Anaphylaxis Campaign

Supporting people at risk of severe allergies

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NICE publishes updated anaphylaxis guidance on the prescribing of adrenaline injectors after emergency treatment

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The National Institute for Health and Care Excellence (NICE) has recently updated its anaphylaxis guidance regarding the prescribing of adrenaline auto-injectors (AAIs) before discharge after emergency treatment.

This update outlines that healthcare professionals should always offer people with allergies a prescription for two further AAIs before being discharged from the hospital and advise patients to carry these with them at all times.

The full Anaphylaxis guidance can be found here

Recent inquests have highlighted a need for more awareness and training for those at risk of an anaphylactic reaction (a severe allergic reaction) and their families and carers. The inquest into the death of Shante Turay-Thomas, an 18-year-old woman who died at her home in North London in 2018 after eating food thought to have contained nuts, heard how Shante had not been given sufficient training on how to use her AAI which had been changed from EpiPen to Emerade. If a patient is switched from one device to another, this could cause confusion and so careful retraining is necessary. It is vital that anyone prescribed an AAI is shown how to use their specific device.

Findings from the inquest also showed that Shante carried one AAI and kept another AAI at her school. The Anaphylaxis Campaign would like to reiterate advice that medical professionals should prescribe two devices to patients in line with the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) recommendations and that patients should carry two AAI’s with them at all times.

Lynne Regent, CEO of the Anaphylaxis Campaign, said:

“We welcome the update to NICE guidelines. The Anaphylaxis Campaign always encourages those prescribed an AAI to always carry two with them at all times. Sadly, recent deaths have highlighted the need for more awareness of this and that the individual and their family members must receive training and support to use their device. We’re pleased to see more action is being taken to address these issues.”

The NICE anaphylaxis guidelines include recommendations on assessment, referral, and providing information. They are for healthcare professionals, commissioners and providers, and people with suspected anaphylaxis and their families and carers.

If you have any questions, please either email [email protected] or call 01252 542029.

University and Allergies: Q&A with Youth Ambassador Dan Kelly

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As new and returning students prepare for university, the Anaphylaxis Campaign has worked with allergy blogger Dan Kelly to bring together students’ most pressing allergy-related questions for a special Q&A video.

Students going to university are often managing their allergies on their own for the first time and learning to cope with new challenges, for example, living in shared accommodation and eating and drinking out with friends.

Last month the charity invited new and returning students to send in their questions for the Q&A with the aim of alleviating some of these pressures.

As a graduate of The University of Huddersfield, Dan knows what this experience is like and has helped to address these concerns in the video which is now available on the Campaign’s website, YouTube and Instagram channels.

Watch the video

Dan Kelly became the Anaphylaxis Campaign’s Youth Ambassador earlier this year to help support the charity’s work with young people living with severe allergies. Dan is also the founder of May Contain, an allergy blog and podcast helping to raise awareness.

Dan was named the youngest ever graduate to be included in The University of Huddersfield ‘Alumni Roll of Honour’ List in July.

Commenting on his involvement in the video, Dan said:

“Going to university with an allergy can be quite nerve-racking. It was great to partner up with the Anaphylaxis Campaign to do a Q&A and share my top tips of going to university with an allergy. It is so important for the student to always bring up their allergy to their new housemates. When moving into halls/new flat I remember worrying what people might think. The students were so understanding and wanting to find out more about my allergy.”

The Campaign has also developed a booklet to help support students with allergies which includes advice on preparing for university, information on eating out, an adult allergy action plan and general tips.

If you need advice about allergies, the charity’s Helpline Team is available to provide support Monday to Friday 9am to 5pm. Please call 01252 542029 or email [email protected]

Statement Regarding the Inquest of Ruben Bousquet

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Southwark Coroner Andrew Harris has ended the inquest into the death of Ruben Bousquet, a 14-year-old boy who died after suffering an allergic reaction at a cinema.

The Anaphylaxis Campaign would like to extend our deepest condolences to the family of Ruben, who died after eating popcorn with a drink at an Odeon Cinema in London with his parents on April 18 2019. Ruben was known to have severe food allergies including cow’s milk, raw egg and soya.

