careful planning and
awareness amongst peers and staff is essential. Individual Treatment
Plans can be uploaded to the Evolve notification and approval system
for educational visits.
Cookery/science
Experiments with food may present difficulties, and appropriate control
measures to reduce the risk of an anaphylactic reaction should be
identified in advance as part of the general risk assessment process.
Suitable alternatives should be agreed.
Some schools have effectively introduced a nut-free environment, but this can be difficult
to achieve. It must, however, be accepted by everyone concerned that while school staff
will endeavour to ensure that a pupil does not come into contact with a particular allergen,
this cannot ever be guaranteed.
Storage of and access to medication
Parents are responsible for checking expiry dates of all medication and should replace
them as necessary. The ideal time to do this is at the end of each term when the kit
should be taken home. Medication should not be left on school premises during school
holidays. The container must not be used for storing general first aid equipment. It can,
however, be used for storing other emergency medication for that pupil, e.g. Insulin etc.
Some pupils, particularly those at a senior level, may wish to carry their own medication
about their person. This is acceptable in some circumstances but must have prior
agreement with the parents. It is important, however, to ensure that a spare ‘pen’ is held
in an alternative place which is accessible in an emergency, should the pupil not have the
‘pen’ to hand.
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If a pupil is going off-site on a supervised visit or activity, it is important that the emergency
details, Individual Treatment Plan and spare ‘pens’ are carried, and that an appropriately
trained person accompanies the pupil’s group.
Further information
Reference should also be made to Safety Advice Note SAN(M)1 – Administration of
Medication and the DfE Guidance ‘Managing Medicines in Schools and Early Years
Settings’ (March 2005), copies of which can be accessed via the schools’ portal or online
below:
https://www.education.gov.uk/publications/standard/publicationdetail/Page1/DFES-14482005#downloadableparts
Internet links
http://medicalconditionsatschool.org.uk/
This website offers information to help schools and school healthcare professionals
support all pupils with medical conditions.
www.anaphylaxis.org.uk
The Anaphylaxis Campaign website contains Guidance for schools, which discusses
anaphylaxis, treatment, setting up a protocols, and support for pupils and staff. It also
includes a sample protocol. The Anaphylaxis Campaign helpline is 01252 542029. The
Anaphylaxis Campaign has also published the 'Allergy in schools' website which has
specific advice for pre-schools, schools, school caterers, parents, students and nurses.
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APPENDIX A
Allergy and Anaphylaxis
INDIVIDUAL CARE/TREATMENT PLAN
This pupil is at risk of Anaphylaxis
Photo Here
Name of pupil:
Date of birth:
Current year/class:
GP/local hospital no:
(Name)
may suffer from an anaphylactic reaction
if he/she is exposed to
(Name)
also suffers from the following medical
conditions:
His/her usual allergic symptoms are:
Emergency procedures
The attached emergency procedures form part of this home/school agreement.
Awareness
The Headteacher will arrange for the teachers and other staff in the school to be briefed about
his/her condition and about other arrangements contained in this document.
The school staff will take all reasonable steps to ensure that he/she does not eat any food items
unless they have been prepared or approved by his/her parents.
The parents will remind their child regularly of the need to refuse any food items that might be
offered to them by other pupils.
In particular,
him/her the following food items:
(name) parents/carers will provide for
E.g. packed lunch, snack, drinks
Medication/Staff training
The school will hold, under secure conditions, appropriate medication, clearly marked for use by
designated staff or qualified personnel and showing an expiry date. It is the parents’ responsibility to
ensure the school has appropriate up-to-date medication and that medication is collected from school at
the end of each term.
The following volunteers from the school have agreed to administer the medication. A training session
was attended by:
Name:
Date/s:
Name:
Date/s:
Name:
Date/s:
Name:
Date/s:
Name:
Date/s:
Further advice is available to school staff at any point in the future where they feel the need for
assistance. The medical training will be repeated
If proposed arrangements lead to
(name) leaving the school site
for educational purposes, prior discussions will be held between the school staff and his/her parents to
agree appropriate provision and safe handling of his/her medication.
Staff indemnity
The County Council provides a staff indemnity for any school staff (of those schools which buy into the
Cumbria County Council Insurance scheme) who agree to administer medication to a pupil following the
full agreement of the parents and the school.
Agreement and conclusion
A copy of these notes will be held by the school and the parents. A copy will be sent to the GP for
information. Any necessary revisions will be the subject of further discussions between the school and
parents.
Signed: Headteacher:
Date:
Signed: Parent/guardian:
Date:
Signed: Health Professional:
(e.g. school nurse, GP, Consultant)
Date:
Review date:
EMERGENCY ACTION PLAN - ANAPHYLAXIS
(Steps to be agreed with Medical Professional)
In the event of an anaphylactic reaction, staff will follow this emergency action plan.
One adult will remain with the pupil and follow the emergency procedures given below.
Second adult will obtain correct ‘pen’ for the pupil and check expiry date.
Third adult will:
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Contact Ambulance service – 999
STATE:
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exact location of individual requiring help message ‘Anaphylactic Reaction’
Inform the Headteacher immediately of action taken.
Inform the following contact numbers in order of priority.
Contact no. 1
Name:
Telephone number:
Relationship:
Contact no. 2
Name:
Telephone number:
Relationship:
Contact no. 3
Name:
Telephone number:
Relationship:
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If possible, remove other pupils from the immediate vicinity to a safe, supervised place.
PROCEDURES
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An adult (trained) should stay with the pupil to assess the severity of symptoms
Record time of event
Check airway – listen for abnormal noises, gurgles, difficulty in breathing
Check breathing – look for difficulty in breathing – listen for an obvious wheeze
In cases of: (Symptoms to be agreed with Medical Professional)
 wheeziness
 swelling of face and throat
 difficulty in breathing/swallowing
 pale and clammy skin
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Check ‘pen’ is correct for pupil concerned
Help the pupil into the position which is comfortable and assists their breathing. Give
‘pen’ injection to outer thigh, mid-way between hip and knee (this can be administered
through light clothing in an emergency). Hold ‘pen’ in place for approximately 10
seconds.
If no breathing/pulse, trained First Aiders or Appointed Persons can initiate mouth-to-mouth
resuscitation.
If there is no improvement as a result of the above action within 5 minutes and there are
symptoms of weakness/floppiness/pallor, then:
Repeat dose once more with 2nd ‘pen’
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Hand over pupil’s care to Paramedic team/parents on their arrival. Teacher-in-charge will
appraise them of the medication already given.
Dispose of used pens in sharps box.
Record details of all medication given with date and time of administration. Record card to
be held in pupil’s medication box.
After the incident, a debriefing session will take place with all members of staff involved.
Make arrangements to replace used Adrenalin pen/s.
In cases of: (Symptoms to be agreed with Medical Professional)
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itchiness
tingling of lips and face
stomach cramps
vomiting
blotchiness of skin
Give (if prescribed)
(oral Antihistamine)
ml at once