The Australasian Society of Clinical Immunology and Allergy

6 September 2005

DEATH FROM PEANUT ANAPHYLAXIS AT SCHOOL CAMP

Findings of the coronial inquest into the tragic death from peanut anaphylaxis of Hamidur Rahman are due to be handed down at the Glebe Coroner's Court this Friday, 9 September 2005.

Peanut allergy has increased alarmingly in prevalence around the world in the past 10-15 years. In a recent NSW and ACT survey, 6% of preschool aged children were reported to be allergic to one or more of the common food allergens, and 2% were reported as peanut allergic. Although most children grow out of allergies to egg, milk and other common food allergens by the time they get to high school, 4 out of 5 peanut allergic children will retain the allergy for life.

Anaphylaxis is the most severe form of allergic reaction and can be life threatening. Although infrequent, children with a clinically documented allergy to food are at risk of developing anaphylaxis if they accidentally ingest the allergen. Most deaths from food anaphylaxis are due to peanut or other nuts. Teenagers and young adults are at greatest risk, especially if they have asthma. Prompt administration of adrenaline via an auto-injector device (EpiPen®) can be life-saving.

As highlighted by the inquest into the death of Hamidur Rahman there is a general lack of understanding of food allergy and the prevention and management of anaphylaxis, not only amongst teachers and other staff in the school system, but amongst doctors and other health professionals.

"Hamidur was failed by the system rather than any one individual" stated Dr Rob Loblay, Co-Chair of the ASCIA Anaphylaxis Working Party, who examined the evidence and made a submission to the inquest. "There were many missed opportunities. His food allergies were never properly assessed and diagnosed; there was poor communication within the school; and there was a lack of awareness of the risk of anaphylaxis and the availability of life-saving medication."

In recognition of the need for high quality information about anaphylaxis, the Australasian Society of Clinical Immunology and Allergy (ASCIA) has developed a range of materials which are freely available on the ASCIA website (www.allergy.org.au):

• Anaphylaxis Action Plan
  
• Prescription Guidelines for EpiPen®
  
• Guidelines for prevention of food anaphylactic reactions in schools, preschools and child-care centres

ASCIA has also recently allocated funds for the development of a national Anaphylaxis Registry. This will provide valuable information to help with public health surveillance; policy development; evaluation of prevention strategies; resource allocation; targeting of public and professional education; and management of those at risk of anaphylaxis.

ASCIA has provided support for NSW Health in producing anaphylaxis guidelines for NSW schools. "Following release of the guidelines in December 2003, three anaphylaxis nurse educators were funded for 2 years by NSW Health to help in their implementation" said Dr Loblay. "However, with more than 3000 schools and over 1000 childcare centres in NSW, it has become clear that 3 nurse educators cannot possibly meet the ongoing need for training and information throughout the state."

ASCIA urges state and commonwealth governments to consider:

• Introduction of mandatory universal anaphylaxis training of staff in all childcare centres, preschools and schools;
  
• Expansion and permanent funding of the anaphylaxis nurse educator scheme;
  
• Incorporation of anaphylaxis as a routine component of all first aid training courses;
  
• A requirement for adrenaline auto-injectors to be placed in first aid kits in all places of risk, including childcare centres, preschools and schools.
  
• Allocation of proper resources for public hospital allergy services, which are non-existent or in desperate shortage in most states and territories;

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