Allergies and Understanding Anaphylaxis

Key Takeaways – Allergies, Anaphylaxis & First Aid

• Allergies occur when the immune system overreacts to normally harmless substances like pollen, dust mites, foods, insect venom, or medications.

• Common allergy symptoms include itchy skin or eyes, hives, swelling, stomach upset, breathing difficulty, and in severe cases, anaphylaxis.

• Anaphylaxis is a life-threatening allergic reaction that can develop within minutes and requires immediate adrenaline (epinephrine) via an EpiPen® or Anapen®.

• Food allergies — especially peanuts, tree nuts, milk, eggs, sesame, fish, shellfish, wheat, and soy — are leading triggers in Australia; even trace amounts can be dangerous.

• Insect stings and bites from bees, wasps, ants, and ticks are major non-food anaphylaxis causes; proper sting/bite management can reduce severity.

• Histamine release drives allergy symptoms, affecting the respiratory, digestive, skin, and cardiovascular systems.

• Food intolerance differs from allergies — it involves the digestive system, not the immune system, and is rarely life-threatening.

• Allergy diagnosis requires specialist assessment; sufferers should have a personalised ASCIA Action Plan and carry up-to-date autoinjectors.

• First aid for anaphylaxis: lay the person flat, use adrenaline immediately, call Triple Zero (000), and monitor until medical help arrives.

• Prevention includes knowing triggers, avoiding allergens, maintaining risk management plans, and ensuring carers, schools, and workplaces are trained in allergy first aid.

What are Allergies?

An allergy is when a person’s immune system reacts to triggers (allergens) that the person is hypersensitive to and is usually harmless to most other people. Symptoms of an allergy can range from mild to potentially life-threatening (severe). It occurs when the body mistakes something harmful and creates a defence system (antibodies) to fight it.

The ways allergens can enter the body:

• Ingested (most commonly, in the mouth)
• Inhaled (breathed in)
• Injected (bees, wasps, ants, or medication)
• Absorbed (through touching the skin)
• Allergy symptoms develop when the antibodies are battling the “invading” allergen.

The most common causes of allergic reactions in Australia are:

• Dust mites
• Pollen
• Foods such as peanuts, tree nuts, cow’s milk, soy, eggs, wheat, fish, seafood, sesame
• Cats and other furry or hairy animals, such as dogs, horses, rabbits, and guinea pigs
• Venom from insect stings (bees, wasps, or ants) or bites (ticks)
• Moulds
• Drugs/medications such as penicillin, aspirin, herbal medicines
• Exercise, latex, cold
  

Symptoms

• Initial signs (these can be used as warning signs to get help)
• It may begin with itchy hands, mouth, or feet
• Eyes may become red, watery, and puffy,
• Tingly around the mouth
• Swollen lips and face
• Rash or hives can develop, especially on the chest, armpits, and groin (hives are white, itchy bumps that look and feel like insect bites)
• Stomach pain, vomiting, diarrhoea

How the body responds (to allergy):

The first time you eat, breathe in, touch or be injected with the allergen, your immune system responds by making disease-fighting antibodies (called immunoglobulin E or IgE). Doing this a second time triggers the release of IgE antibodies and other chemicals, including histamine. Your body is fighting the allergen and trying to get rid of it. All the signs and symptoms happen the second time you are exposed, and the signs and symptoms are signs that the body thinks it is terrible.

Histamine is a powerful chemical affecting the respiratory, gastrointestinal, skin, and cardiovascular systems. If released in the ears, nose, and throat, you may have an itchy nose and mouth or trouble breathing or swallowing. You may develop hives or a rash if histamine is released into the skin. If histamine is released in the gastrointestinal tract, you likely will develop stomach pains, cramps, or diarrhoea. Many people experience a combination of symptoms, but not all of them.

 

What is a Food Intolerance?

The difference between food intolerance and an allergy

Food intolerance is a digestive system (tummy) response rather than an immune system response (fighting germs). Intolerance occurs when something in a food upsets a person’s digestive system or when a person’s stomach cannot digest or break down the food properly. Lactose intolerance, found in milk and other dairy products, is the most common food intolerance.

Symptoms of food intolerance include:

• Nausea
• Stomach pain
• Gas, cramps, or bloating
• Vomiting
• Heartburn
• Diarrhoea
• Headaches
• Irritability or nervousness

What is Anaphylaxis?

Anaphylaxis is the most severe form of allergic reaction and can cause death. It must be treated as a medical emergency, requiring immediate treatment and urgent medical attention.

Anaphylaxis often involves more than one body system, e.g. skin (rash), respiratory (breathing), gastrointestinal (stomach), and cardiovascular (heart and blood pressure).

