Southern Peninsula Paediatric Allergy strives to provide education and understanding to parents and children to enable them to better manage their medical problems.
Anaphylaxis is a severe and potentially life threatening reaction of the body in response to exposure to a food, insect bite or sting or a drug.
In children, the commonest cause of anaphylaxis is related to foods and in the younger age cow's milk, egg and wheat are commonly involved, but in the mid childhood age of 5 to 12 years, the commonest offending food would be peanut followed by tree nuts. Some people can also develop severe reactions to fish and shell fish.
Many children will have mild to moderate allergic reactions to foods which can include vomiting, hives, rashes, itching and swelling, particularly of the eyes, lips and face.
Anaphylaxis, however, involves not only these signs and symptoms, but ALSO involvement of other organ systems, particularly the respiratory tract with difficulty breathing from upper airways obstruction due to swelling of the windpipe around the voice box (laryngeal oedema), or from spasm of the lower airways (asthma). The cardiovascular system can also be involved in the process of anaphylaxis where the blood pressure can drop and the child may become drowsy or unconscious. Involvement of the respiratory tract and the cardiovascular system is potentially life threatening and therefore any child who has symptoms involving the respiratory tract or the cardiovascular system has to be taken very seriously, even if they recover quickly by themselves or after the administration of an antihistamine.
There are certain children who are at particularly high risk of anaphylaxis and they include children who have had a severe reaction with respiratory involvement to even a small dose of exposure and those who have ongoing, unstable asthma. It is also true that children with peanut or tree nut allergy have a high likelihood of anaphylaxis if they are in the 5 - 12 years age group and adolescence.
The treatment for any child who may be at risk of anaphylaxis is firstly, avoidance of those foods after identification by allergy testing and in the older group of children, risk minimization strategies including questioning of any foods, smelling the food, tasting the food and if they do ingest it and feel sick, then vomiting of the food is important.
An antihistamine at the first sign of symptoms is worthwhile but may not necessary stop the progression of the changes toward anaphylaxis, and is not the treatment for anaphylaxis. If these symptoms do occur then there is adrenaline available in the form of an EpiPen which can be given (the EpiPen is a specific dosed spring-loaded device containing adrenaline), which can be used to control the symptoms. The recommendation in using an Epipen is for any child under 20 kg to have the Epipen Junior (150 mcg dosage) and any child over 20 kg should have the adult strength (300 mcg). Along with the EpiPen, the child and the family should have an action plan available for kindergarten, school and home as well as being shown how to use the EpiPen properly.
The Government has provided regular education for kindergartens and schools in the proper use of the EpiPen and while this is important the treatment for any child with potential of anaphylaxis is firstly avoidance and education. Education facilities are now mandated to have their own generic epipens available on site. From November 1st 2018, any person presenting to an emergency department at a public or private hospital with definite anaphylaxis will be reported to the Department of Health so that the possible cause (if unknown) of the anaphylaxis can be investigated.