Anaphylaxis Campaign's Health Professionals Conference: Managing allergies in children and young people
Some notes on the presentations
Lynne Regent, CEO of the Anaphylaxis Campaign, opened their health professionals' conference with a run down on the excellent work that the campaign does both in supporting allergy sufferers and in working with the food industry to improve safety, labelling and choice for allergic consumers. For more on both see the Campaign's website and especially the section on the food industry.
She then handed over to Debbie Hall, a registered nurse who has worked at Wellington College in Crowthorne for the last six years, caring for, among the 1,050 other pupils, 23 severely allergic children who react severally, to nuts, seeds, dairy, fruit, latex and insect bites. It is certainly a tribute to Debbie's care and instruction – as well as to the detailed allergy provision made by the school's caterers, Sodexo – that in six years they have not had a serious reaction.
Debbie described their protocols, which included:
• Detailed information provided by parents and guardians of allergic children entered on college database along with individual care plans for each child attached to their photo.
An interesting presentation at the end of the day by Dr Rebecca Knibb, Senior Lecturer in the School of Life and Health Sciences at Aston University gave a slightly less reassuring slant on allergy provision in school – even though records show that serious food allergy reactions in schools are, in fact, very rare and getting rarer. As Dr Andrew Clarke pointed out earlier in the day, while in 2005 10% of allergic reactions to nuts took place in a school context, in 2009 only 4% did so.
Dr Knibb and her team have just completed some detailed research on allergy awareness in primary schools in the Midlands running from 2008 to 2012. They targeted 50 primary schools, sending detailed questionnaires to all staff and parents. 150 teachers responded as follows:
• 36% of teachers reported having an allergic child in the school; 23% did not know there was an allergic child in the school; only 4% had had to deal with an allergic reaction.
Among the 59 parents who responded:
Prescription of injector pens, and generic injector pens.
In the context of these two presentations there were a number of questions from the floor about the prescribing of generic injector pens.
Adrenaline/epinephrine is a drug and drugs are normally only prescribed for individual patients so some primary care practices are reluctant to prescribe generic pens to be held by a school or other organisation for use on any child or patient who needs them.
Various ways around this (having two pens prescribed for an individual and using one as generic, having them prescribed for emergency use as with asthma and epilepsy medication) were discussed.
It was also pointed out that GPs often prescribe injector pens to patients who they suspect to be allergic but do not necessarily refer them to an allergy clinic so these patients may never have been properly assessed or had any ongoing testing.
Marks and Spencer, who were sponsoring the conference, gave an interesting and detailed description of their rigorous protocols for managing allergens within their factories (or their suppliers' factories) and explained the thinking behind their very comprehensive allergen labelling.
They were followed by three medical presentations from Dr Andrew Clarke, Carina Venter and Dr Claudia Gore.
Dr Clarke, who is a consultant in paediatric allergy at Addenbrooke's Hospital in Cambridge suggested that the figures for food allergy mortality did not really justify the very significant quality of life effects that the fear of food allergy had on many families.
For example, of the 89 deaths from anaphylaxis in Florida between 1996 and 2005, only 16% were as a result of food allergy the rest being from drug allergy (50%) and from venom allergy (20%). Indeed, of every 10 million deaths, only 5 could be attributed to food anaphylaxis.
He also pointed out that compared to drug or venom allergy (both much more common in adults than in children), food allergy was relatively slow to develop. With venom allergy collapse came within minutes, with drug allergy (very often on the operating table) it was almost instantaneous but with food allergy it would normally develop over 20 minutes to an hour working through facial and oral swelling, then abdominal pain, then wheeze and then collapse.
At Addenbrookes they are currently trying to establish the amount of peanut needed to trigger a reaction and it would seem that while 5mg may provoke a mucosal itch, there will be few more dramatic symptoms, whereas 50–100mg will normally provoke more serious symptoms.
However, the severity of the symptoms may depend on a number of other factors such as the patient's general health, their stress levels (as a result of anxiety, sleep deprivation etc) or extrinsic factors such as whether or not they are taking exercise at the time, or very close to the time, of ingestion of the allergen.
Dr Clarke pointed out that most atopic patients suffered from a number of allergies and intolerances and in management terms it was important to identify the most serious and focus management strategies on that. It was also important to identify the anaphylaxis trigger which may not always be just the food. In exercise-induced anaphylaxis, for example, it is the ingestion of the food very close to taking the exercise which causes a reaction which would not be triggered by either the food or the exercise alone.
He also pointed out that new patterns of reactions were continually emerging – such as red meat allergy. Here the patient appears to have been sensitised by the bite of a specific mosquito which shares a protein with red meat so that the first time that they eat red meat after being bitten they will react.
Carina Venter who is a specialist dietitian currently employed as NIHR Post Doctorate Research Fellow at the University of Portsmouth gave a very detailed presentation on the challenges presented by pre-school allergic children, a few of the highlights of which were:
• The importance of understanding the differences between immune mediated and non immune mediated food allergy/sensitivity.
How a child might describe an allergic reaction:
• Some children put their hands in their mouths or pull or scratch their tongues.
Finally, Dr Claudia Gore, consultant paediatric allergist at St Mary's Hospital in London, talked about the difficult transition from childhood to adolescence/adulthood for an allergic person – from time spent with their parents to time spent with their peers.
She views an allergic adolescent as anyone between 10 and 24 years of age during which time, although many of them will outgrow their child allergies, many will not. At 18 roughly 18% will still have eczema, 16% rhinitis and 35% asthma.
During this time they will have to learn to manage their allergy on their own and she believes that this cannot start too early. Small children are far more aware than is often realised and from 5 onwards they should be involved in their allergy management; by the age of 10 they should be taking responsibility for their own medication.
Leaving home to go to university is always difficult but especially so as they need to transfer from paediatric care to adult. Moreover when they change GPs when they move to university there may be a 'data dump' from one practice to another without the receiving practice actually being aware of the history or what is in the notes.
Adolescents need to know:
Injector pens and needle length.
During the lunch break there was some discussion about injector pens and needle length - please see the Foodsmatter blog here for more details.
For more on the Anaphylaxis Campaign and their work please check their website.
First published in October 2013