The most dangerous allergic reactions affect breathing, the heart, and blood pressure. The signs and symptoms of anaphylaxis could occur immediately or within the first 20 minutes after exposure.

Note: Mild/moderate signs and symptoms of an allergic reaction do not always precede anaphylaxis

Symptoms: Severe allergic reaction – ANAPHYLAXIS

• Shock
• Altered mental status
• Difficulty breathing, or shortness of breath and gasping
• Casualty may become very anxious and have a great sense of fear
• Respiratory or cardiac arrest and unconsciousness
• Difficulty and 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 collapse
• Pale and floppy (young children)
• Abdominal pain or vomiting if insect allergy

Common Allergens (triggers) of Anaphylaxis Food

Nine (9) food groups account for approximately 90% of allergic reactions. The most common food triggers are milk, eggs, peanuts, tree nuts, sesame, fish, crustaceans, wheat, and soy.

However, any food can trigger anaphylaxis. It is essential to understand that even a trace (small amount) of food can cause a life-threatening reaction. Some susceptible individuals can react to even the smell of food (e.g. fish, peanut butter).

Foods are the most common trigger in children and young adults, while medications and insect bites and stings are more common in older adults

Insect Venom

Bee, wasp and jumper ant stings are the most common causes of anaphylaxis to insect stings.

Bites from ticks and fire ants also cause anaphylaxis in some individuals. Stomach pain and nausea are severe reactions to this allergen.

Medication

Medications, both over-the-counter and prescribed, can cause life-threatening allergic reactions, e.g. aspirin and antibiotics such as penicillin.

Individuals can also have anaphylactic reactions to herbal or ‘alternative’ medicines.

Other

Other triggers such as cold, latex (gloves and balloons) or exercise (with or without food) induced anaphylaxis are less common.

Occasionally, the trigger cannot be identified despite extensive investigation.

 

Allergy Diagnosis

Allergies often run in families, suggesting that the condition can be inherited. Each year, 15,000 Australian children are newly diagnosed with severe allergies, and an estimated 4.1 million (19.6% of the population) Australians live with at least one allergy.

It is estimated that by 2050, this will increase to 7.7 million (26.1% of the population). Milder forms of allergic reactions commonly experienced by Australians are hay fever and eczema, which, in some cases, can lead to Asthma and Anaphylaxis.

Allergic people who have a history of eczema and asthma are at higher risk of anaphylaxis.

Some reliable sources of information and guidelines on severe allergic reactions are:

• Allergy & Anaphylaxis Australia
• Australasian Society of Clinical Immunology and Allergy (ASCIA)
• National Allergy Strategy
• Ministerial Order 706 – Anaphylaxis Management in Victorian Schools

A person suspected of having an allergy should obtain a referral to see an allergy specialist for a correct diagnosis, advice on preventing it from happening, and emergency treatment.

Those diagnosed with a severe allergy must carry emergency medication as prescribed and an ASCIA Action Plan for Anaphylaxis written and signed by their doctor.

When an adrenaline autoinjector has been used or has expired, the individual’s personal ASCIA Action Plan for Anaphylaxis needs to be reviewed by their doctor. If the individual is a child, the photo should be updated each time so they can be easily identified.

It is recommended that an individual’s personal ASCIA Action Plan for Anaphylaxis be provided upon initial enrolment or during the staff induction process when commencing a new job.

 

Action Plans

Sufferers of severe allergies should always have a personal ASCIA Action Plan for Anaphylaxis in case of an emergency. The sufferer’s general practitioner (GP) should annually complete or review the sufferer’s Action Plan. The Plan should contain:

• The prescribed medication was taken, and when it was to be administered
  Most plans will include administering an autoinjector that has adrenaline in it.
• Emergency contact details
• Contact details of the sufferer’s medical or health practitioner
• Details about deteriorating conditions, including signs to recognise triggers and worsening symptoms, what to do during an attack or medication to be used
• Sufferer’s details, including a photo

These Action Plans are called REACTIVE, which means they are followed after something has happened.

Always follow a casualty’s ASCIA Action Plan for Anaphylaxis, the casualty’s ASCIA Action Plan for Allergic Reactions or the generic ASCIA First Aid Plan for Anaphylaxis (if a personalised one is not available) to provide first aid responses to allergic reactions, including anaphylaxis.

Please read through these to familiarise yourself with their layout when you come to your course. You may also have similar documents at your workplace for children in your care or perhaps for work colleagues.

It is crucial that if you have anyone who suffers from anaphylaxis in your workplace, a personalised Action Plan has been received and incorporated into the individual’s Anaphylaxis Management Plan. This plan should be reviewed and updated at the beginning of each year, per organisational procedures, or when the sufferer sees a doctor to arrange a replacement adrenaline autoinjector. This will significantly help in teaching how to respond to anaphylaxis.