During the inquest, representatives from Odeon Cinemas, the Food Standards Agency, the London Ambulance Service and Royal London Borough of Greenwich gave evidence. The coroner stated that the popcorn Ruben had eaten was contaminated with milk but could not determine whether the contamination occurred during the production process or at the point of sale. This was partly because appropriate food testing was not carried out and partly because the level of milk protein thought to trigger Ruben’s reaction was close to the limits of detection.

Ruben had left his emergency adrenaline auto-injectors at home and had to be taken home to receive treatment.

The Coroner is to make a decision later this month on whether to issue a prevention of future deaths report.

The Anaphylaxis Campaign would like to reinforce the following advice;

  • Always carry two adrenaline auto-injectors with you at all times.
  • Ensure you have registered the expiry date of your devices on the relevant manufacturers’ websites to give you ample warning when a new prescription is required.
  • Ensure you gain a replacement device prior to disposing of any out of date devices.
  • Always make sure you have a trainer device which can be ordered from the manufacturer’s websites for free:Emerade Trainer (Please note that Emerade auto-injectors are currently unavailable)EpiPen TrainerJext Trainer

Make sure that your family and friends are familiar with the device you have and how to use it. If you experience symptoms of anaphylaxis, administer an adrenaline pen without delay, even if you are not sure whether it is anaphylaxis. Early administration is vital.

In an emergency call 999, ask for an ambulance and say anaphylaxis (pronounced as ‘anna-fill-axis’).

The role of the coroner and purpose of an inquest

We wish to make it clear that the Anaphylaxis Campaign are not legal experts.

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. 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.

If you have any further questions, please contact the Helpline on 01252 542029 or email [email protected]

Six-year-old school girl wins compensation after suffering severe allergic reaction at school

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A recent court case has highlighted the importance of allergy awareness and education in schools. Maizy Harman, aged six years, has been awarded £2000 in compensation from North Yorkshire County Council after they provided her with food containing her allergen at Woodthorpe School where she is a pupil.

Maizy has life threatening allergies to egg and milk, yet she was given a pudding that had been made with eggs as part of the ingredients. The school had been fully aware of Maizy’s allergies yet still made the catastrophic mistake. Maizy had to be rushed to hospital by ambulance to receive emergency treatment for the severe allergic reaction she suffered as a result of the error.

As well as £2000 in compensation, the Council have also been ordered to pay £14,161.87 in court costs and fined £4000.

Unfortunately, this is not the first case of a child suffering anaphylaxis whilst in the care of their school. 17% of fatal food-anaphylaxis reactions in school-age children happen while they are at school and 20% of anaphylactic reactions in schools are in children with no prior history of food allergy. In 2017, there were two inquests into the deaths of school pupils from anaphylaxis that highlighted the urgent need for staff training, and for consistent policies and procedures on the management of children with food allergies in schools.

The Anaphylaxis Campaign provides resources to help schools improve their allergy safety. Our ‘Making Schools Safer Project’ took the lessons learnt from these inquests and created a package of resources to help schools effectively and safely manage children with allergies. These resources can be accessed here.

School staff can also take the free online ‘AllergyWise for Schools’ course which is designed to ensure that all staff are fully aware of the essentials for management of severely allergic children in school.

The Anaphylaxis Campaign also provides help for catering organisations as part of the corporate membership scheme. If you provide a catering service to children or adults you can find out more about becoming a corporate member here

For information and support about any of the issues raised you can call our Helpline on 01252 542029 Mon-Fri 9am-5pm

 






Every donation, no matter how small, helps us to continue to provide information and support on key allergy issues. Please click here to donate.

The Emergency Treatment of Anaphylaxis in School during the COVID 19 Pandemic

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As schools prepare for children to return full time, we have been contacted by concerned parents and school staff about how the COVID-19 epidemic and the restrictions in place because of it, affect the giving of emergency treatment to children experiencing a severe allergic reaction/anaphylaxis.

We wrote to the Department for Education in England, Scotland, Wales and Northern Ireland requesting that clear guidance be issued for schools on this matter. We have now received a reply from John Swinney, The Deputy First Minister and Cabinet Secretary for Education and Skills, and Sarah Lewis, Early Years and Schools Group, on behalf of Andrew McCully, Department for Education.

