Allergy Action Plan Form

Paediatrician's Note - Allergy Action Plan **ALLERGY ACTION PLAN – EMERGENCY TREATMENT** **Patient Information:** * **Name:** Lily Thompson * **Date of Birth:** 15/03/2019 * **Age:** 5 years * **Weight:** 20 kg * **Known Allergies:** Peanut, Tree Nut, Shellfish **Emergency Contacts:** * **Parent/Guardian 1:** Sarah Thompson (07700 900123) * **Parent/Guardian 2:** David Thompson (07700 900124) * **Emergency Contact 3:** Dr. Emily White (Paediatrician) (020 7946 0123) **Symptoms & Actions:** **MILD ALLERGIC REACTION (affecting one body system):** * **Symptoms:** Hives or a few red spots, mild itching, runny nose, sneezing, mild abdominal pain, tingling around mouth. * **Action:** Give Antihistamine (Cetirizine 5mg liquid). Re-evaluate after 15 minutes. If symptoms worsen or more than one body system is affected, follow severe reaction protocol. **SEVERE ALLERGIC REACTION (affecting two or more body systems OR any severe symptom listed below):** * **Symptoms:** * **Breathing Problems:** Shortness of breath, wheezing, repetitive cough, hoarse voice, difficulty swallowing, throat tightness. * **Skin:** Widespread hives, flushing, sudden swelling of face/lips/tongue/throat. * **Circulation:** Dizziness, fainting, pale/blue skin, weak pulse. * **Gastrointestinal:** Severe abdominal pain, repetitive vomiting, persistent diarrhoea. * **Action:** 1. **Administer Adrenaline Auto-Injector (Epipen Jr.) immediately.** Inject into the outer thigh. Hold for 10 seconds. 2. **Call for emergency medical assistance (999 in the UK).** State it is an anaphylactic reaction. 3. Lay patient flat with legs elevated unless breathing is difficult (then sit them up). 4. Repeat Adrenaline Auto-Injector after 5-15 minutes if symptoms are not improving or worsening and emergency services have not arrived. 5. Administer Antihistamine (Cetirizine 5mg liquid) and Oral Corticosteroid (Prednisolone 10mg) if able to swallow. **Important Considerations:** * **Always call 999 for emergency services after administering adrenaline.** * Do not allow the child to stand or walk if dizzy. * Staff caring for the child should be trained in the use of the adrenaline auto-injector. * This plan is for informational purposes and does not replace medical advice. **Medication Details:** * **Antihistamine:** Cetirizine 5mg/5ml liquid, 5ml dose as needed for mild symptoms. * **Adrenaline Auto-Injector:** Epipen Jr. 0.15mg, one dose for severe symptoms. Two devices always kept on hand. * **Oral Corticosteroid:** Prednisolone 10mg tablet (dissolved in water for administration), one dose as directed by emergency services or if advised by medical professional. **Date of Issue:** 1 November 2024 **Review Date:** 1 November 2025 **Prescribing Physician:** Dr. Thomas Kelly (GMC: 1234567) **Signature:** Dr. Thomas Kelly