LINK to personal Action Plan PDF Image: ASCIA Action Plan for Anaphylaxis (RED) 2021 EpiPen®

 

 

General: EpiPen – LINK ASCIA First Aid Plan for Anaphylaxis

Personal – LINK  ASCIA Action Plan for Allergic Reactions

Please find the personal Action Plan PDF for managing allergies and understanding anaphylaxis in the link provided: <a href=”https://cprfirstaid.com.au/wp-content/uploads/2022/09/personal-Action-Plan-PDF-1-220×300.png”>personal Action Plan PDF.

Personal: Anapen – LINK  ASCIA Action Plan for Anaphylaxis

  General: Anapen – LINK  ASCIA First Aid Plan for Anaphylaxis

Adrenaline (Epinephrine)

Adrenaline (epinephrine) is the only medication proven to reverse the symptoms of anaphylaxis. Adrenaline acts as a natural “antidote” to some chemicals released during severe allergic reactions and works rapidly to reduce throat swelling, open the airways and maintain blood pressure. Adrenaline must be injected and cannot be taken by mouth.

When someone goes into anaphylactic shock, they need a dose of adrenaline. Adrenaline is not harmful and, in most cases, will temporarily stop the signs and symptoms. This medication is available via an autoinjector such as an EpiPen®.

Please note: If there is no Personal ASCIA Action Plan for Anaphylaxis, follow the General ASCIA First Aid Plan guidelines.

Please note: An individual with a Personal ASCIA Action Plan for Anaphylaxis will have an EpiPen, a prescribed medication. Due to the legalities involved in using someone else’s prescribed medication, it is strongly advised that your workplace, school, or child care centre own several spare autoinjectors for use in an emergency.

Adrenaline autoinjectors are available from pharmacies without a prescription at a total price.

An adrenaline autoinjector (EpiPen/Anapen) for general use may be required when:

• A child’s medication is unavailable or is out of date
• A second dose is needed before the arrival of an ambulance
• The device has misfired or been incorrectly discharged
• A previously undiagnosed individual has an anaphylactic episode for the first time

Note: If, in an emergency, another person’s adrenaline autoinjector was used, immediately send someone to replace it

Changes to labels for Adrenaline Autoinjectors

In Australia, starting in April 2016, the adrenaline autoinjector labels for EpiPens will show ‘adrenaline (epinephrine)’ as the ingredient. Including both names on Australian medicines should reduce confusion and clarify that these are the same ingredient, especially for Australians travelling overseas, visitors to Australia, and health professionals trained internationally.

The autoinjector may not be required for a mild or moderate allergic reaction. As you may have noticed on the Action Plans, only medication (tablets or liquid) may need to be given when the signs and symptoms are not severe.

Always remember that if ever in doubt, administer the autoinjector. Adrenaline is not harmful and can only benefit a casualty!

Whatever treatment you are giving, do not move the casualty. Bring the medication to them. Only move them if there is danger or risk of further injury to the casualty, including more of the allergen that has caused the problem (e.g. a bee hive)).

Autoinjectors are single-use only. Once it is used, it won’t work again.

Once the adrenaline begins to work, the casualty should sweat profusely and increase their pulse and breathing rates. These signs are good!

If the sufferer’s signs and symptoms do not improve after 5 minutes, apply their second autoinjector or use the backup autoinjector intended for general use.

An adrenaline autoinjector for general use can be used on a casualty displaying signs and symptoms of anaphylaxis regardless of whether they have been diagnosed as being at risk of anaphylaxis.

When a person over 20kg is experiencing an anaphylactic reaction and no adult autoinjectors are available, administer either two doses of the EpiPen Jnr (150 mcg) or Anapen® 150.

Risk and Side Effects of Adrenaline

Palpitations (fast, strong heartbeat), tremors, general pallor, or blanching at the site of injection are the main side effects experienced after adrenaline is injected. Other common side effects may include sweating, nausea and vomiting, difficulty breathing, dizziness, weakness, headache, apprehension, nervousness, or anxiety. If the casualty is resting, the side effects usually quickly disappear.

Adrenaline is well tolerated in children, and when given as specified in an action plan, the benefits always outweigh the possible side effects.

There are no published reports of death or severe injury resulting from the use of adrenaline autoinjectors. No serious or permanent harm is likely to occur from mistakenly administering adrenaline using an adrenaline autoinjector to an individual who is not experiencing anaphylaxis.

 

The EpiPen® Autoinjector

The EpiPen® autoinjector contains one dose of adrenaline, which should reverse the effects of anaphylaxis.