Scottish Government letter

The letter outlines the Scottish Government’s support for schools holding ‘spare’ adrenaline auto-injectors and confirmed that the ‘Supporting children and young people with healthcare needs in schools: guidance’ published in December 2017 will still apply. The letter goes on to state:

Our guidance on plans for the return of schools have been clear that there will be circumstances, in order to provide intimate care and medication, where physical distancing will not be appropriate, and that in some cases, the need for personal and protective equipment will be considered. The Scottish Government is updating the guidance for the re-opening of schools, in support of our aim to return to schools in August and that there will not be a need for physical distancing of pupils. However, that also means that the guidance which I referred to above, on the management of healthcare needs in schools will also be in force, and will again guide those in schools on how to respond appropriately, in these circumstances.

You can read the full letter here: Scottish Government Letter

Department for Education letter

The letter from the Department for Education confirmed that its approach to supporting children with medical conditions returning to school will be similar to pre-COVID support, as outlined in the supporting pupils with medical conditions at school guidance.

In addition to this, in the case of an anaphylactic reaction, the letter states:

in the case of an anaphylactic reaction, it is critical that assistance is given immediately. Following your letter, we have therefore liaised with Public Health England and I can confirm that we are now taking forward updates to our guidance on the full opening of schools, as well as our guidance for other education settings, to make absolutely clear that children and young people should always receive prompt and appropriate treatment, in the event of a medical emergency. We will be explicit that, in the case of a medical emergency, people do not need to stay 2 metres apart.

You can read the full letter here: Department for Education letter

Welsh Government letter

The Welsh Government’s Minister for Education confirmed that it will be made clear that in the event of a medical emergency, children and young people should always receive prompt and appropriate treatment, and that healthcare and AAI guidance will still apply.

The letter continues:

It is to be expected that in a medical emergency people may need to be less than two metres apart and may be administering emergency medical care without PPE. We will make this clear on our website as part of our frequently asked questions which are updated regularly.

You can read the full letter here: Welsh Government Letter

We will continue to monitor the situation as it develops.

Highlights from the EAACI Digital Congress 2020

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The European Academy of Allergy and Clinical Immunology (EAACI) Annual Congress 2020, took place digitally this year from 6- 8 June 2020.

EAACI is an association of more than 11,000 clinicians, researchers, and allied health professionals from 24 countries and includes over 50 National Allergy Societies who work to improve the health and lives of people affected by allergic diseases. Originally planned to take place at the ExCel Centre in London, the congress was switched to a digital platform due to the COVID-19 Lockdown. The congress provided an opportunity for allergy experts and professionals to discuss future avenues, new discoveries and developments in the field under this year’s theme which was ‘Bridging Innovations into Allergy and Asthma Prevention’

The diverse and forward-looking programme included presentations and interactive sessions on:-

  • The gut microbiome and allergy
  • Latest developments in prebiotics, probiotics and synbiotics
  • Weaning and allergies – changes in the guidelines and current thinking
  • Diet diversity and the relationship with allergy
  • Cow’s milk protein allergy (CMPA) – current guidelines pros and cons
  • Benefits of human milk oligosaccharides in the treatment of CMPA
  • Novel insights into immunotherapy approaches
  • The quality of life of children and adults with food allergy
  • Impact of climate change on asthma
  • Social Media and allergies – pros and cons

Most of the Congress scientific content is available to registered delegates on the EAACI Digital Congress 2020 platform for a period of six months after the Congress. For anyone not registered, the content will be available for purchase on the EAACI Media Library in the form of thematic packages within the next few weeks.

For details please visit the EAACI website.

Supply of US-labelled EpiPen® 0.3mg Adrenaline Auto-Injectors

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EpiPen (Adrenaline) Auto-Injector 0.3 Mg: supply of a batch (no. 9FM766) with US-labelled auto-injectors packaged in UK cartons with a UK leaflet

  • Mylan has released a batch of US-labelled EpiPen auto-injectors (Batch no. 9FM766) to enable continuous access of auto-injectors in the UK following approval from the MHRA.
  • The EpiPen auto-injectors in this batch are affixed with a US label, and are packaged (as single packs) into UK cartons along with UK patient information leaflets.
  • The drug name is epinephrine in the US but is known as adrenaline in the UK.

