X:\Educational & Student Policy\GBEC\Health & Wellbeing Committee\Anaphylaxis Guidance\Anaphylaxis Guidance May 2014.

docx 14 May 2014

Guidance on the recognition and
treatment of individuals at risk of
Anaphylaxis
Issued by the
Health and Wellbeing Committee
With thanks to Emma Dellar and Sall y Maccallum
Introduction
This document is written for College and Departmental staff and concerns the ongoing safe management
of students with a risk of anaphylaxis.
An increasing number of people are vulnerable to severe, life threatening hypersensitive allergic reactions
(anaphylaxis). These reactions occur rapidly, within minutes or, less often, hours of contact with the
allergen and can lead to death if not treated promptly. Contact may be the result of eating the allergen but
may also be through breathing it in or touching it.
Although food, especially nuts and nut products, is the most common cause of anaphylaxis, there are
others, including bee and wasp stings, drugs and latex. If the trigger is known, the best preventative
measure is avoidance.
Recognition
Symptoms can vary in severity and include the following.
Airway and breathing problems; swelling of the airways lips, face and tongue, and narrowing of
bronchioles in the lungs causing wheezy rapid breathing.
Rapid loss of consciousness usually due to lack of oxygen.
Low blood pressure and fast pulse rate can result in cardiac arrest.
Rash and/or itchy skin in around 80% of cases.
Diarrhoea and/or vomiting or nausea.
Treatment
Call an ambulance immediately (tel 999, 112 or 911).
Advise the appropriate staff of the situation: this could include Porters or Reception staff, who will direct
the ambulance team to the casualty.
Inject a measured dose of adrenaline (epinephrine) into the thigh muscle without delay, usually via an
adrenaline auto-injector (AAI), sometimes referred to by their brand names EpiPen, J ext, Emerade or
Anapen.
Deaths occur when adrenaline is not administered promptly, for example, a delay in diagnosis or when
adrenaline is not available.
A second injection may be administered after five to ten minutes if symptoms have not resolved.
Anaphylaxis causes bronchoconstriction, therefore known asthmatics are encouraged to use their own
Salbutamol inhaler before, but not instead of, the AAI becoming available or after the AAI is used.
College Nurses may wish to keep a spare inhaler, for emergency use only, in an appropriate place.
The casualty must be taken to hospital in an ambulance after an AAI has been administered.
Reassure the casualty.
Monitor the casualty and, where possible, arrange privacy.
It is recommended that Colleges and Departments (especially those which use products containing latex
1

as part of their normal teaching) stock a single dose AAI (various brands are available) for emergency
use. AAIs should be sited in readily accessible places, for example in dining halls/cafeterias, receptions,
porters lodges, and appropriately trained staff should be informed of the location; Departments and
Colleges should also consider giving training in the use of AAIs to staff who work in such locations.

1
Items which may contain latex include gloves, rubber tubing, erasers, rubber bands, food prepared by someone
wearing latex gloves, buttons/switches on electronic devices
Action
While students with a known risk of anaphylaxis are encouraged to take responsibility for their own safety,
the Equality Act 2010 imposes a duty to make reasonable adjustments in order to remove barriers. This
affects both Colleges and Departments, which will need to reduce exposure of susceptible students to
trigger substances. Generally, Departments will not present as great a risk, with respect to anaphylaxis,
as Colleges but both are encouraged to adopt the following practices.
Identification of students at risk
Consult the Student Support Document (SSD) if a student has disclosed an allergy, details will be
included in the SSD, which is distributed to Colleges and Departments by the DRC.
College/Col lege Nurses:
College Nurse (or, where there is none, the Senior Tutor or Admissions Tutor) to review health
questionnaires from new students to identify those with a history of life threatening allergic reactions
identified in advance of admission.
Contact the student, if possible prior to College arrival, to establish whether the student has been
advised appropriately about their allergy management.
Where this is not possible, the student should be invited to see the College Nurse within 48 hours of
College arrival.
Students with an uncertain allergy status should be encouraged to see their General Practitioner as
soon as possible in their first term.
Students with a mild or moderate allergic reaction are at risk of, and may subsequently present with,
suspected anaphylaxis. These groups are not included within the scope of this guidance.
Record Keeping
Maintain an up-to-date record of student allergies, their management and, where appropriate, dietary
requirements. College Nurses may also want to update these records as per professional guidelines.
With the consent of the student, this information (complete with a photograph of the student) should be
shared with key members of staff. This could include the Catering Manager, Departmental
Administrator, First Aiders, Senior Tutor, Head Porter, Lab Technicians.
Student Responsibility
Students should be encouraged to:
Take responsibility for managing their allergy: they should know what to avoid and what constitutes a
reasonable level of risk.
Meet with the appropriate members of staff to discuss their needs: for example, catering staff (including
the Catering Manager), Practical Demonstrator.
Carry their AAI, any other appropriate medication and a medical alert or something similar (eg a card
2
)
at all times.
Let their friends know about their allergy and, if they are willing, show them how to use the AAI.

