17th January 2018

The coroner’s inquest into the death of 18-year-old Shahida Shahid ruled yesterday a verdict of death by misadventure. Our Chief Executive was personally in attendance at the inquest in Manchester over several days to offer support to Shahida’s family.

We wish to make it clear that the Anaphylaxis Campaign are not legal experts; the primary reason we attend inquests are to offer support to families and to identify if there are specific lessons that can be learned to take forward into the work we do to support people at risk of severe allergic reactions.

Shahida was known to have eczema and an allergy to milk from an early age, later developing other allergies to egg, fish and nuts. She collapsed due to a severe allergic reaction following a visit to Almost Famous Burgers in Manchester, where she ate a chicken burger that had been marinated in buttermilk. Although a friend administered the adrenaline auto-injector that Shahida carried with her, she sadly suffered irreversible brain damage and died three days later in hospital on 12th January 2015.

Lynne Regent, Chief Executive of the Anaphylaxis Campaign, said:

“Throughout the coroner’s inquest I have been struck by the dignity of Shahida Shahid’s family, who last week were remembering the third anniversary since her death, and who have had to relive over the past few days the tragic circumstances which led to her dying.

It was clear from the evidence heard at the inquest that Shahida was an intelligent and sensible young woman, who did all the right things to minimise the risks of experiencing a severe allergic reaction, including carrying her emergency adrenaline medication, training her friends and family how to use it and informing people about her allergies.

In their conclusion, the jury raised that there was an issue of lack of communication in the restaurant in which Shahida ate. This is an important reminder to everyone within the catering industry that robust procedures need to be followed when people affected by food allergies draw attention to their needs when eating out.

We will be working with the local authority and other organisations involved in the inquest. We will also be writing to the catering companies that we work with to remind them about our best practice advice in light of the evidence we have heard.”

The role of the coroner and purpose of an inquest

We understand that the extensive media coverage of the inquest has raised several questions from our supporters about the role of the coroner and purpose of an inquest.

A coroner is appointed by a local authority and investigates deaths reported to them to find out who has died and how, when, and where they died. An inquest is a public court hearing held by the coroner to discover the facts about the circumstances of someone’s death. There are a very limited number of specific legal terms used to record cause of death, one of which is the term ‘misadventure’.

The coroner decides who should be called to give evidence as a witness. If a witness lives in England or Wales, they must attend if they are asked; if they live abroad, they do not have to attend.

An inquest is different from other types of court hearing because there is no prosecution or defence. The purpose of an inquest is to establish the relevant facts and cannot blame someone for someone’s death. The coroner or jury cannot find a person or organisation criminally responsible for someone’s death. For legal reasons, therefore, we cannot comment on certain aspects of any inquest.

The Ministry of Justice has produced a booklet called a ‘Guide to Coroner Services’ and if you are interested in the coronial process, you may find it helpful to read: https://www.gov.uk/government/publications/guide-to-coroner-services-and-coroner-investigations-a-short-guide.

Advice for people living with food allergy

By law, food businesses selling catered food (for example in restaurants, takeaways and hotels) are required to provide information on major allergenic ingredients, either in writing and/or verbally. If information is provided verbally, the food business will need to ensure that there is some sort of written signage that is clearly visible, to indicate that allergen information is available from a member of staff. Systems should also be in place to ensure that, if requested, the information given verbally is supported in a recorded form to ensure consistency and accuracy.

You can find out more in our guide to eating out for young people here: https://www.anaphylaxis.org.uk/young-people/young-people-help-a-guide-to-eating-out/.

Advice for the catering industry

We believe every member of your team needs some understanding of food allergy and its possible consequences and this should be incorporated into your staff training. Members of staff, who serve meals to customers, need to be able to offer accurate information about ingredients. If they are unsure of what is in a particular meal, there should be a procedure in place for finding out. There should be a designated person on duty during each shift that is able to answer questions about ingredients.

We have practical advice for the catering industry on our website: https://www.anaphylaxis.org.uk/corporate/corporate-protecting-allergic-customers/.

If you have any concerns or questions, please contact our helpline team at [email protected] or call 01252 542 029.

