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Continuing professional development

Triggers, clinical features and


management of anaphylaxis in children
NCYP35 Diinbar H, Luyt D (2011) Triggers, clinical features and management of anaphylaxis
in children. Nursing Children and Young People. 23, 5, 29-35. Date of acceptance: April 1 2011.

Helena Dunbar is consultant


Summary nurse and David Luyt is
consultant paediatrician,
This article describes the clinical features of anaphylaxis in children and young people. The acute management children's allergy clinic.
University Hospitals of Leicester
of anaphylaxis in hospital and community is described and various prevention strategies are discussed.
NHS Trust

Aims and intended learning outcomes Pathophysiology


Anaphylaxis is described as a severe, life-threatening, Anaphylaxis is a manifestation of a type 1 or acute Keywords
generalised or systemic, hypersensitivity reaction allergic reaction in which the offending allergen binds Adrenaline (epinephrine),
(Johansson ei al 2001). More simply, it is a serious with pre-formed IgE antibodies attached to receptors allergen, anaphylaxis,
allergic reaction that is rapid in onset and can cause on mast cells and basophils. Antibodies are pre-formed avoidance, education
death (Sampson ei at 2006). Incidence appears to be when susceptible individuals first come into contact
increasing, particularly in young children where food with the allergen (sensitisation). The allergen-antibody This article has been subject
to open peer review and
allergy is the most common cause, with peanuts, tree interaction causes the mast cell to break down
checked using antiplagiarism
nuts and milk the most common triggers (Decker ei al (degranulate) resulting in the release of a number software. For related articles
2008, Sheikh ef al 2008, Liew ef al 2009). of chemical mediators, such as histamine, tryptase, visit our online archive and
Anaphylaxis is a medical emergency. It is important leukotrienes, prostaglandins, cytokines and platelet search using the keywords
that nurses understand the basics of anaphylaxis and activating factor. These mediators are responsible
its prevention, are able to recognise symptoms and are for the immediate allergic reaction characterised by
confident in the treatment and management of an acute vasodilatation, smooth muscle contraction and mucus
attack. These skills are necessary to educate parents secretion which, in turn, lead to the different signs and
and carers in avoidance strategies and treatment symptoms observed in the various target organs.
modalities should inadvertent allergen exposure trigger
Anaphylaxis can also occur as a result of a
an anaphylactic reaction.
non-immunological pathway. Most common triggers
The aim of this article is to provide an overview in this area are physical factors such as exercise, cold,
of the clinical features and management of acute heat and sunlight. Other types of anaphylaxis include
anaphylaxis in children and young people. By reading those which fall into a category of idiopathic and
this article and completing the time out activities the mastocytosis. This is beyond the scope of this article.
reader should be able to:
Identify the presenting features of anaphylaxis. Triggers
List potential trigger factors that can cause Potent ally, any allergen can trigger anaphylaxis but the
anaphylaxis in children. most common triggers identified in children are food
Discuss available treatment options. related (Mullins 2003, Braganza ei al 2006,
Demonstrate the safe use of adrenaline (epinephrine) De Silva ef al 2008). These include:
auto-injector devices (AAls). Peanuts and tree nuts, such as cashew, pistachio,
Discuss preventive strategies, education and advice hazelnut, brazil nut, walnut, almond and pecan.
available for parents and children to manage Milk.
anaphylaxis in the community. Egg.
Explore internet and related resources to identify and A small proportion of children will react to the venom
adapt individual patient management plans for use in from stinging insects, such as the honeybee and
your own practice areas. wasp family.

NURSING CHILDREN AND YOUNG PEOPLE June 2011 I Volume 23 Number 5


Continuing professional development

Drugs. Some medications can cause anaphylaxis. To summarise, a diagnosis of anaphylaxis is likely
Although more common in adults, it is important if a child has been exposed to a known trigger and
to recognise that the most common problems are unexpectedly - usually in minutes - has rapid skin
the beta-iactam antibiotics, for example peniciiiins, changes, life-threatening airway or breathing problems,
cephaiosporins, and muscie relaxants, for example and/cr circulation problems.
suxamethonium and vecuronium) (Simons 2010). Now do time out 2.
Now do time out 1.

