Isn’t it time UK nurseries and schools held unassigned EpiPens?

By on September 8, 2013
epipen_accessories

My 17-month-old daughter is about to start nursery and her allergic status has come under the spotlight in the last week. More specifically: what would happen if she had her first allergic reaction whilst at nursery?

She will be going to the same nursery as her big brother. They have always inspired confidence in the way they have handled his peanut allergy. However, when completing my daughter’s paperwork, the position on allergies was not so clear cut:

  • Does she have any allergies? Well, no, nothing has been diagnosed as yet.
  • Any special dietary requirements? No nuts please, at least until she has been allergy tested.
  • Any medication requirements? No. Well, not as yet…

Allergy testing siblings

I’ve blogged in the past about the NHS policy on allergy testing siblings. Siblings of food allergic children have a higher peanut allergy risk. Dr Andrew Clark (in his 2010 Q&A piece for Mumsnet), said that siblings of peanut allergic children have a 7% chance of developing nut allergy, compared to a 1-2% background population rate.

Our doctors’ advice has varied as to whether my daughter will be offered allergy tests for nuts. My understanding is that allergy tests are not routinely offered on the NHS, where the sibling has not shown any allergy symptoms. However, given my son’s initial reaction was severe, some doctors have indicated that the hospital would be prepared to test my daughter too, for our peace of mind. I understand she could be tested now (at 17 months), however the hospital would prefer to wait “until she is a little older, say 3 or 4″. I’m not entirely sure what the logic is for waiting and this is something I will check with our doctors.

How would nursery handle a child’s first allergic reaction?

So far, my daughter has shown no signs of eczema, asthma or food allergies, and obviously I have my fingers crossed that long may that continue. However, my comments on the nursery form that she should not have any nuts lead onto a discussion with one of the nursery supervisors as to whether this was due to an allergy or “parental preference”. In her case, at the moment, it is “parental preference”. I explained about her increased peanut allergy risk and that she will be tested at “around 3 or 4″. The nursery are going to control her food in the same way as they do for my son, with the chef checking that her food is nut free (and this being double checked by a member of the management team). So far, so good.

We then talked about medications. Our allergy doctor has confirmed to me in the past that, if my daughter ever suffered anaphylaxis, we should use my son’s EpiPen. (I suspect the doctor might have thought it was a slightly ludicrous question for me to even ask – but I wasn’t sure whether she might have needed a smaller dose of adrenaline. However, it turned out the EpiPen Jr would be suitable. For more information, see the EpiPen website).

During the discussion with the nursery supervisor, it dawned on me that, even with my express permission, the nursery staff could not do the same thing. If my daughter had a severe allergic reaction, they would need to call an ambulance and wait for the paramedics to arrive, to administer the dose of adrenaline. Immediately after dialing 999, they would telephone us and we would also tear down to the nursery with my son’s emergency medication. We live only a couple of minutes away from the nursery and may well arrive before the ambulance.

However, given that, with anaphylaxis, every second counts, this arrangement has left me feeling extremely unnerved. I now want my daughter to be tested for peanut allergy ASAP, so she can be prescribed her own EpiPen, if the results are positive.

Unassigned EpiPens in UK nurseries and schools?

In recent weeks, there have been several news reports from the US about schools holding “stock” or “undesignated” epinephrine (adrenaline) auto-injectors. According to a New York Times article published today, “Amarria’s Law” (made following the death of a young girl, Amarria Johnson, from anaphylaxis) requires:

“Virginia schools to stock epinephrine and allows school authorities to give it to children without a prescription, and indemnifies those who administer it in a life-threatening situation”

The NYT article states that the School Access to Emergency Epinephrine Act is due to go before the US Senate this autumn. If passed, this will allow similar legislation to be enacted across the USA. American schools can also acquire free undesignated EpiPens through Mylan Specialty LP’s EpiPen4Schools program.

Isn’t it time we had similar measures in the UK?