For further information, please contact our press office via [email protected] or call 01252 893 862.

10th January 2018

We were very saddened to learn of the death of 18-year-old Shahida Shahid a few years ago. Our Chief Executive is currently attending the coroner’s inquest that has been taking place this week in Manchester to understand if lessons can be learned from this tragic case.

Shahida was known to have eczema and an allergy to milk from an early age, later developing other allergies to egg, fish and nuts. She collapsed due to a severe allergic reaction following a visit to Almost Famous Burgers in Manchester. Although a friend administered the adrenaline auto-injector that Shahida carried with her, she sadly suffered irreversible severe brain damage and died three days later in hospital on 12th January 2015.

Lynne Regent, Chief Executive of the Anaphylaxis Campaign, said:

“Our heartfelt condolences go out once again to Shahida’s family. The Anaphylaxis Campaign will continue to monitor this case very carefully as it progresses to understand if lessons can be learned from this tragic case.

It is vital that people living with food allergies draw attention to these when eating out and that all in the food service industry are fully trained and aware of the importance of dealing with food allergies correctly.”

The inquest began on 8th January 2018 and is expected to last at least eight days. We do not expect to release further comments until the conclusion of the inquest, when all the evidence has been heard.

By law, food businesses selling catered food (for example in restaurants, takeaways and hotels) are required to provide information on major allergenic ingredients, either in writing and/or orally. If information is provided orally, the food business will need to ensure that there is some sort of written signage that is clearly visible, to indicate that allergen information is available from a member of staff. Systems should also be in place to ensure that, if requested, the information given orally is supported in a recorded form to ensure consistency and accuracy.

You can find out more in our guide to eating out for young people here.

If you have any concerns or questions, please contact our helpline team at [email protected] or call 01252 542 029.

For further information, please contact our press office via [email protected] or call 01252 893 862.

We were interested to see that BBC Rip Off Britain’s most recent feature about holidays highlighted travelling with food allergy. The programme raised that airlines can vary widely in the policies they adopt and how they implement them when addressing the needs of customers with allergies, specifically regarding examples from parents and carers of children with peanut and treenut allergies.

We would like to see more airlines adopt a culture of allergy awareness and education. We support the view that there should be greater consistency across and within the airline industry to help all people at risk of severe allergic reactions (anaphylaxis) feel safer whilst travelling. Although airlines tend to focus on the possible risk from peanuts and treenuts – an issue we recognise generates strong views – other types of allergens must not be neglected.

Examples of how this might look in practice include:

• Making an allergy policy freely accessible to passengers before making a booking which clearly explains what steps they need to take and what the airline expects to know to safely accommodate their needs.
• Allowing people with food allergy, or their parents and carers, to board flights early in order clean their seating area using alcohol wipes to decrease the risk of allergic reactions due to inadvertent skin contact with food particles or spills.
• Allowing people with food allergy, or their parents and carers, to bring their own food on the flight and making passengers aware in advance of any restrictions regarding the types of food they can bring on board.
• Making an announcement on the flight to other passengers encouraging them to be allergy aware and requesting them to not open or eat peanut or treenut snacks.
• Ensuring that loose peanut or treenut snacks are not sold or served as complimentary snacks on flights where there is a person with peanut or treenut allergy on board to decrease the risk of exposure.
• Ensuring that all cabin crew are trained in first aid, especially how to recognise the signs and symptoms of anaphylaxis, how to provide emergency treatment and how to reduce risks on board.

No airline could guarantee a truly allergen free environment for a person at risk of severe allergic reactions, but there should be greater consistency in the policies that are adopted across the airline industry to reduce risks.

We will continue to engage with the airline industry about key issues affecting people at risk of severe allergic reactions. Our aim is to create a safe environment for all people with allergies by working with and educating the travel industry; focusing on medical facts, food labelling, risk reduction and allergen management.

Every person is different, so if you have concerns about travelling we would encourage you to speak to your GP or allergy specialist who can advise you what to do to minimise risks.

We also provide medically informed advice and information via our clinical panel to help educate and empower people living with allergies to be aware of risks to their safety when travelling and the precautions they can take to feel reassured and safe.