There are two strengths:

• Adults and children and over 20kg (yellow)
• Children 10kg to 20kg (green)

The doctor will prescribe the correct one and write it on the Action Plan.

Upon use, an adrenaline autoinjector (EpiPen) should be immediately replaced.

How to Use an Epi-Pen®

1) Remove the autoinjector from its container

2) Check that it is an adrenaline autoinjector

3) Ensure the expiry date is still valid and that the solution does not look contaminated by viewing the window on the device

4) You will receive guidance on how to do this from your practical trainer in your class

5) EpiPen® should never be stored in a locked-up, inaccessible area

6) Remove the blue cap on top

7) Find the meaty part of the outer thigh; do not simply jab this in any old place; it should be injected into the muscle. It should work through jeans and lighter materials, but try

8) It should be flush with the skin. Once there, press the plunger in until it clicks, and then HOLD IT IN PLACE FOR A FULL COUNT OF 3.

9) Remove when finished 

10) Always call an ambulance, as the casualty will need extra medical treatment and observation by a doctor

11) The single dose of adrenaline may only buy up to 20 minutes, and then the airway may swell again. The ambulance will have adrenaline on board to get them to the hospital, and they will be treated and observed there

12) on time, accurately convey first aid management steps undertaken to relieve emergency services

13) Give the EpiPen® to the Ambulance officers and a copy of the Action Plan if available

See a video on using an EpiPen: LINK or scan the QR code to access and play the video.

When administering an EpiPen®, it is essential that:

• You hold the orange end to the thigh, not the end with the blue safety cap. Previously, confused first aiders would inject their thumb rather than the sufferer. Remember: The orange end is the needle end!
• After removing the safety cap, ensure you push the pen in hard enough until a click is heard for the spring to activate the needle injection
• The needle stays in the sufferer’s thigh for 3 seconds. Please do not remove it too early, as the adrenaline may still be releasing
• Call 000 for an ambulance
• Contact parent/guardian or another emergency contact

If you are anaphylactic and own an EpiPen®, you should always ensure:

• The autoinjector never exceeds its expiry date (12 – 18 months)
• The autoinjector’s window does not display a cloudy or brown colour
• The autoinjector is always stored below 25 degrees (away from direct sunlight) but not in the fridge
• The autoinjector is with you at all times and is accessible to people who are responsible enough to help you administer it.
• The autoinjector remains in its sharps storage container

Anapen® is a pre-filled syringe of adrenaline (epinephrine) contained in an auto-injection device for the immediate emergency treatment of severe allergic reaction (e.g., anaphylactic shock), distributed by Allergy Concepts in Australia.

To manage the symptoms of allergies and anaphylaxis and open the airways, it is imperative to treat the reaction immediately with an emergency injection of adrenaline (epinephrine), followed by close medical supervision at a hospital. This medicine is for emergency use only, and patients or carers should call emergency assistance on 000 after the Anapen® injection, even if symptoms appear to be improving.

You should always carry two Anapen® devices to ensure the recommended dose can be given. If one adrenaline dose is not enough to effectively treat the reaction or the device doesn’t function as intended, be prepared to administer a second dose.

Information as per: https://www.anapen.com.au/anapen

Anapen® Sizes

Anapen® Jr (150 micrograms) is prescribed for children 7.5-20kg (aged around one to five years).

Anapen® 300 (300 micrograms) is prescribed for adults and children over 20kg (aged around five years or over).

Anapen® 500 (500 micrograms) is prescribed for adults and children over 50kg (aged around twelve years or over)

How to use the Anapen® Autoinjector

1. Remove the black needle shield by pulling hard toward the arrow. This also removes the rigid protective needle shield
2. Remove the grey safety cap from the red firing button by pulling it as indicated by the arrow
3. Hold the open end (needle end) of the Anapen® against the outer part of the thigh. If necessary, Anapen® can be used in light clothing, such as denim, cotton, or polyester. NB: Anapen® auto-injector is intended only for intramuscular use. Only administer into the outside of the thigh muscle, nowhere else.
4. Press the red firing button so that it clicks. Keep holding the Anapen® auto-injector against the outer thigh for 10 seconds, then slowly remove it from the thigh and note the time adrenaline was administered
5. The injection indicator will have turned red. This shows that the injection is complete. If the injection indicator is not red, the injection must be repeated with a new Anapen®.
6. After the injection, the needle sticks out. To cover it, click the wide end of the black needle shield back on the open end (needle end), as indicated by the arrow.
7. Immediately after use, call 000, ask for an ambulance, and say “anaphylaxis”.
8. Advise the expert that an Anapen® has been administered to the thigh muscle and show them the product box for more information.

