I plan to write a few blogs about allergies and food intolerance or sensitivity and start today with Anaphylaxis or anaphylactic reactions.
Anaphylactic reactions are life-threatening allergic reactions and have been on the rise in developed countries for a number of years. The WHO (World Health Organisation) actually recommends eight potential allergens that should always be declared on pre-packaged foods: shellfish, fish, eggs, milk, peanuts, tree nuts, sulphites, and cereals containing gluten. This recommendation is in line with findings of a recent Canadian study where “Food was responsible for 84.5% of reactions with peanut/tree-nut accounting for almost 50% of food-induced reactions. Half of milk and peanut induced anaphylaxis cases were attributed to inadvertent exposure to the known allergen.”
What does an anaphylactic reaction look like and why are they so dangerous? They are very fast occurring allergic reactions that not only affect the body part in direct contact with the triggering substance but have an impact on the entire body: skin signs are hives, itching and swelling, which also affects the moth and the throat. The swelling in the mouth and throat can then cause shortness of breath and more problems breathing with wheezing and tightness in the chest. The reaction can then weaken the heart and cause a drop in blood pressure, which can then lead to dizziness and unconsciousness. Anaphylactic reactions can cause cardiac arrest. The symptoms can begin in just a few minutes and can be fatal within less than 30 minutes if not treated or treated too late. The only drug that can stop an anaphylactic reaction is epinephrine, the synthetic version of adrenaline. Most people suffering from anaphylaxis are prescribed an “auto-injector” and additional, supplementary mediations including antihistamines, steroids and asthma inhalers. While auto-injectors can stop the reaction, early administration is essential and repeated dosages at the time of the event might be required.
Anaphylaxis rates vary largely in different countries, in percentage and in triggers. It is estimated that globally 220-250 million people suffer from food allergy and especially in children is on the rise in developed and developing countries. According toe the WAO (World Allergy Organisation), it is estimated that 2% of the population in the USA suffer from anaphylaxis, compared to 0.6-1% of the population in Australia. Data are provided by national registers. In Europe, there are some national registers with surveys on allergy rates. A register of anaphylaxis, which includes the German-speaking part of Switzerland, was started in 2005. 1,163 anaphylactic reactions were reported in Germany, Austria and Switzerland between 2005 and 2009. In a 2004 study, the incidence rate of anaphylactic reactions was 7.9–9.6 per 100,000 inhabitants per year in Canton Bern, equalling 0.008% of the population and its sill considered to be around 0.1%.
In the United States, it is estimated that 4-8% of school age children suffer from a food allergy, the most common one being to hazelnut and peanut. The former is the most common one in Switzerland. Both allergies to tree nuts and peanut often include anaphylactic reactions, including fatalities. A study showed that 20% of children suffering from peanut allergies will outgrow their anaphylactic reaction whereas only 9% of children will have the same positive change in tree nuts. Anaphylaxis rates in Canada are comparable to rates found in the USA and are considerably higher than rates in Europe and Australia.
Treatment, both emergency and long term, varies largely between countries and depends on substances triggering the anaphylactic reaction.
Thus, if these life-threatening allergies are on the rise, what can be done to protect these children and adolescents?
The first law was Sabrina’s Law in Canada and has been force since January 2006. The law regulates that all school boards must have policies and procedures addressing anaphylaxis and must include instruction and guidance on the recognition of anaphylaxis and the administration of medication.
In the United States, where anaphylaxis rates are amongst the highest world wide in just a few days, as of January 1, 2014, the School Access to Emergency Epinephrine Act is in place to protect students with food allergies by allowing schools to stock undesignated epinephrine auto-injectors. In the USA, approx. 20-25% of epinephrine administrations occur in the school environment to students or staff not known to be severely allergic. According to FARE (Food Allergy Research and Education) “about thirty states have either introduced or are very close to introducing legislation allowing schools to stock undesignated epinephrine auto-injectors. Some twenty states have already passed such laws.” Legislation differs by state and access may be restricted to school nurses allowed to administer an epinephrine auto-injector.
A Swiss study published 2011 clearly recommends that all caretakers in day-care facilities, sports clubs and teachers in Switzerland should be informed about an anaphylactic reaction in children and adolescents. School medical services should help for an optimal patient care, i.e., students in school environment. Swiss guidelines for teachers also state that teachers, substitute teachers and all other personnel involved in student care, should be informed about certain conditions of students, including allergies. Up-to-date first aid training is not a mandatory requirement for teachers.
In Switzerland three types of epinephrine auto-injectors are available upon prescription: EpiPen®, Anapen®, and Jext®.
Using an auto-injector is very easy and a combination training of how to recognise and how to manage an anaphylactic reaction, is the preparation every parent, care-taker, or teacher responsible for a child or an adolescent with a serious allergy. This training is vital for appropriate immediate care for someone suffering from a life-threatening anaphylactic reaction. A basic training and annual refresher are highly recommended as studies have shown that already within six months after an “Anaphylaxis Training” more than 50% of patients, parents and care-takers do not remember how to use an auto-injector.
Do you feel that your school or childcare facility should be trained to recognise anaphylaxis? All FIRST AID ON CHILDREN FOR TEACHERS & CAREGIVERS trainings Healthy And Safe Away From Home offers for teachers, schools and all child-care providers include basic anaphylaxis training. We also offer specific ANAPHYLAXIS TRAINING to help teachers and child-care providers to recognise and manage life-threatening allergic reactions.
Severe allergies can limit a person’s ability to travel and communication in foreign languages is essential to make local staff at hotels and restaurants aware of allergies a guest has. There are different options to help with this communication: the book “No Thanks, I’m Allergic” is a small pocket book with important phrases about allergies and food sensitivities, including gluten and lactose intolerance, in 30 languages. An alternative for smart phone users are apps such as the “GlutenFree Passport Gluten-Free Translation Cards for Travel” app or the “Allergy Food Translator” App (62 allergies; E, F, G, Spanish).
Posted on December 28, 2013 by Luitgard Holzleg
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