Food allergy management and prevention — formative SAQs

SAQ 1 — Manage the reaction (10 marks)

A six-year-old with known peanut allergy and mild asthma develops lip swelling, widespread urticaria, wheeze and drowsiness within five minutes of eating a biscuit at a party. A carer has a 0.15 mg adrenaline autoinjector. ^{[14] [6]}

Questions

1. Outline the immediate management of this reaction and the rationale for each step. (4 marks) ^[14]
2. State the weight-banded adrenaline dosing approach and when to repeat it. (2 marks) ^[14]
3. Describe the disposition and observation plan, including the biphasic risk. (2 marks) ^{[14] [6]}
4. Outline the written action plan and equipment the family should leave with. (2 marks) ^{[6] [14]}

Model answer

Immediate management (4). Call for help. IM adrenaline into the anterolateral thigh as the first drug — do not wait for antihistamines or IV access. Lie flat with legs elevated if shocked; high-flow oxygen; IV fluids for shock; bronchodilator adjunctive for wheeze. Reassess ABCDE continuously. ^[14]

Dosing and repeat (2). Roughly 0.01 mg/kg of 1:1000 (1 mg/mL) IM; autoinjector doses 0.15 mg for smaller children (under ~20 kg) and 0.30 mg for larger (~20 kg and over). Repeat after 5 minutes if no response. ^[14]

Disposition (2). Observe for biphasic reaction — at least 6 hours for moderate reactions. Admit this child because of co-existing asthma and the severe initial reaction, and because more than one adrenaline dose may be needed. ^{[14] [6]}

Action plan and equipment (2). Personalised written anaphylaxis action plan (ASCIA/BSACI/FARE) with photo, allergen, dose and stepwise response; two adrenaline autoinjectors by weight; medical-alert identification; school/childcare plan and staff training. ^{[6] [14]}