Reaction time

When faced with a child having a severe allergic attack, time is of the essence
By Vanessa Papas

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More and more cases are being reported worldwide of children dying or suffering multiple heart attacks at school following a major allergic attack. A recent survey by Pharma Dynamics, which involved 800 learners between the ages of 10 and 18 and teachers from independent, government and Model C schools across the country, found that none of the students nor the teachers knew what to do in case of a severe allergic attack, putting children’s lives at risk.
According to international studies the incidence of anaphylaxis (a serious allergic reaction that is rapid in onset and may even cause death) is on the increase. It’s as simple as a teacher offering a child a treat for good behaviour, without knowing about the child’s allergy, or children sharing their lunchboxes with their friends who may be allergic.
Dr Michael Levin, head of the division of paediatric allergy at the Red Cross Children’s Hospital, explains that the main causes of allergic attacks in children is foods, with peanuts being the biggest culprit. Other foods include milk, egg, wheat, soy, fish and shellfish. Certain medications can also cause reactions, such as antibiotics (penicillins and cephalosporins), painkillers (aspirin, NSAIDS, opiates) and radio contrast media (X-ray based imaging techniques). Bee and wasp stings are also a major cause. Rarer causes are blood products, vaccines and allergen extracts in people undergoing injection immunotherapy.
“There are certain common signs that indicate a child is having a severe allergic attack,” says Levin. “Look out for urticarial rashes (hives), angioedema (swelling) and tingling of the palms and soles. Signs of severe anaphylactic attacks include upper airway (high-pitched ‘grating’ sound, coughing, throat clearing) or lower airway (wheezing, difficulty breathing) obstruction, abdominal issues (pain and vomiting), loss of blood pressure (leading to fast weak pulses and loss of consciousness) and central nervous signs (feeling of panic or extreme lethargy).”
Levin says it’s important that parents and teachers know the difference between a mild episode and a severe anaphylactic attack. “For mild attacks, an antihistamine is usually sufficient, but the child should not be left alone. They should be closely observed, their relatives called, and if they have an adrenaline injection (such as epipen), it should be urgently located in case the attack progresses. For severe attacks the adrenaline should be injected into the large muscle of the thigh immediately. If the child is asthmatic a dose of their reliever pump should be administered (six to 10 puffs, one at a time) and the antihistamine given. The ambulance must be called and notified that this is an emergency. If there is no improvement in five minutes a second dose of adrenaline should be given.”
Living with an allergic child
Lori Bentley from Joburg knows first hand how challenging it is to have a child with a severe allergy. At just days old, Lori’s son Ross was diagnosed with eczema and later developed asthma. When he was five years old he suffered a near-fatal severe allergic attack.
“He was bouncing on a hammock that had collected a layer of pollen and had a severe asthma attack from inhaling the pollen,” says Lori. “We were just lucky because I saw him within seconds of the reaction and rushed him to hospital, where they treated him and then told me he was critical. He tested positive for seven airborne allergens as well as peanuts and is at risk of life-threatening anaphylactic attacks. While we have done everything in our power to avoid nuts, we have had a few close calls. A friend brought around some homemade soup a family member had cooked for her. When Ross broke out in hives and started complaining of stomach cramps I knew he was having an allergic reaction, but had no idea where the nut products had come from. After investigating, it turned out that the vegetables in the soup had been sautéed in peanut oil. There have been a few other cases over the years, so we always have to be on our toes.”
Lori explains that having a food allergic child changes what you would think of as a “normal” life. “You develop a new ‘normal’ where you read labels on every new product you consider buying. You adapt recipes, leaving out the nuts if they are present and can be left out. You always ask if your child has his meds on him when he goes anywhere. And you worry a lot when they go out on trips with their school or with friends. My son has also had to accept his condition. He has developed a system where he asks about ingredients before he eats anything that is not home-cooked. He’s had to endure bullying at school (boys in his class throwing peanuts at him) until the school was alerted to it and put a stop to it. He used to be very paranoid about nuts and coming into contact with them, but has calmed down as he’s grown older. I have become an allergy advocate as a result. My biggest achievement has been educating and training the staff of my child’s school in recognising an allergic reaction and what to do about it.”
Allergy action plan
  • Ensure your child’s school is fully aware of his or her allergies.
  • Provide the school with emergency contact information and clear procedures for handling medical issues.
  • Explain the early warning signs of an allergic attack to your child’s teachers so they can be alert for early symptoms.
  • Provide the school with multiple adrenaline auto-injectors to use in case of anaphylaxis and be sure to check the expiry date. Teachers should also be shown how to administer the medication regularly.
  • Be sure that your child fully understands his or her allergies and knows what they can and cannot eat or be exposed to.
  • Send special snacks and treats your child can eat so he or she doesn’t feel left out on special occasions.
  • Get a medical bracelet for your child to wear.
For guidelines on how to treat children suffering from an allergic attack or how to use an adrenaline auto-injector, parents and teachers can visit Allergy SA or Allergy Expert.
To connect with other parents of children with allergies, visit Allergy Epicentre.

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