Living with peanut allergy

Just how prevalent is peanut allergy? The tabloids claim as many as 30 Australian children in every 1,000 are at risk of a severe allergic reaction – anaphylaxis, of which peanuts as the trigger top the list. Anaphylaxis Australia states that life threatening emergencies occur in approximately 1 in 200 school age children, with 1 in 6 episodes occurring at school. 

The definition of anaphylaxis is a severe, rapidly progressing allergic reaction that is potentially life threatening and should be regarded a medical emergency. Reactions develop within seconds of exposure. It may begin with itching hives or swelling of the lips or face and the throat may begin to close choking off breathing and leading to death.

Other nuts, cow’s milk, eggs, fish and shellfish can also cause an anaphylactic reaction. The major medication used for an anaphylactic reaction is an epipen which contains a concentrated shot of adrenalin.

Diagnosis of peanut and other allergies is generally carried out through a skin prick test which involves applying the suspected allergen to the forearm. If a hive 8mm or larger develops, then a potential allergy is determined.

There are no reliable statistics on food allergy deaths in children. A 2002 study by The Australian Paediatric Surveillance Unit found there were 110 cases of acute food-induced anaphylaxis, one third triggered by peanuts.

Medical experts state that the only way to safely determine the severity of a food allergy response to those foods commonly associated with anaphylaxis is through a hospital supervised food challenge. This means that the food suspected of causing the allergy is given to the person under controlled conditions with appropriate precautions taken.

Media reports of children who have died show that children are at greatest risk when a number of conditions are present:

• When microscopic amounts of the allergen are present – often when not immediately obvious.
• When children are removed from regular routines at home or at school.
• Emergency measures were not adequately understood and applied immediately.

Peanut allergy is incurable and few children grow out of it. If a child has been diagnosed as being at risk from anaphylaxis from peanuts or other allergens, then there are definite preventative measures that parents can take to reduce the risk when outside of the home environment.

A shared responsibility

Keeping anaphylactic children safe in a school or childcare setting depends on the cooperation of the entire community. Even though your child may not be affected, they may have a classmate with a severe allergy, so it is important that all parents are well informed about the allergy and its consequences.

After a number of highly publicised deaths, most states have developed guidelines about managing anaphylactic risk. The most commonly adopted position is that schools or childcare services cannot guarantee that they will be peanut or other allergen free.

Although preventative measures are taken and strictly adhered to, it is simply too hard to completely eliminate all risk, such as accidental exposure to someone’s little sister who had peanut butter on their toast that morning!

Anaphylaxis educators make these general recommendations:

• Adopt a no sharing food or drink policy
• Promote hand washing before and after eating
• Encourage children with allergies to wear a medic alert
• Include information on severe allergic reactions in the curriculum
• Inform other class members’ parents and caregivers of trigger substances and request that these foods be avoided
• Be aware that craft items can be risk items (eg egg cartons, peanut butter jars)
• Place a copy of the child’s anaphylaxis action plan on the wall
• Be aware of the risk of cross contamination when preparing food
• Know who has the epipen, how it can be quickly accessed and how to use it

Parents should have the opportunity to discuss their child’s needs at staff meetings, parent/teacher meetings, staff in-service training and first aid seminars. If a balance can be struck between the right and convenience of all students to eat what they like and the allergic child’s right to relative safety, community support usually follows. That will rely on parental involvement, keeping the lines of communication open and information sharing to reduce the risk.

Anaphylaxis

• Anaphylaxis is a medical emergency that requires a rapid response
• The key to prevention of anaphylaxis is identification of triggers and prevention of exposure to these
• Adrenaline given by injection is the treatment of choice for anaphylaxis; an epipen is an auto injector of adrenaline which can be administered by a lay person
• All carers of children at risk of anaphylaxis should be informed of the risks, the symptoms and the emergency treatment
• If a person is at risk of anaphylaxis from an allergen, this risk is often lifelong. You generally do not ‘grow out of’ a severe allergy problem

Epipen

An epipen is a first aid device for delivering one measured shot of adrenaline. The device has a spring activated and concealed needle designed to be self-administered  or administered by people with no formal medical or nursing training.

Steps are as follows:

• Hold the epipen in a fist like grip
• Remove the grey safety cap
• Press the black end firmly into the upper thigh until a click is heard or felt
• Hold in place for ten seconds
• Remove and discard to prevent needle stick injury

Raising community awareness

Within the school or childcare space

• What is the physical area of the school playground? If an incident occurs in the playground, how quickly can the alarm be raised? Teachers on duty need to know where the epipen is located, how to use it and who the ‘at risk’ children are.
• Are all staff aware of at risk children and how to deal with an emergency? Could a poster showing an emergency plan be erected in the staff room as well as in common areas (library, canteen, art room etc)

Staff

• Where is the nearest phone? Is it close enough to make an emergency call if an ambulance needs to be called? What is the chain of command in managing a medical emergency? Is it clear who is responsible for what?
• Is there an opportunity for to have an additional member of staff on hand on enrolment days to specifically deal with parents who have children with special medical needs? Often there is insufficient time to talk about action plans, management etc.

Food sharing

• What specific measures does the school take to ensure food sharing isn’t encouraged? Can the teacher advise students of a child’s allergy and make it very clear to them not to ever share their food?
• What is the policy when it comes to birthday cakes? Are parents able to know in advance of when class birthdays are celebrated so they can send along alternative food?

The epipen

• How many epipens does the school/centre have? Should parents supply more than one for each child?
• Is the epipen in a locked cupboard or is it easily accessible? Who has the key? It is recommended that epipens are kept out of locked cupboards, away from where children can reach, but on display, eg in a plastic bag on a hook on the wall.

Parents

• Are parents of affected children encouraged to provide information to the parent and staff body? Often they are the best source of up to date information and can provide resources on the condition.
• Can parents put a notice in the school newsletter inviting other parents of affected children to contact them so that they can work together to manage the children?

Resources

A clear and simple anaphylaxis action plan can be downloaded from The Australasian Society of Clinical immunology and allergy.

A newsletter article can be downloaded from Allergy Facts.
 

The information provided in this article is intended as a guide only. Always consult your doctor if you or your child is suffering any medical complaint. Any websites referred to by Australian Family contain information moderated by government and medical institutions or organisations.
 

This article was first published in Australian Family Magazine, May 2008. Updated July 2009.