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Worried about nut allergies? Would you know what to do in an emergency?

09 November 2012

Many of us may have read reports in the press about allergic reactions in children, mostly involving nut allergies. Just recently an 11 year old boy suffered an extreme anaphylactic shock and died after eating a curry from a local take-away.

His parents were aware of his nut allergy and took all the right emergency actions to try and save his life, but would you know what to do if your child had such an allergy? We asked George du Toit, Consultant Paediatrician Allergist at The Portland Hospital, for his advice:

Food allergy is now increasingly common with between 6-8% of young children being allergic to certain types of food. The most common food allergies in young children are eggs, milk and increasingly, peanuts. Other nuts can also be food allergens, including cashews.

Food allergies can result in allergic reactions and even severe reactions (anaphylaxis). A rigorous diagnosis is therefore required in ‘at risk’ children during early childhood.

The majority of food induced allergic reactions, although unpredictable, are not life threatening.  However life threatening and fatal anaphylactic reactions are preventable events, which can and do occur.

Although experimental treatments are being trialled, the only available strategy for the management and prevention of food allergic reactions, is to avoid the risk in the first place. This may prove difficult unless children themselves, and their parents and carers, are trained in the challenging task of successfully identifying, and avoiding, their relevant food allergens.

The expertise of a dietician is invaluable. The child and parents and carers must also be trained to identify common presenting allergic symptoms and to react quickly and give appropriate emergency treatment.

What to do in the event of an allergic reaction

Call for help: stay with the patient, remove the food, lie the patient down unless he or she has difficulty in breathing, when sitting up may be more comfortable.

Administer emergency medication: if the reaction is mild then antihistamines should be sufficient, but repeat the dose if the child vomits. For moderate and severe reactions then immediately administer the injectable adrenaline device (eg EpiPen) that allergic individuals carry. This may need to be repeated after five minutes if the response is inadequate

Observation: when help arrives the patient should be observed in hospital for at least another 4 hours to assess for delayed reactions

Can parents be prepared?

Emergency plan: all patients with food allergy require a written emergency plan which clearly identifies the patient and their medical contacts, lists their food allergy and the steps to be taken in the event of an accidental exposure

Register with Medic Alert: Patients should ideally be registered with Medic Alert and order an identifying bracelet or necklace; this is particularly important for older children who may appear frightening to helpful strangers

Know your environment: Dangerous scenarios for accidental food reactions include school environments, restaurants and commercial air flights. For teenage food allergic patients additional risks include ‘kiss induced’ reactions and the ingestion of unfamiliar meals which may contain hidden allergens. It is important to remember that food allergen inhalation may also result in allergic reactions; this is especially so with inhaled fish and milk vapour

Carrying pre-loaded injectable adrenaline: Portland Hospital allergists always recommend that allergic individuals have two devices on their person. The child and/or their caregiver must be carefully instructed on how to use the pre-loaded injectable

Asthmatic children: Wheezing is a common food induced allergic symptom, particularly in children, therefore all food allergic asthmatic children should also have a Salbutamol inhaler included in their emergency plan

Where can I go for further help and advice?

If you are worried about nut or any other allergies, then The Portland Hospital has a specialist allergy clinic to test children and offer quality advice to parents. In addition, educational materials, such as model medication plans, are available through allergy organisations such as the UK Anaphylaxis Campaign, these organisations also provide guidance for schools and patients who are about to travel http://www.anaphylaxis.org.uk/

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