Anaphylaxis

About Anaphylaxis

Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires immediate emergency treatment.

It can develop rapidly, often within minutes of exposure to an allergen. The reaction involves the immune system overreacting to a trigger substance. Since 2017, UK schools have been permitted to hold spare adrenaline auto-injectors (AAIs) for emergency use, in accordance with guidance from the Human Medicines (Amendment) Regulations 2017.

Most pupils at risk of anaphylaxis will have their own AAI (such as EpiPen or Jext) and an Individual Healthcare Plan detailing their allergens and emergency procedures.

Common Triggers

• Foods (especially peanuts, tree nuts, milk, eggs, fish, shellfish, sesame, soya)
• Insect stings (particularly wasp and bee stings)
• Latex
• Certain medications
• Exercise (in some cases, particularly when combined with certain foods)

Cross-contamination is a serious concern. Even tiny amounts of an allergen can trigger anaphylaxis in sensitised individuals.

Recognising Anaphylaxis: Signs and Symptoms

Anaphylaxis typically affects more than one body system. According to Resuscitation Council UK guidance, symptoms may include:

Airway and Breathing

• Difficulty breathing or swallowing
• Wheezing or persistent cough
• Throat or tongue swelling
• Hoarse voice
• Feeling that the throat is closing

Circulation

• Dizziness or feeling faint
• Collapse or loss of consciousness
• Pale or clammy skin
• Rapid pulse
• Low blood pressure

Skin and Other Systems

• Widespread red, itchy rash (urticaria or hives)
• Swelling of face, lips or eyes (angioedema)
• Abdominal pain, nausea or vomiting
• Sense of impending doom
• Sudden tiredness

Emergency Response Protocol

Follow the pupil's Individual Healthcare Plan. General steps include:

1. Recognise symptoms (see above)
2. Call for help immediately (send someone to alert trained staff and get the AAI)
3. Lie the person down (unless they are having breathing difficulties, in which case allow them to sit upright). If they feel faint, lie them down with legs raised
4. Administer adrenaline auto-injector into outer thigh (can be given through clothing):
   • EpiPen: remove blue safety cap, press orange end firmly into thigh, hold for 3 seconds
   • Jext: remove yellow safety cap, press black end firmly into thigh, hold for 10 seconds
   • Emerade: remove safety cap, press into thigh, hold for 5 seconds
5. Call 999 and state "anaphylaxis" (even if symptoms improve)
6. Record the time the AAI was given
7. A second dose may be given after 5 minutes if there is no improvement or symptoms return (use a second AAI)
8. Stay with the person until emergency services arrive. Monitor breathing and consciousness
9. Keep the used AAI to show paramedics

Classroom and School Strategies

Prevention and Planning

• Ensure all staff know which pupils are at risk and can recognise signs of anaphylaxis
• Display Individual Healthcare Plans prominently (e.g. staff room, classroom)
• Train sufficient staff in AAI administration and arrange regular refreshers
• Store AAIs accessibly (not locked away) in consistent, known locations
• Check AAI expiry dates regularly
• Consider holding spare AAIs for general use under school's medicines policy
• Implement strict allergen management procedures in food technology, dining hall and packed lunches
• Avoid "ban" language (e.g. "nut-free school"), which can create false reassurance; instead emphasise vigilance and management

Supporting the Pupil

• Teach age-appropriate self-management (e.g. older pupils carrying own AAI)
• Ensure pupils know to report any symptoms immediately
• Create a supportive, inclusive environment (avoid singling out or stigmatising)
• Plan carefully for school trips, ensuring trained staff and AAIs accompany the pupil
• Review lunch and snack arrangements to minimise cross-contamination risk
• Liaise with catering staff to ensure allergen information is accurate and accessible
• Educate classmates age-appropriately about allergies to foster understanding
• Supervise younger pupils closely during mealtimes and snack times
• Encourage handwashing before and after eating
• Avoid food-based rewards or activities involving allergens

For Trips and Activities

• Always take the pupil's AAI and a fully trained member of staff
• Ensure easy access to a working phone to call 999
• Risk assess activities and venues for allergen exposure
• Inform venue staff of pupil's needs
• Consider taking spare AAIs (if school holds spares)

Further Information and Resources

Allergy UK provides comprehensive resources for schools, including training and action plans.

Anaphylaxis UK (now part of Allergy UK) offers specific guidance on managing anaphylaxis.

Resuscitation Council UK publishes the definitive emergency treatment guidelines for anaphylaxis.

NHS information on anaphylaxis provides accessible guidance for families and schools.