Signs and symptoms


Epidemiology
Imagine you are admitting a chQd in
Ascertain the number of children who have anaphylaxis, consider the organ systems
diagnosed adlergies to food in your area involved and describe the main signs and
of practice and whether these are locally symptoms that you may expect to see. How
diagnosed as potentially anaphylactic? you would explain to a child and their parents
Consider the potential impact that has on the effects of anaphylaxis on the body?
your service?
Clinical presentation
Anaphylaxis can affect any body system but the most
Recognition of anaphylaxis common systems affected are skin (80 to 90 per cent
The lifetime prevalence of anaphylaxis from all triggers episodes), respiratory (70 per cent), gastrointestinal
has been estimated to be up to 2 per cent of the (30 to 45 per cent), cardiovascular (10 to 45 per cent)
population (Lieberman e al 2008). Annual incidence and central nervous system (10 to 15 per cent)
rates will vary across countries but the UK has been (Simons 2009).
reported as seeing a sevenfold increase in the past Symptoms can occur within the first few minutes
decade, estimating the annual incidence as 10.2 per of exposure to the allergen and time to arrest can be
100,000 (Gupta ef a/2007). quick, 30 minutes with food allergens to respiratory
The rate of occurrence seems to be increasing arrest (Pumphrey 2000). There is a range of signs and
particularly in young children. A study in Melbourne, symptoms commonly seen in children (Box 1, page 32).
Australia, of children presenting in the emergency A single set of criteria will not identify all
department with anaphylaxis reported a median age for anaphylactic reactions. Nurses need to be able to
first presentation of two and a half years (De Silva et differentiate which symptoms are more serious,
al 2008). Death from anaphylaxis is considered rare, potentially life threatening and require immediate
however 20 to 30 deaths (adults and children) occur in emergency treatment:
the UK every year attributed to anaphylaxis (Pumphrey Difficulty in swallowing/breathing.
2000, Pumphrey and Gowland 2007). However, Cough and wheeze, shortness of breath.
uncertainties about how to distinguish anaphylaxis from Hoarse voice and/or stridor, aphonia.
lesser allergic reactions make it difficult to ascertain its Pale and clammy.
true prevalence. Tachycardie.
An article published in the United States showed Loss of consciousness.
that in emergency department visits for acute systemic Children should be observed and monitored for six to
allergic reactions, only 1 per cent received the diagnosis eight hours after the first signs of symptoms due to
of anaphylaxis, alternatively diagnosed as acute allergic the possibility of a second reaction (biphasic). A small
reactions or acute hypersensitivity reactions (Gaeta et number, approximately 5 per cent, have a second
al 2007). To enable practitioners to recognise and reaction (Dibs and Baker 1997, Lee and Greenes
diagnose anaphylaxis an international task force has 2000).
drawn up a clinical working definition (Sampson et al
2006). In its guidelines on the emergency treatment of Differential diagnosis Conditions that present with
anaphylactic reactions, the Resuscitation Council (UK) clinical features similar to anaphylaxis need to be
(2008) describes three clinical criteria which, if all are considered, such as:
present, suggest anaphylaxis is a likely diagnosis: Panic attacks - usually no urticaria or swelling.
Sudden onset and rapid progression of symptoms. Breath-holding attack.
Life-threatening airway and/or breathing and/or A vasovagal reflex episode - usually no urticaria, skin
circulation problems. cold and pale, slow pulse.
Skin and/or mucosal changes, such as flushing, Acute life-threatening asthma attack.
urticaria and angioedema. Shock.

