Guidelines and Treatment of Anaphylaxis

Guidelines and Treatment of
Anaphylaxis
This leaflet explains anaphylaxis and what to do if your child suffers from this severe
form of allergic reaction.
Anaphylaxis
Anaphylaxis is a dangerous type of allergic reaction which is most likely to be caused
by particular foods, insect bites or medicines. In anaphylaxis, cells release histamine in
large amounts. This caused blood vessels to become leaky causing swelling in the
surrounding tissues. It is characterised by the following features:
Early signs of
allergic reaction
• Swelling and itching; the face may be flushed and
wheals or hives may erupt on the skin
• Lip or facial swelling
• Acute vomiting or abdominal pain
Anaphylaxis or
severe reactions
• Difficulty breathing, coughing and/or wheezing due to
swelling of the air passages.
• Loss of colour; cold and clammy as the blood pressure
falls.
• Collapse / loss of consciousness (the child may appear
asleep).
Antihistamines
For a mild reaction a dose of antihistamine such as Chlorpheniramine (Piriton) can be
given as soon as possible. Syrup is absorbed more quickly than tablets.
Chlorpheniram 2mg in 5ml syrup
ine doses
0—2 years 1mg = 2.5 ml syrup
2-5 years 2mg = 5 ml syrup
5-8 years 3mg = 7.5 ml syrup
8> years 4 mg = 10ml syrup (1 tablet)

Cetirizine doses
(once a day only)
6 months–2 years 2.5mg = 2.5ml syrup
2 – 4 years 5mg = 5ml syrup
5 > years 10mg = 10ml syrup (1 tablet)
Inhalers
Asthma medications will improve breathing symptoms if the child normally takes them.
Epinephrine (formally known as adrenaline)
Epinephrine works by constricting the small blood vessels and relaxing muscles. This
helps to reduce the swelling and improve the breathing. For a more severe reaction
(see above) or if there is no improvement following the antihistamine, an injection of
epinephrine in a pre-loaded syringe (e.g. EpiPen® or Anapen®), will need to be given
into the thigh muscle.
Epinephrine must never be given into the blood supply as it may cause very high blood
pressure and serious bleeding in the brain.
Any child with Epinephrine should have a written management plan. It is important that
your child wears a Medic-alert/SOS bracelet or necklace. These are pieces of
jewellery containing a telephone number a doctor can ring to find out about your child’s
medical condition.
EpiPen doses
Less than 25kg
More than 25kg
0.15mg
0.3mg

How to use your EpiPen
The allergy nurse will demonstrate how to use the EpiPen. There are also dummy
EpiPens on which you can practice.
1. Remove the EpiPen from the packaging.
2. Remove the grey safety cap.
3. Hold the EpiPen placing the black tip at right angles to the middle of the outer
surface of the thigh and press hard until a click is heard. After hearing the click,
hold in place for 10 seconds.
4. Remove the EpiPen.
5. For children more than 12kg a 2nd EpiPen can be given after 5-10 minutes if there
has been no improvement.
If you had to use the EpiPen for an allergic reaction always call for help without leaving
your child by dialling 999, or go immediately to the nearest casualty, whichever is
quicker. This is important even if your child has got better with the EpiPen.
General Points
• EpiPen can be given over clothing, however if your child is wearing a thick cloth,
e.g. a jean, it is advisable to remove it before using the EpiPen.
• If you are not sure whether your child's allergic reaction needs EpiPen, it is safer to
use the EpiPen and then seek help.
• Remember there are minimal side effects of using the EpiPen, whereas an
untreated allergic reaction can make your child very unwell.
• The Adrenaline in EpiPen is light sensitive and should be stored in the tube
provided at room temperature. Do not keep EpiPen in the refrigerator.
• EpiPen should only be given in the outer surface of thigh. If you inject in any other
part of the body there may be serious side effects.
Accidental use
Keep the epinephrine pen away from small children. If epinephrine is accidentally
injected into the wrong place, particularly the hand, seek medical attention immediately.
It will reduce the blood supply to the area and may make the area go blue.

After Use
The needle remains out so it needs to be carefully disposed of. Although there is fluid
left it cannot be re-used. Get a replacement auto injector from your GP.
Looking after your Autoinjector (Pen)
• Carry the pen with you at all times.
• Protect the pen from heat and light
• Check the expiry date and get a replacement from your GP in plenty of time.
• Children need to have all their asthma and allergy medication with them.
Going to School
School age children may need to have epinephrine pens at school. The school will
need to have two epinephrine pens. This needs to be discussed with the school and
there must be someone trained to administer it. A contract to administer the
epinephrine pen with your consent needs to be drawn up.
Further information is available for school. We recommend children wear an
emergency bracelet such as MedicAlert or SOS.
You may find it useful to go through the following checklist:
When to use an epinephrine injection
How to use an epinephrine injection
When to carry an epinephrine injection
Storage/disposal of an epinephrine
injection
Expiry date of epinephrine injection
Friends/babysitters aware
School aware of risk
School trained and have 2 epinephrine injections
MedicAlert information

Useful contact Addresses
Anaphylaxis Campaign
PO Box 275, Farnborough, Hants., GU14 6SX
Tel: 01252 542029
www.anaphylaxis.org.uk
British Allergy Foundation
Deepdene House, 30 Bellegrove Road, Welling,
DA16 3PY
Tel: 020 9303 8525
Fax: 020 8303 8792
www.allergyfoundation.com
MedicAlert
1 Bridge Whart
156 Caledonian Road
London
N1 9UU
Tel: 020 7833 3034
“Trainer EpiPens” can be obtained free from:
www.epipen.co.uk
Or from:
ALK-Abelló (UK)
2 Tealgate, Hungerford
Berks. RG17 0YT
Tel: 01488 686016

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format. Please contact: 01895 279973
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