We have a whole host of information available on our website including…

• Travelling advice and tips
• Airline Meals
• Peanut Snacks
• Booking Your Flight
• The Day of Your Flight
• Translation Cards

If you have any concerns or further questions, please contact our helpline team at [email protected] or call 01252 542 029.

Yesterday two men appeared in court having been charged with manslaughter following the death of 15-year old Megan Lee on 1st January 2017.

Megan had eaten food from the Royal Spice Indian takeaway in Hyndburn, Lancashire on Friday December 30th 2016 before experiencing an apparent severe allergic reaction. She was admitted to Royal Blackburn Hospital but sadly passed away on New Year’s Day.

We understand at the brief hearing at Blackburn Magistrate’s Court on 4th January 2017, Mohammed Abdul Kuddus, 39, of Blackburn, and Harun Rashid, 38, of Rossendale, confirmed their name, age, address and nationality and were released on conditional bail.

The Magistrates have sent the case to Burnley Crown Court, where the men will appear on 7th February 2018.

Both men have been charged with manslaughter, one count of failing to discharge general health and safety duty to a person other than an employee and one count of contravening or failing to comply with EU provision concerning food safety and hygiene.

The company that owned the takeaway at the time of the incident, RS Takeaways Ltd, has also been charged with one count of failing to discharge general health and safety duty to a person other than an employee and contravening or failing to comply with EU provisions concerning food safety and hygiene. The company charges will also be heard at the crown court on the same date.

The Royal Spice Indian takeaway is now trading under new ownership.

Lynne Regent, Chief Executive of the Anaphylaxis Campaign, said:

“The Anaphylaxis Campaign will continue to monitor this case very carefully as it progresses and continue to support Megan Lee’s family who have worked with us tirelessly to raise awareness about severe allergies and anaphylaxis and have fundraised actively to support our work. It is vital that anyone affected by food safety issues continues to report any problems to their appropriate Trading Standards or Environmental Health Officer.”

The Anaphylaxis Campaign is the only UK wide charity focused solely on supporting those at risk of severe allergies and anaphylaxis. We provide information and support to people at risk of severe allergies, their parents and carers, the food and pharmaceutical industries as well as healthcare professionals; and campaign and fundraise to achieve our ultimate aim, to create a safe environment for all people at risk of severe allergies.

We have more information and advice about eating out when you have a food allergy on our website here.

If you have any concerns or questions, please contact our helpline team at [email protected] or call 01252 542 029.

For further information, please contact our press office via [email protected] or call 01252 893 862.

We will be closed for the festive season from the afternoon of Friday 22nd December 2017 to Monday 1st January 2018.

During this time our helpline team will be unavailable to take your calls or emails.

Call NHS 111 if you urgently need medical help or advice but it’s not a life-threatening situation.

Call 999 if someone is seriously ill or injured and their life is at risk.

We will reopen at 9am on Tuesday 2nd January 2018.

The Anaphylaxis Campaign was saddened to learn of the death of 18-year-old Dylan Hill a few years ago and our Chief Executive has attended the coroner’s inquest that has been taking place this week in Sheffield to understand if lessons can be learned from this tragic case.

Dylan collapsed after dining at an Indian restaurant in Barnsley with his partner Demi Cash on 17th May 2015 and died after experiencing a severe allergic reaction known as anaphylactic shock after eating a curry which contained peanuts.

Lynne Regent, Chief Executive of the Anaphylaxis Campaign, said:

“Our heartfelt condolences go out once again to Dylan’s family. Teenagers and young people are a particular risk group of dying as a result of a severe allergic reaction, which is why we worked so hard to get our Take the Kit film made to raise awareness of anaphylaxis and the importance of always carrying emergency medication.

It is also vital that those affected by severe food allergies draw attention to these when eating out and that all in the food service industry are fully trained and aware of the importance of dealing with food allergies correctly. We will be working closely with the parties concerned in this tragic case to take forward the lessons learned”

Further updates regarding the case are expected to be released by the coroner’s office after Christmas.

We have more information and advice about eating out when you have food allergy and the importance of carrying life saving emergency medication below, and on our website.