1 ^ June
June 2011 | Volume 23 i Number 5 NURSING CHILDREN AND YOUNG PEOPLE
Investigations
There is no diagnostic test for anaphylaxis. Blood
tests can look at tryptase or histamine levels, however
both have to be taken soon after the onset of the
anaphylactic episode as levels return to normal quickly.
It has also been shown that the serum tryptase level
is seldom increased when anaphylaxis is triggered by
food (Sampson ef al 1992). Skin-prick testing or serum
Diagnosis - look for:
specific IgE blood tests can help identify allergens, thus
Acute onset of illness.
enabling families to identify possible triggers and help in
Life-threatening Airway and/or Breathing and/or
avoiding allergen exposure.
Circulation problems'.
And usually, skin changes.
Risk factors
Risk factors to help practitioners identify those children
and young people who are at risk if exposed to a known
trigger include;
Call for help. 1
Lie patient flat.
Patients who have had an anaphylactic reaction have Raise patient's legs.
a strong likelihood of having another one (Pumphrey
and Stanworth 1996, Mullins 2003).
A strong link has been identified between poor
Adrenaline^.
asthma control and fatal anaphylaxis in children with
food allergy (Sampson ef al 1992, Pumphrey 2000,
2004). When skills and equipment available:
Adolescents who take less care avoiding known Establish airway.
triggers, particularly in foods, or fail to carry their High flow oxygen. Monitor:
AAls (Greenhavirt ef al 2009). IV fluid challenge^. Pulse oximetry.
Treatment in hospital. Chlorphenamine". ECG.
The management of anaphylaxis involves treating Hydrocortisone^. Blood pressure.
the acute episode and implementing strategies in the
community to prevent reoccurrences.
'Life-threatening problems:
Airway: swelling, inoarseness, stridor.
Treatment in hospital Recognition and rapid treatment
Breathing: rapid breathing, wheeze, fatigue, cyanosis, SpO^ < 9 2 % , confusion.
of the acute episode are vital. This includes rapid CitcHlation: pale, ciammy, low blood pressure, faintness, drowsy/coma.
assessment of airway, breathing and circulation using
the ABCDE approach. If a child is in cardio-respiratory ^iV fluid chailenge:
'Adienaiine (give IM unless experieticed with IV adrenaline)
arrest they should be managed via a standard arrest Aduit:
IM doses of 1:1000 adrenaline (npeat after 5 minutes if rx> better)
500-1,OOOmL
protocol (Resuscitation Council (UK) 2010). The key Adult 5 0 0 micrograms IM (0.5mL).
Ciiiid: crystaiioid
steps for the treatment of anaphylaxis in hospital are Child more than 12 years: 5 0 0 micrograms IM (0.5mL).
20mLykg.
Child 6-12 years: 3 0 0 micrograms IM (0.3mL).
shown in the anaphylaxis algorithm published by the Stop IV colloid if tinis
Child less than 6 years: 150 micrograms IM (0.15 mL).
migiit be tiie cause of
Resuscitation Council (UK) (2008) (Figure 1).
Adrenaiine IV to be given only by experienced specialists anapi^yiaxis
Titrate: aduits 5 0 micrograms; chiidren 1 microgram/kg
Adrenaline This is the medication of choice for the
treatment of acute anaphylaxis. The first-aid dose ^Chlorphenamine 'Hydrocortisone
of adrenaline is O.Olmg/kgof a lmg/mL (1:1,000) (iMorsiowiV) (iMorsiowiV)
Aduit or ciniid more than 12 years: lOmg 200mg
diljtion to a maximum dose of 0.3mg in a child or Chiid 6-12 years: 5mg lOOmg
0.5mg in an adult. Ciiiid 6 months to 5 years: 2.5mg 50mg
> 1 2 years: 500 micrograms (meg) intramuscular Chiid iess than 6 months; 250 microgramVi<g 25mg

(IM) (0.5mL) - same as the adult dose. 300mcg (Resuscitation Councii (UK) 2008)
(0.3mL) - if child is small or prepubertal.
>six to 12 years: 300mcg IM (0.3mL). response and if there is no improvement in the
>six months to six years: 150mcg IM (0.15mL). patient's condition.
<six months: 150mcg IM (0.15mL) (Resuscitation The alpha-adrenergic effects of adrenaline increase
Council (UK) 2008). peripheral vascular resistance, blood pressure and
The guidelines recommend that the dose can be coronary artery perfusion, while reducing angiodema
repeated at five-minute intervals, according to patient and urticaria. Its betaj adrenergic effects increases

NURSING OHILDREN AND YOUNG PEOPLE June 2011 | Volume 23 | Number 5


Continuing professional development

<six months: 25mg IM or IV injection slowly


(Resuscitation Council (UK) 2008).
Organ system Symptoms and signs
Skin and mucosal Flushing and erythema - patchy or generalised. Fluid Fluid replacement 20ml/kg.
membranes Urticaria - hives/wheals/welts. The dosing schedule for the various options mentioned in
Pruritus- palms, feet, head, lips, tongue. this section for the treatment of anaphylaxis in hospital is
Angioedema - lips, eyelids. summarized in Table 1.
Respiratory Early rhinitis symptoms - runny nose, itch, sneezing. Now do time out 3.
Itchy throat and external auditory meatus.
Clearing throat.
Treatment options
Swelling lips and tongue.
Look up in a formulary or pharmacology
Cardiovascular Hypotension - fainting and light headedness.
textbook the actions of adrenaline, identifying
Neurological Sudden behaviour/mood change, irritable, persistent crying. how it can reverse the effects of anaphylaxis.
Feeling of impending doom. Look at policies, or medical guidelines in your
Gastrointestinal Itchy tongue and palate. workplace to treat anaphylaxis in chdren
Nausea and abdominal cramps. and young people. If there are none available
Vomiting. perhaps consider developing one.
Diarrhoea.

