Anaphylaxis prevention, action plans and autoinjectors — formative SAQs

SAQ 1 (10 marks)

A 6-year-old girl weighing 19 kg was reviewed in the emergency department after an anaphylactic reaction to peanut at a friend's house. She had lip swelling, wheeze and pallor, and recovered after one dose of intramuscular adrenaline from her friend's sibling's EpiPen Jr. She has never had an adrenaline autoinjector prescribed for herself, has asthma treated with a salbutamol inhaler only, and attends before-and-after-school care. Her parents ask what she needs to stay safe. ^[1]

Question: Outline the prevention prescription you would provide at discharge, including the written documents, the device and dose, the education, the school and care setting plan, and the follow-up. (10 marks) ^[10]

Model answer

The two written plans (2 marks). The child is issued both the green ASCIA Allergic Reaction Plan (for any future mild-to-moderate skin reaction, where the carer gives an antihistamine and watches for escalation) and the red ASCIA Anaphylaxis Action Plan (which triggers adrenaline the moment airway, breathing or circulatory involvement, or a multi-system reaction, is recognised). The plans are dated, carry her photo, and are distributed to every carer — parents, the school, and the before-and-after-school care. The colour-coded plan removes diagnostic deliberation at the moment of crisis: the carer reads the colour, they do not diagnose. ^[10]

The device and the dose (2 marks). At 19 kg she is within the 7.5 to 20 kg band, so she is prescribed the 0.15 mg adrenaline autoinjector (EpiPen Jr or Anapen 150), given intramuscularly into the outer middle third of the thigh and held for three seconds. Best practice is to prescribe two devices — one for home and one for school or care — and a trainer device for rehearsal. The family is taught that the dose is repeated after five minutes if there is no response, which is why the second device and the ambulance are essential. The critical counselling point is that the moment she reaches 20 kg the device must be up-titrated to the 0.3 mg device, and her weight is checked at every review. ^[10]

Education and technique (2 marks). Every carer is taught to recognise the anaphylaxis features (throat tightness, wheeze, collapse, pallor, a rapid multi-system reaction) and to demonstrate correct device technique on the trainer device — cap off, orange end to the outer mid-thigh, push and hold three seconds, can go through clothing. The child is taught at an age-appropriate level. Technique is rehearsed because it decays, and the family is told the device expires (around twelve to eighteen months) and must be replaced before the expiry date. ^[9]

The school and care plan (2 marks). The school and the before-and-after-school care each receive a copy of the red plan and a device, a named staff member is confirmed as trained, storage is agreed to be accessible rather than locked away, and the response is rehearsed. Label-reading and cross-contamination advice for peanut is given, and the school's peanut management approach is confirmed. Trigger avoidance is the daily layer that makes the device a backup rather than a first resort. ^[10]

Asthma and follow-up (2 marks). Her asthma is formally optimised — she moves onto a preventer and an asthma action plan, because uncontrolled asthma multiplies anaphylaxis fatality risk and an allergic wheeze treated as asthma delays adrenaline. A referral to the allergy service is made for component testing (Ara h 2) and a review of whether oral food challenge or immunotherapy is appropriate. Follow-up is set at a minimum of annually, at every reaction, and at every weight-band transition. She is sent home only after a period of observation for the biphasic window. ^{[11] [12]}