Allergy UK report that 50% of children in the UK have allergies, however they advise that there is “no test which can predict risk of anaphylaxis”.

Around one in 50 UK children has an allergy to peanuts. According to Dr. Carla Davis (quoted in an article on ABC13):

“Twenty to 25 percent of children [in the US] with peanut or nut allergies have their first reaction at school before anyone knows that they have a food allergy. So it’s very important to have epinephrine in the school to treat those children, and it has to be an unassigned pen.”

So, it might follow that something like 1 in 200 UK children will discover their peanut or tree nut allergy when they have a reaction at school. It would be very interesting to know how many UK children (who at that point have not been diagnosed as having an allergy) have their first anaphylactic reaction at school and have to wait for the paramedics to arrive with the adrenaline.

Wouldn’t it be reassuring if nurseries and schools (and restaurants, shopping centres, railway stations etc) held adrenaline auto-injectors in the same way as some public places now have defibrillators? And if ALL nursery and school staff were trained in how to recognise the signs of anaphylaxis and administer an EpiPen, if need be? Is that a realistic goal for the UK? What do you think?

Sources / further reading

About Louise @ NutMums

City solicitor turned full time mum and food allergy blogger. Writes and tweets (@nutmums) about all things peanut and nut allergy, from a parent's perspective.

10 Comments

  1. Pig in the Kitchen

    September 9, 2013 at 2:25 pm

    Hmm, it’s an interesting debate. I thought, like you, that the amount of adrenaline administered was dependent on weight and the idea of one of my younger children being administered a teenage-sized dose of adrenaline scares me! I wonder how many children have NEVER been exposed to nuts before they start school or nursery? Presumably most children have been and therefore it wouldn’t be necessary for staff to hold injectors ‘just in case’. And in an increasingly litigious culture I can see why staff would be reluctant to let rip with an injector when there’s no medical evidence of a nut allergy. Perhaps the safer option is to make it a ‘no nuts’ environment?

    Great site btw, only just found you!

    Pig x

    • Louise

      September 11, 2013 at 1:58 pm

      Thank you very much!
      That’s true that my daughter would probably be fairly unusual in being school age and never having eaten nuts. However, if “Anyone can develop an allergy to anything at any time” (according to NYT article), even those children who have eaten nuts fine in the past could one day become allergic and react. (Also, as Alexa says below, nuts aren’t the only foods which can trigger anaphylaxis.)
      An unassigned EpiPen could benefit those children with a known allergy too. For example, those who haven’t been prescribed an EpiPen (my friend’s little girl is allergic to various nuts but has only been prescribed anti-histamine) or those who only keep one EpiPen at school (if a second dose was needed before the paramedics arrived, the “unassigned” pen could then be used).
      I agree though, staff would need to know they were covered if they used the EpiPen and it turned out the child was actually not having an allergic reaction or the child suffered a side effect. Maybe this could be dealt with by a Government indemnity (like in the States) plus training about anaphylaxis and reassurance about the safety of the medication?
      Louise

  2. Alexa Baracaia

    September 10, 2013 at 8:10 pm

    I’m in complete agreement that this would be a sensible move.

    As I understand it an EpiPen costs around £70-£90, a small sum from a school budget to provide peace of mind. As in the US, where many states have made stock EpiPens compulsory, teachers could be indemnified against legal action (hideous thought that anyone would sue, but sadly that’s life) should they decide to administer an EpiPen.

    Also, re the previous comment – nuts are not the only allergen to provoke an anaphylactic reaction and banning all potential allergens is simply impossible (and inadvisable). If teachers are trained to spot a reaction then EpiPen use is the best course of action – the quicker the better, as guidelines state.

    I think it’s an advisable inclusion in the First Aid kit of any nursery, school or even workplace – along with an asthma inhaler, arguably.

    Thanks for the post – definitely a point worth making.