heart rate and contraction while its beta^ adrenergic Treatinent in the community
effects cause bronchodilation and inhibits the release of Anaphylaxis mostly initiates in the community setting
inflammatory mediators. There are no contraindications and for this reason patients need to recognise the early
for the use of adrenaline in an anaphylactic reaction. symptoms of anaphylaxis and when they need to use
There are other medicines that can help, such as: their adrenaline. This [adrenaline] should be given
Antihistamines Hj antagonist, for example to a child with life-threatening signs or symptoms of
chlorphenamine and cetirizine, can be used to treat itch anaphylaxis. If these are absent it is recommended that
and hives which occur in anaphylaxis. However, there is the child is carefully watched and reassessed. Allergic
no research evidence of their efficacy in anaphylaxis and reactions which affect the skin only can be treated with
for this reason they should never delay the administration antihistamines.
of adrenaline if required (Sheikh e al 2007). Antihistamines are best given in liquid form
Chlorphenamine to encourage rapid absorption, for example
> 1 2 years and adults: lOmg IM or intravenous (IV) chlorphenamine and cetirizine. If, however, the child's
injection slowly. condition deteriorates in any way then adrenaline must
>six to 12 years: 5mg IM or IV injection slowly. be administered. Adrenaline should be administered
>six months to six years: 2.5mg IM or IV and repeated every five to 15 minutes until clinical
injection slowly. improvement is seen. In the community, the best way
<six months: 250m^kg IM or IV injection slowly of providing first aid treatment with adrenaline is by
(Resuscitation Council (UK) 2008). using an AAI which delivers an intramuscular injection
of adrenaline into the mid-anterolateral aspect of the
Inhaled beta^ agonists These can be administered thigh. Intramuscular adrenaline is absorbed rapidly with
via a spacer device or nebuliser as a treatment for peak concentrations being reached within ten minutes
bronchospasm associated with anaphylaxis. of administration (Simons et al 1998).
Adrenaline is currently available in the UK in
Oxygen For patients experiencing respiratory symptoms two types of single-use AAls (Table 2, page 34). As the
or low blood pressure, high flow oxygen should be journal went to press, a third adrenaline autoinjector,
delivered. Jext, was due to be launched later in 2 0 1 1 , Jext
150mcg has been licensed for children 15-30kg and at
Corticosteroids These should only be given after first 300mcg for children of 30kg and above.
line emergency treatment has been received, that is AAls should be kept at room temperature, away
adrenaline and/or antihistamines. from heat sources and direct sunlight. All devices will
Hydrocortisone have an expiry date and should be renewed at this
> 1 2 years and adults: 200mg IM or IV injection slowly. time. Information about EpiPen and Anapen use and
>six to 12 years: lOOmg IM or IV injection slowly. registration for their expiry scheme is available on the
>six months to six years: 50mg IM or IV injection slowly. following websites www.anapen.co.uk and

|^ June 2011 Volume 23 Number 5 NURSING CHILDREN AND YOUNG PEOPLE


www.alk-lifeline.co.uk. Devices are also available as
trainer devices, which are needleless replicas of the
actual devices patients can use to practise with. Age range Adrenaline Antihistamine - Corticosteroid -

Patients should have access to their AAls at all (epinephrine) 1:1000 chlorphenamine hydrocortisone

