Allergy Awareness Week

It’s Allergy Awareness Week and this year’s topic is quite fittingly childhood food allergies.

Written by Nina Ferraro Msc, RNC

We have decided to commemorate this year with a food allergy case study, which school staff can share, discuss, and learn from together. After presenting the details of the scenario, we have also included a framework for discussion, followed by the correct action staff should have taken. There is then a summary of learning outcomes from this scenario.

Our mission at TEACH is to empower and support all schools in achieving gold standard Asthma & Allergy-Friendly School status. We believe that harnessing a safe and non-judgemental learning environment where staff can share ideas and fears and discuss prevention strategies is vital for the creation of an allergy-aware school community.

We encourage you to read the case study below and discuss amongst your colleagues.

Trigger warning: This case study describes a serious medical incident that some may find distressing. 

Case Study: 

A 13-year-old pupil is attending a lunchtime detention after finishing lunch in the school canteen. He is a regular at lunchtime detention groups as he often displays disruptive behaviour in his classes. This detention group is being supervised by a new teacher who has not met the pupils before.

During the detention, the pupil begins to clear his throat and become unsettled. He raises his hand and tells the teacher he needs his salbutamol inhaler. The school’s emergency medicines are kept in the welfare office on a different floor in the building. The teacher permits the pupil to leave the detention and go to the welfare office to administer his inhaler.

On arriving at the welfare office, the pupil is given his salbutamol inhaler by a member of reception staff, and he self-administers 5 puffs. He starts to scratch at his neck and torso, and appears to become agitated, pacing around the room.

The staff member attempts to calm him down and encourages him to take 5 more puffs of his inhaler. The pupil then shouts that he “can’t breathe!” and collapses, becoming unconscious. The staff member puts him into the recovery position and calls 999 for an ambulance.

Other members of staff arrive to support the situation, and one member of staff who knows the pupil well realises he could be having an allergic reaction as the pupil has an EpiPen prescribed.

Staff find the pupil’s EpiPen, but do not know what he is allergic to or what he has eaten for lunch. The ambulance call-handler advises the staff to check the expiry date on the EpiPen and they realise the EpiPen is 7 months out of date. The call-handler advises staff not to administer the expired EpiPen and states an ambulance will arrive shortly.

The pupil is taken to hospital by ambulance but does not regain consciousness. He later, sadly dies.

What was the correct action staff should have taken?

When the pupil asked for his inhaler, the supervising teacher should have called for support so another adult could bring the pupil’s emergency medicines to the pupil. The pupil should not have been left unaccompanied, nor been sent to collect his own medication. The pupil should have been supported and monitored by the supervising teacher.

Whilst waiting for the emergency medication, the supervising teacher could have asked the pupil his allergy status. Given that the pupil had just eaten, and finding out the pupil had allergies, this would have been the critical window where a potential anaphylactic reaction could have been identified.

The members of staff who supported the pupil downstairs also had missed opportunities for action. The pupil’s EpiPen should have been kept together with his salbutamol inhaler and been accompanied by two individual health care plans (IHCPs) containing up-to-date information on both conditions. On requesting his inhaler, staff should have read both IHCPs and identified the high-risk situation.

When the pupil began to scratch at his neck and display agitation, these symptoms of a severe allergic reaction were also missed. Staff should have administered the pupil’s EpiPen and called an ambulance immediately.

What learnings can we take away?

1. Asthma attacks and anaphylaxis can have similar presentations and are closely linked. This is why it is recommended asthma and allergies are taught together, and that all school staff receive regular and thorough training.
2. Anaphylaxis can present differently each time. There may not always be multiple symptoms present at the onset of a reaction (such as facial swelling, hives, vomiting), and airway symptoms can be confused with asthma. Guidance now states that if a pupil has known asthma and allergies and anaphylaxis is suspected, administer their AAI first, and then administer their salbutamol inhaler.
3. Pupils always need two of their own adrenaline auto-injectors (AAIs) kept at school or on their person at all times. There must be a system in place to check expiry dates regularly.
4. It is best practice that schools purchase spare emergency AAIs so that when a pupil’s own is missing, damaged or expired adrenaline can still be given immediately.
5. All staff and pupils have an active role to play in allergy awareness and creating a safe environment for pupils with allergies. Policies and procedures should be in place with clear instructions of how to respond in emergency situations, and pupils with allergies should be easily identifiable to all staff.

The Author has made every effort to ensure the accuracy of the information contained within this article. The Author does not accept any liability or responsibility for any inaccuracies or for any diagnosis made, or actions taken based on this information.

It is strongly advised that all school staff attend Asthma, Anaphylaxis and Allergy Awareness training to understand what to do in a medical emergency.

TEACH run specific courses covering in detail how to support pupils with asthma and allergies. Our team are highly experienced specialist nurses who will tailor the training to your needs.

Please visit www.teachealth.co.uk, email us at info@teachhealth.co.uk or telephone: 020 8720 6635 for more information about our courses.