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?
"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
- ABC 13, Keeping allergy pen at child's school can be life saver by Christi Myers (22 August 2013).
- KOMONews, Wash. schools can now give allergy meds without prescription by Rose Egge (22 August 2013).
- New York Times, EpiPens for All by Curtis Sittenfeld (7 September 2013).
- Daily Mail, Now you can start a heart as defibrillators are introduced in shopping centres, airports and railway stations by Alice Smellie (14 November 2010).