Adrenaline jabs 'badly managed'

A child receives a skin-prick test for allergies

Researchers have found major inconsistencies in the management of children prescribed adrenaline injections to stave off potentially fatal allergic reactions.

Adrenaline autoinjectors, or injection pens, are carried as an antidote for extreme allergic reactions - also called anaphylactic shock.

But a study published in the journal Archives of Disease in Childhood indicates the injection pens are inconsistently prescribed and issued with inadequate training or monitoring.

It found just a tenth of 60 children identified could demonstrate how to use the pens correctly.

We get people who have been prescribed the pens and they've not actually been shown how to use them

Muriel Simmons, British Allergy Foundation

The study's authors are calling for national guidelines on the management of how the injection pens are prescribed and used.

Researchers identified 60 pupils at 86 schools in Hounslow, west London.

They then interviewed 25 children aged four to 17 and their parents about how and why they used the pens.

Nut allergies

On average, the children had been prescribed the pens for a period of three years.

Of those, two thirds were allergic to peanuts and the rest to tree nuts, such as hazelnuts and walnuts.

Ten had experienced allergic reactions after being prescribed the pens, but only two had used the device.

Eight had experienced breathing problems as a result of their allergy.

One child had tested positive for allergens but had no symptoms.

Eleven children also had asthma.

Half were being treated by a specialist at a hospital. a quarter by their GP, and the remainder at an allergy clinic.

A third of children treated by their GP or at a district general hospital were not given any training on how to use the pens.

Just one in three children at an allergy clinic were given written instructions with the devices.

A third of those prescribed an injection pen by their GP had been given an allergy test, and none of these children had subsequently been actively monitored.

Three children had been prescribed an incorrect dose.

Concerns

Dr Ratna Sundrum, a consultant paediatrician at Hounslow and Spelthorne Community and Mental Health NHS Trust who worked on the study, admitted it had its limitations because just 45% of people contacted responded.

But she added: "Our study has shown that there are several areas of difficulty surrounding the use of adrenaline autoinjectors in the community.

"The main problems are a lack of consistency in management, problems with training, and poor follow-up. We recommend development of evidence based national guidelines."

Since the study was done, Hounslow has changed its treatment of children with severe allergies to ensure they are all treated in the same way.

We have serious reservations about teachers administering any medications to children

Spokeswoman for the NASUWT

Muriel Simmons, chief executive of the British Allergy Foundation (BAF), told BBC News Online: "Our major concern is that we get people who have been prescribed the pens, for themselves or their children, and they've not actually been shown how to use them - so you might as well not give them at all."

"This should also be a necessary part of teacher training," she added.

The BAF, with patient interest groups representing diabetics and asthmatics, is in the process of drawing up national guidelines on how schools can best cope with children with these conditions.

But a spokeswoman for the National Association of Schoolmasters and Union of Women Teachers (NASUWT) said: "We have serious reservations about teachers administering any medications to children.

"They have no legal or contractual responsibility to do so and where they engage in such activities this is entirely voluntary.

"We believe that the medical care of children is the responsibility of parents and health practitioners, not teachers."