Note: Do not touch the exposed needle

Information as per: https://www.anapen.com.au/anapen-instructions

Images as per: https://www.allergy.org.au/hp/anaphylaxis/adrenaline-injectors-faqs

See a video on using an Anapen: LINK or scan the QR code to access and play the video.

First Aid for Anaphylaxis

DRS ABCD – Basic Life Support flow chart

The Australian Resuscitation Council (ARC) recommends using the following seven-step acronym when caring for a casualty: D R S A B C D.

1. DANGERS Check for danger (hazards/risks/safety)
2. RESPONSIVENESS Check for response (if unresponsive)
3. SEND Send for help (Call 000)
4. AIRWAY: Open the airway
5. BREATHING Check breathing (if not breathing / abnormal breathing)
6. CPR Start CPR (give 30 chest compressions followed by two breaths)
7. DEFIBRILLATION Attach an Automated External Defibrillator (AED) as soon as available and follow the prompts

How to position a person having anaphylaxis

The ASCIA Action Plans for Anaphylaxis include infographics showing the correct and incorrect positioning of a person with a severe allergic reaction (anaphylaxis).

Note: Layperson flat – do NOT allow them to stand or walk

• If unconscious or pregnant, place in the recovery position – on the left side if pregnant, as shown below
• If breathing is difficult, allow them to sit with legs outstretched
• Hold young children flat, not upright. If unconscious, place them in the recovery position
• The person should NOT stand, walk, or be held upright, even if they appear to have

When a person has anaphylaxis, their blood pressure can drop rapidly, reducing blood flow to the heart. Laying the person flat will help blood flow to the heart, improving blood pressure, while standing can make anaphylaxis worse by causing blood pressure to drop.

Note: If the casualty walks, stands, or sits up suddenly, they can die within minutes.

Anaphylaxis people should not be allowed to stand, sit up suddenly or walk, even if they look like they have recovered. They should be carried on a stretcher or trolley bed to the ambulance.

Source information and video on correct positioning: https://www.allergy.org.au/hp/anaphylaxis/positioning

You can watch a video on positioning a person with anaphylaxis, scan the QR code to access it, and play the video.

First Aid Management of Anaphylaxis:

• Follow DRS ABCD – Check for danger
• Appropriately position the person having anaphylaxis
• If known and possible, remove the source of the allergy
• Use the autoinjector (EpiPen/Anapen) to inject adrenaline. (Note that the devices have been designed for use by anyone in an emergency as instructions are shown on the label)
• Call 000 / 112 for an ambulance
• Stay calm and monitor the casualty’s airways, breathing, and respiration. A sudden change may occur, and CPR may be needed anytime. Ensure that the EpiPen/Anapen has been administered before commencing CPR. Ensure that you know how to properly deliver CPR by taking CPR training. 
• Contact parent/guardian or other emergency contacts
• If available, further adrenaline doses may be given if there is no response after 5 minutes.
• If uncertain whether it is asthma or anaphylaxis, give adrenaline autoinjector FIRST, then asthma reliever

Note: If adrenaline is accidentally injected (e.g., into a thumb), phone your local poisons information centre. Continue to follow the plan for the person with the allergic reaction.

Allergic Reactions – Insect Treatment

• In the case of a bee sting, remove the sting. Try to scrape it sideways away from the entry point.
• Apply a cold compress to the affected area for 20 minutes to help reduce swelling and pain (do not apply ice to the eye area).
• Monitor for signs or symptoms of anaphylaxis
• If an anaphylactic reaction occurs, follow the Anaphylaxis Guideline

Allergic Reactions – Tick Treatment

• In the case of a tick bite, if there is no history of tick allergy, immediately remove the tick
• If the casualty has a history of tick allergy, the tick must be killed where it is rather than removed.
• Monitor for signs or symptoms of anaphylaxis
• If an anaphylactic reaction occurs, follow the Anaphylaxis Guideline

To kill the tick where it is:

• For small ticks (larvae & nymphs), use permethrin cream (available at pharmacies)
• Adult ticks should be frozen with an ether-containing spray (available at pharmacies).
• Please wait for the tick to drop off or remove it, taking the utmost care not to compress the tick (as this will squirt allergen, toxin and possibly infection into you)
• Note: Do not use tweezers

Calling Triple Zero (000)

Immediately after using an autoinjector (EpiPen/Anapen), call 000, ask for an ambulance and say “anaphylaxis”. Besides the address details, also convey:

• The time that the anaphylactic reaction started
• The time you administered the adrenaline and second adrenaline if required, after 5 minutes
• Everything the casualty was saying to you about their condition
• The signs they are displaying

The casualty should constantly be monitored for at least four hours following anaphylaxis.