If you have any concerns or questions, please contact our helpline team at [email protected] or call 01252 542 029.

For further information, please contact our press office via [email protected] or call 01252 893 862.

Adrenaline

Adrenaline Auto-Injectors, known as AAIs, are the life saving drugs used to treat severe allergic reactions. The AAIs currently prescribed in the UK at present are Emerade®, EpiPen® and Jext®.

If you are prescribed adrenaline, it should be available at all times – with no exceptions. After an injection has been given, someone should call the emergency services immediately as the person will need observation in case of a secondary reaction and further treatment may be needed.

You can find out more in our adrenaline factsheet here.

Eating Out

By law, food businesses selling catered food (for example in restaurants, takeaways and hotels) are required to provide information on major allergenic ingredients, either in writing and/or orally. If information is provided orally, the food business will need to ensure that there is some sort of written signage that is clearly visible, to indicate that allergen information is available from a member of staff. Systems should also be in place to ensure that, if requested, the information given orally is supported in a recorded form to ensure consistency and accuracy.

You can find out more in our guide to eating out for young people here.

Take the Kit

#TakeTheKit was created after results from our Youth Survey in 2012 revealed that only 33% of young people carried their AAIs at all times. A recent similar survey which ran earlier this year in February 2017 has shown that 72% of the respondents said they carried their AAIs, an increase of 39%.

Find out more about #TaketheKit here.

Mylan UK has released an updated EpiPen® demonstration video to reflect changes to instructions on the administration of EpiPen® and EpiPen® Junior adrenaline auto-injector, which is available to view on Vimeo.

More information about the changes are also detailed in a statement available on the www.epipen.co.uk website, as follows [1]

Mylan UK has recently received approval for a change to the instructions for use of EpiPen® and EpiPen® Junior. There is no change to the device or the drug (adrenaline); the change is in the instructions for use as outlined below:

• Reduced holding time from 10 to 3 seconds.
• Removal of the massage step after administration.
• The changes are aimed to simplify the process and improve compliance.
• It is important to remember, the effectiveness of the EpiPen® and EpiPen® Junior will not be impacted
  regardless of whether it is held for 3 or 10 seconds.
• We expect EpiPen® and EpiPen® Junior with the new instructions to enter pharmacies in the UK from
  November 2017 onwards, and these will gradually replace the 10 second labelled pen. As we go through
  the transition period, there will still be some EpiPen® and EpiPen® Junior with the 10 second label
  available in the UK.
• If you have an EpiPen® with the 10 second label, you don’t need to get it replaced. EpiPen®’s only need
  to be replaced when they have been used or when they are about to expire.
• All EpiPen®’s should be used following these new instructions. The pen should be held for 3 seconds and there is no need to massage. If a patient forgets, and holds the EpiPen® for 10 seconds and/or massages the site, it won’t affect the way the EpiPen® works.

The adrenaline auto-injectors prescribed in the UK at present are Emerade®, EpiPen® and Jext®. The Anaphylaxis Campaign has contacted ALK the pharmaceutical company that produces Jext® and Bausch and Lomb who produce Emerade® who have informed us that they have, at present, no plans the change the method of administration of their adrenaline auto-injectors.

The place where the adrenaline is administered is the same for all three injectors; Emerade®, EpiPen® and Jext® are injected into the muscle in the front quarter of the outer thigh. However, the method of administration for each autoinjector varies slightly. Training should be given to all those who might be required to administer the adrenaline in an emergency, such as family members and friends. You can also find help on the website relevant to the injector you carry. For Emerade® visit www.emerade-bausch.co.uk, for EpiPen® visit www.epipen.co.uk and for Jext® visit www.jext.co.uk.

If you have any concerns or questions, please contact our helpline team at [email protected] or call 01252 542 029.

EpiPen Demonstration Video (Change of use) from Mylan UK on Vimeo.

With reference to the new SmPC guidelines

[1] MYLAN UK, www.epipen.co.uk [online] 15h December 2017, www.epipen.co.uk

6th December 2017

Two men have been charged with manslaughter following the death of 15-year old Megan Lee on 1st January 2017. Megan had eaten food from the Royal Spice Indian takeaway in Hyndburn, Lancashire on Friday December 30th 2016 before experiencing an apparent severe allergic reaction. She was admitted to Royal Blackburn Hospital but sadly passed away on New Year’s Day.