Patients and carers familiar with the term adrenaline may be confused.

Further information on the safety concern and recommendations

The auto-injector device in this batch is exactly the same as the normal UK EpiPen in every way except for the information on the label on the device.

Other differences between the US-labelled and UK-labelled auto-injectors are:

  • The UK label has the instruction to ‘Dial 999, ask for ambulance and state ‘anaphylaxis!’, which is replaced with ‘Get emergency medical help!’ on the US label.
  • The warning ‘Keep of the reach and sight of children’ is omitted on the US auto-injector label. However, the UK carton and patient information leaflet include this statement.

Please see below a comparison of the US and UK labels on the autoinjectors:

 

EpiPen

Reminder: Patients and carers should ‘Dial 999, ask for an ambulance and state anaphylaxis!’ after every use of the EpiPen auto-injector.

The label on the EpiPen (epinephrine) auto-injector is meant for the US. Therefore, patients and carers should read the outer carton and enclosed patient information leaflet which is designed for UK patients.

This Important Information leaflet from Mylan explains the difference for patients and healthcare professionals.

The Anaphylaxis Campaign would like to reinforce the following advice;

    • Always carry two adrenaline auto-injectors with you at all times.
    • Ensure you have registered the expiry date of your devices on the relevant manufacturer’s websites to give you ample warning when a new prescription is required.
    • Ensure you gain a replacement device prior to disposing of any out of date devices
    • Always make sure you have a trainer device which can be ordered from the manufacturer’s websites for free:
    • Make sure that your family and friends are familiar with the device you have and how to use it.
    • In an emergency call 999, ask for an ambulance and say anaphylaxis (pronounced as ‘anna-fill-axis’).
    • All adrenaline auto-injectors (AAIs) come with the following instructions on storage of their device: keeps AAIs in their original containers to prevent light exposure, do not store above 25oC and do not freeze. For EpiPen devices there is an additional instruction to not refrigerate the device.
    • Your adrenaline auto-injector devices should be checked regularly to ensure the liquid is clear and colourless. If it appears discoloured or contains particles, the device should be replaced.

Hednesford takeaway owner prosecuted for serving unsafe food to allergic customer

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Limited company Rosehill Nites Limited?, operators of Rosehill Balti of Pye Green, Cannock, Staffordshire, was fined £3000 and ordered to pay £250, after it sold food which contained peanuts to a customer with a nut allergy.

The customer, Tony Locke, suffered a severe allergic reaction to the dish, which had been described as being free from nuts and peanuts.

The takeaway owner, Mr Mohammed Badrul Islam, pleaded guilty to offences relating to the provision of unsafe food on two separate occasions at a court hearing last December. Mr Islam was sentenced to a 20 week suspended sentence, ordered to complete 150 hours of unpaid work and pay the victim £1000 compensation as well as a £115 victim surcharge.

The hearing, which was originally due to take place on 16 April but was rescheduled ?due to the COVID-19 pandemic, was heard at Stafford Crown Court on Thursday 18 June.

According to the Staffordshire County Council website, on 8 February, 2019, Mr Locke from Hednesford, ordered a Modhu Minty Lamb Aloo from the business and had explained that he had a nut allergy. After returning home and eating two forkfuls of the dish, Mr Locke suffered a severe allergic reaction and ended up in hospital.

The case was reported to Staffordshire County Council’s Trading Standards service who made a test purchase of the same meal on 13 March 2019. Following testing by a specialist team, the curry powder used in the dish was found to contain nut powder.

Mr Islam told the court that he did not know that the curry powder contained nuts and expressed regret and remorse that Mr Locke suffered an allergic reaction that necessitated the need for him to attend hospital.

This case highlights the importance of food businesses checking the ingredients in the products used in the food and drink they provide. Different ingredients, dishes and products may contain ?unexpected allergens, and ingredients and recipes can change. Food businesses must ALWAYS thoroughly check ingredient labels ?of all the products that they use in order to give customers the correct information.