Supporting a Casualty

The first aider should always display a respectful attitude towards the casualty (whether conscious or not) by respecting privacy, cultural beliefs, religious beliefs, ethnicity, languages, genders, disabilities, and age when communicating and interacting with the casualty. While giving aid to a casualty, be mindful of the following:

• Help comfort the casualty to feel safe, secure, and supported
• Be gentle and help maintain their dignity
• Avoid any unnecessary personal contact with the casualty
• Use appropriate and respectful communication. Speak in a clear, calm, and slow manner
• Help the casualty to remain calm and reassure them that help is on the way
• Stay with the casualty until help arrives
• If available, seek support from others nearby to provide assistance
• A first aider should not go beyond their level of training to help save a casualty

Being Prepared for Individuals with Anaphylaxis

Parents or those who care for individuals with anaphylaxis should be prepared by:

• Knowing their allergic trigger/s
• Knowing how to avoid the trigger/s (if possible)
• Being able to recognise the early symptoms of an allergic reaction and anaphylaxis
• Having a first aid anaphylaxis plan. This would include having an autoinjector device (EpiPen®/Anapen) available.

Critical aspects of caring for a child or young adult with anaphylaxis are identifying risks and hazards and removing or minimising them so that adrenaline can be quickly administered. For example, if a child has been stung by a bee, this may mean moving the child from the area to a safe location away from the bees.

Anaphylaxis Video:

 

Anaphylaxis in Victorian Schools

While the following applies to Victorian schools, it is a good model for all schools, childcare settings, and workplaces.

“Ministerial Order 706”

All Victorian schools must review and update their existing policy and practices in managing students at risk of anaphylaxis to ensure they meet the legislative and policy requirements as per the following:

Any school that has enrolled a student or students at risk of anaphylaxis must by law have a School Anaphylaxis Management Policy in place that includes the following:

• A statement that the school will comply with Ministerial Order 706 and associated guidelines
• An Individual Anaphylaxis Management Plan on an annual basis (that includes an individual ASCIA Action Plan for Anaphylaxis) for each affected student, developed in consultation with the student’s parents/carers and medical practitioner.

An Individual Anaphylaxis Management Plan must be distributed to all staff responsible per individual at risk and contain the following information:

• Individual personal details
• Parent/carer details (depending on the age of the individual)
• Emergency Contact
• Medical information such as the ASCIA Action Plan for Anaphylaxis
  o Photo identification
  o Allergic triggers/allergens
  o First aid response, including prescribed medication
  o Other medical conditions
• Activities that could involve risk
• Preventative strategies to avoid triggers and minimise risks
• Location of the adrenaline autoinjector
• Information and guidance to the school’s management of anaphylaxis, including:
  Prevention strategies to be used by the school to minimise the risk of an anaphylactic reaction in in-school and out-of-school settings
  School management and emergency response procedures that can be followed when responding to an anaphylactic reaction
  The purchase of spare or ‘backup’ adrenaline autoinjector devices(s) as part of the school first aid kit(s) for general use
  Development of a Communication Plan to raise staff, student, and school community awareness about severe allergies and the School’s Anaphylaxis Management Policy
  o  Regular first aid training and updates for school staff in recognising and responding appropriately to an anaphylactic reaction, including competently administering an EpiPen and completing an Annual Anaphylaxis Risk Management Checklist
  o (DEECD website, Anaphylaxis guidelines for Victorian Schools, Ministerial Order 706”, 17/05/16, Internet)

Staff that is caring for and educating a child or young adult with anaphylaxis must complete anaphylaxis training covering:

• Schools Anaphylaxis Management Policy
• Causes, symptoms, and treatment of Anaphylaxis
• Identities of students diagnosed at risk of Anaphylaxis
• Where medication is located
• How to use an adrenaline autoinjector
• The school’s first aid emergency response plan
• Caring and educating a child means being in the classroom, on yard duty, on excursions, camps, and special events
• Out-of-Hours School Care – Qualified staff (with Anaphylaxis training) must be on the premises at all times if the child that has been diagnosed with Anaphylaxis is in their care

The principal of a school/director of a centre is responsible for ensuring that a Communication Plan is developed in consultation with all relevant stakeholders, and it must include strategies on how to respond to an anaphylactic reaction by a student in various environments, including:

• During regular school activities, including in the classroom, in the schoolyard, in all school buildings and sites, including gymnasiums and halls
• During off-site or out-of-school activities, including excursions, school camps, and special events conducted or organised by the school
• Students with a medical condition that relates to allergy and the potential for anaphylactic reaction and their role in responding to an anaphylactic reaction by a student in their care

Stakeholders may include Carers/parents, Workplace first aiders, Management, Students, Teachers, Nurses, Casual staff, Specialist staff, Early childhood staff, Food industry staff such as carers, canteen staff, School camp providers, Volunteers, etc.