Lancashire Constabulary have confirmed that – following an investigation by Lancashire Constabulary, Lancashire County Council and Hyndburn Borough Council and consultation with the Crown Prosecution Service – Mohammed Abdul Kuddus of Blackburn has been charged with manslaughter, one count of failing to discharge general health and safety duty to a person other than an employee and one count of contravening or failing to comply with EU provision concerning food safety and hygiene. Harun Rashid of Haslingden has been charged with the same offences [1].

The company that owned the takeaway at the time of the incident has also been charged with one count of failing to discharge general health and safety duty to a person other than an employee.

Lynne Regent, Chief Executive of the Anaphylaxis Campaign, said:

“Our heartfelt condolences go out once again to Megan Lee’s family who have worked with us tirelessly to raise awareness about severe allergies and anaphylaxis and have fundraised actively to support our work.

The Anaphylaxis Campaign will attend the hearing of this case at Blackburn Magistrate’s Court and will be monitoring this case very carefully as it progresses.

It is vital that anyone affected by food safety issues continues to report any problems to their appropriate Trading Standards or Environmental Health Officer.”

The Anaphylaxis Campaign is the only UK wide charity focused solely on supporting those at risk of severe allergies and anaphylaxis. We provide information and support to people at risk of severe allergies, their parents and carers, the food and pharmaceutical industries as well as healthcare professionals; and campaign and fundraise to achieve our ultimate aim, to create a safe environment for all people at risk of severe allergies.

We have more information and advice about eating out with a severe allergy on our website here. 

If you have any concerns or questions, please contact our helpline team at [email protected] or call 01252 542 029.

For further information, please contact our press office via [email protected] or call 01252 893 862.

[1] https://www.lancashire.police.uk/news/2017/december/men-charged-in-connection-with-teenagers-death

The Anaphylaxis Campaign has contacted Mylan who distribute EpiPen® in the UK for an update and clarification regarding recent supply issues. They have provided us with a statement, which is below.

If you have any concerns please speak to your pharmacist or contact Mylan customer services on +44 (0)1707 853 100. You can also contact our helpline team at [email protected] or call 01252 542 029 for information and support.

EpiPen® is an adrenaline auto-injector used for the emergency treatment of severe allergic reactions known as anaphylaxis and is a Prescription only Medicine. The Anaphylaxis Campaign is in continuous dialogue with the distributors of adrenaline auto-injectors in the UK and we will continue to keep you updated about supply issues.

Update on the Availability of EpiPen® 0.3mg

We would like to inform you about the potential limited availability of EpiPen® 0.3mg (Senior) stock in coming weeks. To minimize the impact of this supply situation on patients, we are monitoring the situation closely and have taken the following actions.

Mylan is working closely with our distribution partner Alliance Healthcare to help manage stock and ensure that EpiPen® scripts can be fulfilled.

Centralised distribution of EpiPen® 0.3mg only

EpiPen® 0.3mg (Senior) stock is now kept at one warehouse at Alliance healthcare. This allows for better distribution of EpiPen® and reduces the risk of uneven distribution.

Please be assured that deliveries will be made nationwide to pharmacies with a valid script for EpiPen® on a next day delivery upon receipt of an order before 5pm.

EpiPen® 0.15mg (Junior) stock will be available to order from local Alliance Healthcare depots across the country as usual. 

Mylan is aiming to prioritise patients with anaphylaxis diagnosis to minimise the risk of anaphylaxis complications. We are working diligently to minimise the effect on all patients and stabilise EpiPen® supply nationwide.

Should you still have difficulty in obtaining your EpiPen® you may contact Mylan customer services on +44 (0)1707 853 100. Mylan’s Medical information team may also be contacted for any medical information request on +44 (0)1707 853 000 select option 1.

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. Side effects should also be reported to Mylan pharmacovigilance team tel no: 0800 121182267 email: [email protected].

By reporting side affects you can help provide more information on the safety of this medicine.