times. Despite this, evidence suggests that up to given intramuscularly IM or slow I M or slow IV
70 per cent of patients do not carry their AAls at all (IM) intravenous (IV)
times. (McLean-Tooke ef al 2003). There is ongoing injection
debate on the number of AAls that patients should carry > 1 2 years 500 micrograms (meg). lOmg 200mg
or have access to. 300mcg small child or
The number of AAls that should be prescribed prepubertal, 0.5mL,
depends on careful assessment of the risk factors and 0.3mL
individual child and family circumstances, for example >six to 12 300mcg, 5mg lOOmg
the remoteness of location from medical facilities, years 0.3mL
and weight of child of more than 60kg. There is no >six months 150mcg, 2.5mg 50mg
self-injectable adrenaline pen for infants under 15kg. to six years 0.15mL
The alternative to prescribing the 0.15mg dose is
<six months 150mcg, 250mcg/kg 25mg
to show parents how to draw up the correct dose of
0.15mL
adrenaline using a needle and syringe. This, however,
presents the risk of drug errors occurring. Therefore, (Adapted from Resuscitation Council (UK) 2008)
above the age of six months it is recommended that it
is safer to use the 0.15mg AAI (Resuscitation Council delivery of anaphylactic training in primary care. Box 2,
(UK) 2008). It is crucial that, at all times, a child page 34, summarises the key areas and actions that
should have access to at least one of their AAls. shoulc be covered when a diagnosis of anaphylaxis is
made in a child.
Education Now do time out 4.
Age, lifestyle, hobbies and access to medical care
should be considered in management strategies. Emergency plans
Obviously, the mainstream of management is careful The prescribing of adrenaline has almost doubled in
avoidance of trigger factors. Education is adapted recent years (Sheikh ef al 2008) but there is evidence
depending on the trigger implicated. to suggest that a significant proportion of patients fail
Dietitians are vital members of the multidisciplinary to use their AAI when an event occurs (Simons ef al
team and in food allergy can offer specific trigger-related 2009). Some are uncertain whether their reaction is
advice, including alternative names for food items, severe enough to require treatment and others turn to
exclusion of foods in a diet, ingredient checking on other medication choices as first-line treatments, such as
labels, eating out, takeaway foods and recipe plans. It antihistamines and asthma inhalers. They may be afraid
is important that children do not follow a restricted diet to inject or simply have forgotten how to use the device.
or exclusion diet unless supervised by a dietitian as they Individual management plans (IMPs) have been
require a well-balanced diet to ensure adequate growth shown to result in up to an eight fold reduction
and development. in frequency of anaphylactic events and a 60-fold
There are some circumstances where desensitisation reduction in severe reactions (Nurmatov ef al 2008).
may be an option for management. This is true for Education is an ongoing process and regular revision
those children who have had an anaphylactic episode is encouraged.
on contact with a stinging insect. Immunotherapy
(desensitisation) is not routine in clinical practice;
Education and training
for this reason children should be referred to an
allergy specialist. Some clinics in the UK are offering Study the Walker ef al (2010) article and
immunotherapy either sublingually or subcutaneously others, for example, Muraro (2010), to review
for foods such as milk, egg and peanut, animal danders alternative models of care and packages
and grass pollen. that Ccin be adapted to use in your area of
There is, however, ongoing research in these areas to practice to train professionals and families
determine the efficacy and extent of the desensitisation in cinaphylaxis management. Consider some
and its long-term effects. Healthcare professionals need of the ways parents cope with the fear of
to be trained to use AAls correctly and safely so that inadvertent exposure. What do you need to
they can, in turn, teach parents, careers and children. include in your training to support them?
Walker ef al (2010) describe best practice for the