The communication plan should be reviewed annually to maintain its effectiveness.

Anaphylaxis in Australian Childcare Services

Strategies to reduce the risk of an individual’s exposure to known triggers/allergens should be implemented. This should include organisational policies, staff training, emergency response procedures, and all potential risks, for example:

• Food-related risks
  Avoid using food in activities or as a reward
  Should selected food items be banned from the premises?
  o Sharing of food
• Outdoor activities (Insect stings)
  Stay away from flowering plants
  Children should wear closed shoes and light or dark colours instead of bright
  o Clover to be sprayed (outside of school hours)

The effectiveness of risk minimisation strategies should be reviewed annually or after an incident.

• If a child has a first-time Anaphylactic Shock, qualified (Anaphylaxis) staff can give the autoinjector without ringing “000” for authorisation.
• However, “000” is always called after an autoinjector is given for continuing treatment or during the process if a phone is nearby.
• All staff must know the Management policy at all times
• All staff must have been trained every 2 years in the Anaphylaxis course. Also:
  o Skills/knowledge relating to using adrenaline injectors be refreshed annually
  When a new device enters the market
• This also refers to Long Day Care, Family Day Care, OSHC and Pre-schools.
• All staff must also practice with autoinjectors every 12 months
• The Centre must have an Action Plan for each child with an autoinjector from the parents, which has been completed by a General Practitioner (Doctor) or specialist
• The Centre must show the policy and provide a copy to parents. This includes a Risk Minimisation, Communication Plan and Emergency Management Plan.
  A risk assessment is undertaken for proposed activities in different environments, e.g. excursions, art, craft, cooking, science, parties, etc.
  Identification of potential sources of allergens
  Consider the effect of environments on the level of risk, e.g. remote camp location exponentially increases risk
  o Rating of risks
  The required staff skills in the risk management of anaphylaxis are kept current
• Staff can give medication for Asthma and Anaphylaxis but must call “000” and a parent/guardian
• An appropriate amount of First Aid kits must be fully stocked and available where the child is being educated

Regulation 162 says that there must be health information on the enrolment record for each child with:

• Healthcare needs and any medical conditions
• Allergies and, if diagnosed as a risk of Anaphylaxis
• Any documents to be followed (e.g. Action Plans)
• Details of dietary restrictions

Regulation 173 (if applicable) says a notice stating that a child diagnosed as at risk of anaphylaxis is enrolled at the education and care service. This must be displayed for all staff.

To maintain confidentiality and privacy, the personalized charts should not be displayed publicly, as parents, tradesmen, and visitors may have access to the information. A system needs to be developed per centre where approved staff have daily and quick access to the charts while keeping the files away from public eyes.

• The General ASCIA Action Plan for Anaphylaxis should be publicly displayed.
• If the child is taken on an excursion, their medication and Action Plan must be taken.
• Medication must be recognizable and readily accessible to staff but not to children and stored away from heat. (Education and Care Services, National Regulations 2011)

10-point allergy action plan for starting school

1. Notify the school about your child’s allergy as early as possible. Be clear about which foods or other allergens may trigger an anaphylactic reaction.
2. Provide the school with a written diagnosis and a personalised ASCIA Action Plan for Anaphylaxis from your treating doctor. This should include details of prescribed medications such as adrenaline or antihistamines.
3. Supply necessary medication and ensure it is clearly labelled, stored correctly, and kept up to date. Anaphylaxis Australia recommends an EpiPen/Anapen travels with the child between home and the classroom, while a second backup unit is stored permanently in the school office.
4. Visit the school and enquire about any other potential risks. For example, are children exposed to food allergens during cooking and craft lessons? What can the school do to reduce the risk of insect stings?
5. Ensure teachers and other staff are aware of prevention strategies and ensure they are implemented. Especially when planning special events such as excursions, sports days, and parties.
6. Work with the school to develop an emergency action plan. Ensure appropriate staff members are trained and confident to administer medications.
7. Teach your child not to accept food from others from a young age. Provide a labelled lunchbox and remind them not to trade food with friends.
8. Be creative in providing safe food treats for your child. Ask the school to store some of your cupcakes in the canteen freezer so your child can join in with birthday celebrations.
9. Encourage your child to become independent. Remind them always to take their medication to school. It can be kept in an insulated lunch bag with a copy of the emergency action plan.
10. Record and check the expiration dates of EpiPens® used at school and home, and ensure each unit is replaced before expiry.