2
http://food.gov.uk/multimedia/pdfs/chefcard.pdf
Communication and Training
Trained first aiders employed by the University and Colleges should be able to provide assistance to
students using an AAI.
Further training for first aiders on anaphylaxis and the use of AAIs is available. For example, details
are available from http://www.anaphylaxis.org.uk or, in Colleges, through College Nurses.
Non-catering staff who offer food and drink to students on an irregular basis (for example, during open
days, social gatherings or academic receptions) should be encouraged to access training (see above).
Staff should be briefed and updated annually to help create a confident understanding of anaphylaxis.
It may be useful to identify key personnel who would be able to answer subsequent queries from staff
or students.
Appendix II provides details of other useful sources of information.
Catering Staff
Service and, where appropriate, waiting staff both casual and permanent should be briefed about
the menu content of each setting and should be given a contact person to handle queries about food
allergies related specific dishes.
In December 2014, new legislation (the EU Food Information for Consumers Regulation 1169/2011) will
be introduced which will require food businesses, including Colleges and Departments, to provide allergy
information on food which is sold unpackaged. Further guidance regarding the new legislation for caterers
may be found at:
http://www.food.gov.uk/business-industry/guidancenotes/labelregsguidance/nonprepacked#.UtfXJ mxFCUl
Full guidance for businesses regarding the appropriate catering practices is available from
http://food.gov.uk/business-industry/guidancenotes/allergy-guide/#.Uxi6rk3ivcs
Catering department auditing is available from external specialist providers, to identify potential risks and
provide advice on unpackaged food labelling rules (EU Provision of Food Information to Consumers
Regulation 1169/2011).
Share Information
Colleges, Departments and the Disability Resource Centre are encouraged to share information.
Appendix I
College Health Questionnaire Allergy Questions
Have you ever had a serious, life threatening allergic reaction?
If so, do you know what triggered it?
Do you have any food allergies?
If so, to which foods are you allergic?
Do you carry any medication for these allergies?
If you have been seen by an allergy specialist, please give details of:
advice on avoidance
advice on management of a reaction
a written emergency treatment plan

Appendix II
References and useful organisations
Food Standards Agency
http://allergytraining.food.gov.uk/english/default.aspx
The Resuscitation Council
http://www.resus.org.uk
The Anaphylaxis Campaign
http://www.anaphylaxis.org.uk
National Institute for Health and Clinical Excellence, 2011. Anaphylaxis: assessment to confirm an
anaphylactic episode and the decision to refer after emergency treatment for a suspected anaphylactic
episode, [Online] Available at:
<www.nice.org.uk/nicemedia/live/13626/57474/57474.pdf>[accessed 20 J anuary 2014].
Allergy Clinic (Clinic 2a)
Addenbrookes Hospital
Hills Road
Cambridge
CB2 2QQ
Tel 01223 217777
http://www.cuh.org.uk/addenbrookes/patients/outpatients/clinics/clinic_2a.html
The NHS 111 Service
Tel 111
http://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/NHS-
111.aspx