NURSING OHILDREN AND YOUNG PEOPLE June 2011 | Volume 23


Continuing professional development

Table 2 Role of schools


Schools need adequate mechanisms to support
Device Adrenaline dose Child's weight
children with allergies. Food allergy particularly is a
EpiPen 0.3mg >30kg to adult common trigger of anaphylaxis for school-aged children
EpiPen Junior 0.15mg 15-30kg (Bock ef al 2007, De Silva ef al 2008). Consequently,
EpiPen Junior 0.15mg <15kg schools need to be able to prevent and treat anaphylaxis
Anapen 500 0.5mg >60kg by having access to training, written emergency plans
Anapen 300 0.3mg >30kg and labelled emergency kits. Recommendations and
Anapen 150 0.15mg 15-30kg actions, as they apply to families, schools and students
Anapen 150 0.15mg <15kg are summarised by Muraro ef al (2010).
Identified school staff should be trained in the
(British National Formulary for Children 2010-2011)
early recognition of the symptoms of anaphylaxis and
understand that adrenaline must be administered when
respiratory or cardiovascular signs are present. They
should be shown how to administer adrenaline via the
Educating families and care givers should cover the following:
child's AAI and know how to call for emergency medical
The basis of anaphylaxis; the allergen responsible, including alternative names
help to transfer the child to a medical facility for
for the allergen in foods; how to avoid the allergen and recognition of the early
ongoing assessment.
signs and symptoms.
Prescription of adrenaline and training in how to use an adrenaline auto-injector. An IMP that is drawn up between family, medical
Provision of emergency kit with correct doses of medication. staff, the community or school nurse and the school
Provision of individualised management plan. can support schools to achieve a plan for the day to day
Implementation of the individual management plans into the community management of the allergic child. Schools can also be
including other facilities as necessary, such as schools, nurseries and encouraged to develop a policy for the management of
childminders. the allergic child in their school. Ideally the IMP and its
components should be reviewed on an annual basis.
Use of alert jewellery, such as medic alert bracelet, informing others of allergy.
There are also many resources available for schools to
Annual updates.
help with their education and training. Training should
Guidance in up-to-date resources available for their access.
be provided by nurses in the community, school nurses,
How to call for emergency help.
health visitors or community children's networks who
have been trained to deliver education packages to
Different types of management/action/care plans are schools and nurseries.
available and many can be downloaded from websites Now do time out 5.
to be adapted for use. Copies should be kept by the
child, their parents, their educational establishment, Role of industry and the puhlic
and childminders, with emergency medication. IMPs With food allergy the possibility of anaphylaxis
should include the following: occurring, if a child comes into contact with or
ingests the food which is their trigger needs to be
Patient information Include contact details for parents discussed. This includes hidden allergens, that is cross
and GP's details. reacting allergens in other foods and high-risk places
Identification of allergens to be avoided For example, where children are exposed to foods, for example,
peanuts and egg. schools, restaurants, other homes, childcare facilities
and nurseries.
Stepwise approach for management If there is a Research into food allergy fatalities has shown that
rash or local swelling administer liquid antihistamine; individuals need to enquire in detail about ingredients of
monitor child for any respiratory symptoms; administer
adrenaline if any respiratory or cardiovascular
Individual management plan
compromise, for example if there is any wheezing in
the chest or difficulty in breathing; call emergency Using web-based resources consider the
numbers. different action/care plans available to
support the training of children, parents and
Delivery Instructions on how to deliver medication via professionals in the emergency treatment of
stated device. anaphylaxis. What plans would work best for
your area of practice ? Prepare a plan which
Repeat dose Recommendation to repeat dose if no could be used in a school or nursery.
clinical improvement in five to ten minutes.

June 2011 Volume 23 | Number 5 URSING CHILDREN AND YOUNG PEOPLE


foods eaten away from home, for example bakeries and Chi dren and their carers must be trained in the
res:aurants (Bock et al 2007). avoidance of pertinent tri^ers. In the case of inadvertent
Nurmatov (2008) showed that among food allergic exposure the early recognition of the symptoms of
individuals almost 47 per cent attributed at least anaphylaxis and first-aid treatment with adrenaline via
one accidental exposure event to inappropriate food their A.M. Trainer pens should be used in education to
labelling, 29 per cent failed to read the labels and ensure that parents and age-appropriate children can
8 per cent ignored a precautionary statement. Although administer them. Community nurses can support parents
it is the responsibility of the child and family to disclose and ensure that schools, nurseries and childminders are
an allergy, industry and the public have a role to ensure aware of a child's allergy and potential for anaphylaxis.
that foods are labelled correctly and that foods used in Schools and nurseries should have established policies
the cooking process are disclosed accurately in place and available resources to ensure that staff
are trained in anaphylaxis management. IMPs are one
Conclusion way to support patient education and training. Although
Anaphylaxis is a severe life-threatening allergic reaction anaphylaxis is intermittent in nature it is unexpected,
thart is becoming more common. In children it is rapid in onset, potentially life threatening and therefore
triggered mainly by food allergens. It manifests with a medical emergency. Nurses should ensure they have
the competencies to manage anaphylaxis and therefore
a broad range of clinical features. Its management
support the children and families that they care for.
consists of emergency treatment and prevention of
reoccurrences. Healthcare professionals must be
trained in anaphylaxis and its management to help Practice profile
train parents, children and other carers. Intramuscular
adrenaline injection is the first-line treatment for Now that you have read the article you might
anaphylaxis with respiratory or cardiovascular like to write a practice profile. Guidelines to
compromise, and nurses in the hospital or community help you are on page 36.
should be able to recognise anaphylaxis and deliver
an adrenaline injection as soon as they are aware of
symptoms.

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NURSING CHILDREN AND YOUNG PEOPLE June 2011 | Volume 23 | Number 5


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