If anaphylaxis is suspected, follow the emergency response protocol.

If the pupil has been diagnosed with an allergy and if the PAAP gives authorisation to use a spare AAI for anaphylaxis, this should be administered immediately.

If parental consent and medical authorisation to use a spare AAI has not been obtained, a dose of antihistamine should be given and the emergency services should be called (999) immediately to ask for advice, making clear that you suspect anaphylaxis.

The Department of Heath states that the operator can give school staff the authority to use an AAI if there is one on site e.g. a spare AAI or another pupil’s device.

In the 2012 Medicines Act, adrenaline is listed as a drug that can be administered by anyone if the intention is to save a life.

The dose of adrenaline in the AAI is safe, meaning it is unlikely to harm a healthy pupil. Side effects include increased/ irregular heartbeat, dizziness, headache, or nausea. These are short lived and should resolve within ~30minutes.

The overwhelming consensus among experts is the benefit greatly outweighs any risks. However, the pupil should be assessed by a medical professional following inappropriate administration of adrenaline.

The advice is: If in doubt, give adrenaline and dial 999.

AAIʼs need to be stored in an unlocked and easily accessible location so they can be retrieved quickly in emergencies.

However, if you are worried about pupils getting hold of the AAIʼs and playing with them, store them at height or in places where adults are always present e.g. the school office or where pupils are not usually allowed such as the staff room.

Educating pupils about allergy and anaphylaxis from an early age is a good way of encouraging responsible behaviour.

If a child was to inappropriately inject themself or another pupil with adrenaline using an AAI and no anaphylaxis is suspected, staff should call NHS 111 to seek advice. The pupil should be monitored closely in a first aid room and their parents informed.

If the pupil is having breathing difficulty, the salbutamol inhaler (blue inhaler) should be given after the first AAI. The pupil should be left sitting on the floor or should be positioned lying down with the legs raised if signs & symptoms of low blood pressure are seen i.e. dizziness, tiredness. The allergen should be removed if visible and possible e.g. bee sting or food.

If no improvement in symptoms is witnessed or the child appears to be deteriorating after 5 mins of administering the first AAI, a second AAI device should be administered. Guidelines state that all patients at risk of anaphylaxis should carry, or have access to two AAIʼs at all times.

A second phone call to the ambulance should be made to make sure this has been dispatched.

Storing out of date medication goes against the principles outlined in the Scottish government statutory guidance. Strategies to avoid this can be found in the Emergency response to anaphylaxis section.

In an emergency where the only available AAI is out of date, it should be used and 999 called. The adrenaline is likely to be less effective, but it is better to use this than none at all.

This should only be done in exceptional circumstances where no in date medication is available.

An incident report should be completed, investigating why the medications were not in date and how to avoid this in the future. Following this incident, measures should be put in place to ensure medication is in date, including regular audits.

An asthma attack can present with similar symptoms to anaphylaxis.

Anaphylaxis is also often overlooked in pupils with asthma, which leads to an incorrect emergency response.

This is why it is important for pupils at school to have management plans in place, their medication stored as part of an emergency kit and that staff are aware of their medical condition(s). Symptoms of allergy often appear acutely and may occur with other symptoms such as vomiting, diarrhoea, skin rash or dizziness. Symptoms of asthma often have a gradual onset.

If a child with a food/drug/latex allergy and asthma develops breathing difficulty, they should be treated with adrenaline via an AAI first if it is suspected he/she has been exposed to a known allergen. Following this, the Salbutamol inhaler (blue inhaler) should be used.

Symptoms of a mild reaction include itchy, red, watery eyes; red, itchy skin, rash; swelling of the eyes or lips.

Mild to moderate symptoms are usually responsive to antihistamines. The child normally does not need to be sent home from school or require urgent medical attention.

A second dose of antihistamine can be given if needed i.e. in cases of vomiting, (see BSACI Plan). Staff should always document when a dose of antihistamine is given and inform the parent/carer(s).

If symptoms worsen and progress to severe, antihistamines are ineffective. The pupilʼs prescribed AAI should be given immediately and 999 dialled. If the pupilʼs AAI is not available or they have not been prescribed one, a spare AAI should be given if authorisation for use is in place.

If no AAI is available to use, 999 should be dialled immediately stating anaphylaxis.

The operator can give authority to use an AAI if there is one on site e.g. a spare AAI or another pupil’s device.