Record Keeping and Reporting

Incident, injury, trauma and illness policies & procedures and reporting Law Section 174, Regulations 12, 85-87, 168, 177-178, 183

• Centres must have incident, injury, trauma and illness policies and procedures if a child:
  (a) is injured, (b) becomes ill, or (c) suffers a trauma.
• A Centre must ensure that a parent of a child is notified as soon as practicable but not later than 24 hours after an occurrence if the child is involved in any incident, injury, trauma or illness
• The details of the occurrence must be correctly and accurately recorded within 24 hours
• The occurrence records are stored safely and securely until the child is aged 25 years
• The Regulatory Authority is notified of a serious incident, which includes:
  (a) death of a child; or (b) where medical assistance was required; or (c) attendance of emergency services at the education and care service premises was sought or ought reasonably to have been sought.

Early Advanced Care

Early advanced care means the sooner a expert can attend to the casualty, the greater the chance a casualty can be stabilised. As such, you must call 000 as quickly as possible. The sooner you contact emergency services, the sooner a expert will be on the scene, dramatically increasing the casualties’ chance of survival.

When they arrive, it is essential to calmly provide accurate and detailed information about the casualty and the incident to expert and emergency workers. The actions taken and treatment you have provided, the time of the incident, any medications involved, and the behaviour of the casualty are all essential things emergency workers will want to know. Provide details in a way that recognises that it is time-critical.

It is essential that all first aid incidents, inside or outside of work, be recorded in writing.

Each workplace should have appropriate documentation for the reporting of illness or injury.

These documents need to be completed in full and should not be altered. Therefore, correction fluid or pencil should not be used on these documents.

If an incident occurs Outside of the workplace, first aiders should take accurate, brief, and clear notes and keep them on hand in case an investigation occurs.

Notes should include:

1. The time of the incident
2. The date of the incident
3. The location of the incident
4. What the first aider found upon arrival
5. What actions did the first aider carry out
6. Any changes in the casualty’s condition
7. Any witness details
8. Handover to medical professional’s details
9. Did the casualty recover and relieve the first aider of their duty of care?

All documentation should be signed and dated by the first aider and stored securely to maintain confidentiality. Keep your notes clear and easy to understand, and ensure you write down exactly how things are presented.

Note: Incident reports should be thoroughly completed and submitted on time

Recurrent Episodes

It is not uncommon for recurrent episodes of anaphylaxis to occur following the first presentation of anaphylaxis. Studies show that 10-20% of these episodes may occur in the childcare setting. Under such circumstances, there should be an anaphylaxis action plan which can be followed.

For an event that has occurred, the Event Record Form (see image) can be used by the casualty, school staff and medical personnel.

Evaluate Incident Response

Once the documentation and reporting process has been completed, the following steps must take place:

• The First aider’s and organisation’s responses to the incident and adherence to the casualty’s ASCIA Action Plan for Anaphylaxis are reviewed and assessed
• The effectiveness of risk minimisation strategies is reviewed
• The casualty’s anaphylaxis management plan is reviewed
• Reviews can generate improvements in processes and procedures. If so:
  Implement improvements as soon as possible
  Communicate improvements and updates to all stakeholders

Post-Incident Debriefing

Once you have provided first aid to a casualty and handed over responsibility to the expert, it is recommended that you undergo a debriefing.

• Discuss your actions with your manager, other first aiders, psychologists, doctors, family, or friends.
• Take time to calm down and reflect on your actions. If the incident occurred in a workplace, don’t return to work.

Note that anyone around the incident, such as the casualty, the first aiders, and onlookers, who may include children, can be affected by stress from the trauma that had occurred. Psychological stress can badly affect people of all ages, either during or after the incident. For example, talk with children about their emotions and responses to the incident. Provide support as required.

Post Incident Reactions

The following reactions are normal and help people understand a critical incident.

Physical reactions

Disturbed sleep, nausea, nightmares, restlessness, headaches, excessive alertness, undue crying, and being easily startled.

Poor concentration, visual images of the event, intrusive thoughts, disorientation or confusion, poor attention, and memory.

Emotional reactions

Fear, numbness and detachment, avoidance, depression, guilt, over-sensitivity, anxiety and panic, withdrawal, and tearfulness.

Seek Professional Help

Traumatic stress can cause extreme reactions in some people. You should seek professional help if you:

• Are unable to handle the intense feelings or physical sensations
• Don’t have normal feelings but continue to feel numb and empty
• Feel that your emotions are not returning to normal after three or four weeks
• Continue to have physical symptoms
• Continue to have disturbed sleep or nightmares
• Find that relationships with family and friends are suffering
• They are becoming accident-prone and using more alcohol or drugs.
• Support can be accessed through counselling, educational material explaining the situation, stress-management techniques, professional help, and wellness programmes.