    • Louise

      September 11, 2013 at 2:00 pm

      Thanks Alexa – great to hear your thoughts! I’ve seen EpiPens online retailing around the £40 mark. If UK schools were required by law to hold an unassigned EpiPen, I’m guessing they would be able to be bought in bulk and procured for even less than that. Absolutely agree – a small price to pay for safety and peace of mind. Louise

  3. Karen

    November 18, 2013 at 2:37 pm

    Imagine my surprise that, on taking my son to the allergy clinic where it was confirmed he has a cashew/pistachio allergy they said his identical twin brother would not need to be referred. They relented when I pointed out that he had a 65% chance of sharing the allergy (thank goodness for google).

    I agree wholeheartedly that schools should keep unassigned epipens, for first attacks and to save money as they pass their use by dates. I’m in the position where one son would be given the epipen immediately, whilst the other wouldn’t. Both are flagged as nut allergy just in case and you’d hope, if put in the position were either needed the epipen, they would use it regardless of the name on the prescription label.

    • Louise

      December 1, 2013 at 10:36 pm

      Hi Karen, Thanks for your comment. We’re in the same boat, where my son would be given the EpiPen, but my daughter would have to wait for the ambulance. Luckily, we’ve now been told she can be allergy tested (and get her own emergency medication if need be) – which will definitely make me feel more relaxed! Louise

      PS. In case you haven’t seen it, here’s a link to a petition urging the UK government to follow the US and have stock EpiPens in schools: http://epetitions.direct.gov.uk/petitions/57117 .

  4. Lisa

    January 28, 2014 at 11:20 pm

    Hi,

    Just came across your article, very interesting and I fully agree with your comments. I have a 12 year old daughter who carries an Epi-pen (nut allergy) and is atopic. Her 3 year old sister on the other hand hasn’t been prescribed any medication even though she has had a hives breakout which we think may have been caused by a type of medicine. She has also recently started getting a rash when eating tomatoes. I have brought this up with her GP who states that there is such a back log of children awaiting tests in Buckinghamshire that they are currently only testing children who are admitted to A&E after an allergic reaction. This is even when a sibling has a severe allergy. The only thing I can do is carry around Anti histamine as I wouldn’t be able to administer my eldest daughters pen as she now uses an adult dose.

    • Louise @ NutMums

      April 7, 2014 at 9:19 pm

      Hi Lisa – thanks very much for your comment – it’s concerning how the availability of testing varies across the country. I know we’ve been lucky to have my daughter tested (http://www.nutmums.com/allergy-testing-siblings-quick-update/). We’re also lucky the EpiPen Jr is the correct dose for both my son and daughter – I hadn’t considered what would happen when my son moves up to the normal EpiPen dose. I hope your authority’s policy changes and you get some peace of mind soon.

  5. Zoeh

    April 2, 2014 at 9:34 pm

    Hi Louise,
    I have just come across your post and epetition since researching the guidelines in school re Epipens.
    I have a 4yr old who started school last Sept and has never suffered any allergies. But I am very aware that that doesn’t mean he never will! For me, bee stings is also a massive worry with anaphylatic shock.
    I spoke with the head teacher, to confirm that they had a policy in place and an Epipen in their medical emergency kit…. I am flabbergasted to find that this is not the case!!
    I genuinely believe that many parents are unaware of this and sadly not educated of the implications.
    I see that only 300 or so signed the petition, I was wondering how you were getting on with this within your school?

    • Louise @ NutMums

      April 7, 2014 at 9:19 pm

      Hi Zoeh, I think that’s exactly right, unless your life has been affected by allergies in some way, many people are unaware of the danger and how important it is to have access to an adrenaline auto-injector in an emergency. The ePetition started last year by @Izzy_and_Ollie highlighted the issue and it seems there will be a further campaign by the Anaphylaxis Campaign during 2014 (http://www.anaphylaxis.org.uk/living-with-anaphylaxis/news/new-year-new-campaigns-for-our-20th-anniversary). I’m certainly keeping an eye out for news on this one – will post as soon as I hear more.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>