Lynne Regent, CEO of the Anaphylaxis Campaign, says:

“We are saddened to hear of Mr Locke’s serious reaction and are pleased to see that action has been taken by Staffordshire County Council and that the food business involved has accepted responsibility. The importance of understanding allergy safety and how to provide allergen information correctly is imperative to the running of all food businesses. As a charity that supports people at risk of severe allergic reactions and anaphylaxis, we can provide guidance to food businesses on how they can ensure the safety of customers with allergies.”

In the UK, food businesses must provide information about any of the 14 allergens when used as ingredients in the food or drink they provide. There is more information about what these allergens are and how food businesses can provide this information here.

‘Natasha’s Law ‘– Food Standards Agency publishes updated technical guidance

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Following a key stakeholder consultation that was held between January and March this year, the Food Standards Agency has today published an update to the Food Allergen and Labelling Information:Technical Guidance along with a summary of responses and updates made as a result of the consultation.

The guidance aims to help food businesses follow allergen labelling requirements and also to help authorised food officers enforce the allergen provisions of the EU Regulation on the provision of food information to consumers (Regulation (EU) No. 1169/2011) and Food Information Regulations 2014 (SI 2014/1855) as amended and corresponding Regulations in Wales, and Northern Ireland.

The guidance has been updated to reflect the new allergen labelling requirements which will apply from the 1st October 2021. These cover foods that are prepared and packed on the same premises from which they are sold – such as a packaged sandwich or salad made by staff earlier in the day and placed on a shelf for purchase. The new law requires these products to carry a full list of ingredients with the 14 allergens, as listed in European Legislation, emphasised on the packaging.

Currently, food prepared on the premises in which it is sold is not required to display allergen information on the label, meaning food allergic individuals sometimes lack confidence buying food to eat whilst they are out.

The Anaphylaxis Campaign contributed to the consultation and CEO Lynne Regent says

‘We welcome the publication today of these updated technical guidelines. We have strongly supported full ingredient labelling on food pre-packed for direct sale as a necessary step, and we are now one step closer to seeing food businesses fully prepared to implement this successfully in October 2021, making eating out a safer experience for all those living with allergies.’

The FSA’s response to the consultation can be found here

The updated technical guidance can be accessed here

The emergency treatment of anaphylaxis in schools during the COVID-19 pandemic

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Children are beginning to return to school under new social distancing rules and regulations. We have been contacted by concerned parents and school staff about how the COVID-19 epidemic and the restrictions in place because of it, affect the giving of emergency treatment to children experiencing a severe allergic reaction/anaphylaxis.

Anaphylaxis is a potentially life-threatening allergic reaction and always requires an immediate emergency response. The response will inevitably require close contact which could increase the risk of cross infection for any infectious disease, including COVID-19. However, this risk must be weighed against the likelihood that the child could die if assistance is not given immediately.

If a child is having a severe allergic reaction, it is vital that they receive an adrenaline injection. This must be given as soon as a severe reaction is suspected to be occurring and an ambulance must be called. The adrenaline should be administered first and an ambulance should be called immediately afterwards.

If a child requires CPR the Resuscitation Council (UK) has the following advice:-

We accept that doing rescue breaths will increase the risk of transmitting the COVID-19 virus, either to the rescuer or the child/infant. However, this risk is small compared to the risk of taking no action as this will result in certain cardiac arrest and the death of the child.

Anaphylaxis Campaign, along with the BSACI and Allergy UK, has sent a joint letter to the Department for Education requesting that it issue a clear statement about teacher’s obligations should a child suffer anaphylaxis at school. The joint letter is available to read here.

Please see government guidance for first responders here

For further advice and precautions for giving life saving emergency treatment during the COVID-19 pandemic please see the full resuscitation council guidelines here

The Health and Safety Executive has also published guidance for First Aiders in non-healthcare settings which can be accessed here

For guidance on ‘What to do in an Emergency (Anaphylaxis) go here

Free Anaphylaxis Training for schools can be found here