Nurses have long been aware of the need to ensure they obtain information from their patients regarding possible allergies. Questions about allergy are part of most patient information sheets and preoperative checklists. The meticulous documentation of patients’ allergies is an essential part of care, especially when dealing with those who are not able to communicate, such as very young children or unconscious patients.
VOL: 99, ISSUE: 45, PAGE NO: 22
Terry Hainsworth, BSc, RGN, is acting clinical editor, Nursing Times
Nurses have long been aware of the need to ensure they obtain information from their patients regarding possible allergies. Questions about allergy are part of most patient information sheets and preoperative checklists. The meticulous documentation of patients’ allergies is an essential part of care, especially when dealing with those who are not able to communicate, such as very young children or unconscious patients. Administration of medication or any substance to which a patient is allergic can, as happened recently to Thomas Egan (BBC, 2003), prove fatal. The incidence of allergic disease is increasing, with one in three people now reported as having some kind of allergy (Allergy UK, 2003). As a result nurses will need to be more aware of the issues surrounding allergy.
Allergy is an abnormal reaction of the immune system to contact with a substance or allergen (Youngson, 2002). Allergy to environmental agents can affect almost every organ of the body. Allergic rhinitis is the most common allergy, but the lower respiratory tract, eyes, skin, and the gastrointestinal tract are frequently affected by allergic disease (Rusznak and Davies, 1998). Symptoms range from mildly irritating to severely debilitating chronic conditions or acute, life-threatening anaphylactic reaction. They can include: - Breathlessness; - Swelling of the face or hands; - Muscle weakness and joint pains; - Giddiness; - Upset stomach; - Skin rashes. The allergen can be a common, substance such as: - Medication; - Food or food additives; - Pollutants in the air - either indoors or outside; - Chemicals in the home, workplace or hospital; - Materials such as latex and nickel; - Insect venom. For those who have an allergy, management of their daily life and avoidance of the allergen can be a problem. A recent report by the Royal College of Physicians, Allergy, The Unmet Need (2003), suggests that the NHS is failing people with allergy because of a lack of specialist services and staff trained to treat allergies (Dyer, 2003).
There are several organisations that support people with allergies (see Box 1). One of these is Allergy UK, which provides help to people in managing their allergies and raises funds for allergy research and training. The organisation was formerly The British Allergy Foundation and was formed in 1991 to improve awareness, management and treatment of allergy. In May 2002, the organisation changed its operational name to Allergy UK. Raising awareness Allergy UK has several health promotion events during the year to raise awareness of the issues surrounding allergy (see Box 2). This week (10-14 November 2003) is indoor allergy week, during which the organisation aims to highlight health issues related to allergy in the home and work environments by informing the public of the facts regarding allergy-related conditions, such as: - One in three people now has an allergy; - Four in 10 schoolchildren have an allergic condition; - Allergic disease is growing at 5 per cent per year; - In a survey of 6,500 people, more than 67 per cent reported reacting to chemicals and perfumes; - Asthma, rhinitis and eczema, often caused by the house dust mite, have increased threefold in the last 20 years; - There are 28,000 house dust mites in an ounce of dust; - House dust mite droppings enter the body via the nose, linings of the eyes and linings in the airways of the lungs; - Sitting on a bed or sofa disturbs these droppings, which then stay airborne for at least 30 minutes; - The average bed contains more than 10,000 dust mites and over two million droppings; - Microscopic mould spores stay airborne for one hour waiting to be breathed in; - The average pillow doubles in weight in six months due to the droppings of the house dust mite.
There has been an increase in allergic diseases throughout the developed world in the last few decades (Royal College of Physicians, 2003). This has led to issues such as: - Anaphylaxis, occurring in over one in 3,500 of the population each year; - Peanut allergy, trebling in incidence to affect one in 70 UK children; - Adverse drug reactions accounting for five per cent of all hospital admissions in the UK; - Eight per cent of health care workers having an allergy to latex. Allergic disease accounts for six per cent of general practice consultations, and 0.6 per cent of hospital admissions. The cost to the NHS is 900m per year (Royal College of Physicians, 2003). It is thought this rise is not solely attributable to an increase in the number of people with an allergy. It is also due to a change in the nature of allergic disease, as a number of severe and potentially life-threatening disorders that were previously rare are now common, and to increased complexity of allergies, so patients have disorders affecting several systems.
Recommendations for improved services
The Royal College of Physicians (2003) report suggests the NHS is currently not coping with the size and nature of the problems presented by allergy and its related conditions. It has made several general recommendations for an improved allergy service: - The provision of an allergy care service led by specialists trained in allergy with front-line allergy management within primary care; - The development of consultant posts and funded training posts in allergy; - The setting up of appropriately staffed regional allergy centres evenly distributed across the whole country.
The increase in the number and severity of allergic reactions has implications for nurses. Anaphylaxis and anaphylactic death are becoming more common. Anaphylaxis can be frightening to deal with because of its rapid onset and severity (Ewan, 1998). All health care professionals, especially those working in general practice and in A&E departments need to be confident in recognising the signs of anaphylaxis (Box 3) and in delivering prompt treatment. Nurses also need to be vigilant about recording drug sensitivities and preadministration checking procedures in their trust. Some drugs are more commonly implicated than others (Box 4). It is worth being aware which ones. Health care workers are especially at risk of latex rubber allergy. While this can cause anaphylaxis it normally develops more slowly - 30 minutes or longer from the time of exposure. This is because the allergen has to be absorbed through the skin or mucosa (Ewan, 1998). A growing awareness of latex allergy in primary and secondary care means that non-powdered gloves are now being used. These help combat latex allergy (Crouch, 2003). It should, however, be remembered that patients can also have latex allergy and care should be taken during abdominal or gynaecological surgery, vaginal examination or dental work (Ewan, 1998). Nurses, especially those working in general practice, school nursing and paediatrics can play an important role in the support and training of patients with allergy and their carers (Percival, 2003). Health promotion events and national awareness campaigns such as indoor allergy awareness week are ideal prompts to reflect on individual nursing practice and to update on current policies, incidence, treatment and management regimes.