Speaker: Kathy Mulligan

Hi, I'm Kathy Mulligan from the NSW Anaphylaxis Education Program based at the Children's Hospital at Westmead and we're going to go through the 2026 Allergy Update for ECEC. Sydney Children's Hospital Network acknowledges that our facilities are built on the lands of the Bidjigal, the Cammeraygal, the Burramattagal, Cabrogal and the Woddi Woddi. Our services extend across the lands now known as NSW.

Aboriginal people believe these lands hold the ancestral spirits of those who have come and gone before them. We acknowledge this is, was and always will be Aboriginal land. So let's go through the 2026 ASCIA Action plans and adrenaline devices. So the action plan you can see on the screen is the general version of the personal action plan. So the biggest difference between this action plan and the plans that you've seen before is that the symptoms are in picture form, which is really helpful for those people who might respond better to pictures or who panic in emergency situations, or perhaps those who have English as a second language.

This is a 2-page document. It has the symptoms and management for allergic reactions and anaphylaxis on the front, and it has the device instructions on page 2. So it really should be printed as a one-page document with front and back. But if you're going to put this on a wall for instance, then it should be printed on 2 separate pages so you can see both sides of the document.

The plan on the front and also the device instructions. It's really important that the device instructions are visible. If you've got lots and lots of action plans on display though, just one copy of the instructions for adrenaline devices on display, visible is adequate. There is a line on the front of the plan, which in amongst all the personal details, that says adrenaline device prescribed, and that's where the treating doctor writes which of the adrenaline devices has been prescribed to that child.

This is the personal action plan device specific version. So this is a design that you’re probably more familiar with. It's similar to the 2025 versions. It's a single page document. It has symptoms written as as per previous versions. There's no symptom pictures and the device instructions are shown on the front of the plan.

This is what you're probably going to see the most of to be honest. And then we have the 2026 ASCIA action plan for allergic reactions. This is for people with no known, sorry. with a known allergy, but no prescribed adrenaline device. There's no device instructions because there's no prescribed device. There is a QR code that leads to device instructions if someone were to need it.

The important thing about these action plans are, in fact, the risk management for these children is that it should be exactly the same as for those children with a red action plan and an adrenaline device. So just because they don't have adrenaline device does not mean that they should be treated any differently in terms of risk management. It's a really, really important point.

This is the 2026 action plan, the first aid version and this is similar in terms of the pictures for the symptoms. Then the first action plan I showed you, it's a 2-page version. It has device instructions on page 2. A copy of these should be stored with each first aid adrenaline device that you have for your service.

It can also be used as a poster, so it's got no personal details on it. So you don't have to worry about confidentiality. And if it is displayed as a poster, you should display it with both sides visible, because we want to see the adrenaline device instructions visible. So this is a close up of the pictorial, the images that you use for the symptoms for allergic reactions and anaphylaxis. The mild to moderate symptoms on the left and the anaphylaxis symptoms are on the right.

One of the other differences for the 2026 action plan is that it's made it a little bit clearer about the nuance between abdominal pain and vomiting as a symptom of a mild to moderate reaction and anaphylaxis. If the trigger is food, then abdominal pain and vomiting is a mild to moderate symptom. If the trigger is an insect sting, then abdominal pain and vomiting is actually a sign of anaphylaxis. And this makes it a little bit clearer on the 2026 version of the action plans.

There's been some wording changes in the 2026 versions of the action plans. So the top box there is where I mentioned before where it says adrenaline device prescribed, where the treating doctor writes which specific adrenaline device was prescribed to that person. The middle box there, there is a little bit of clarity and emphasis on the fact that anaphylaxis can indeed occur with no mild to moderate symptoms beforehand, no skin symptoms, to make it really clear to people that the child or the person is having anaphylaxis or having allergic reaction.

And the bottom line there is just, making it, giving instructions on what to do if someone is accidentally injected with an adrenaline device, someone who is not having anaphylaxis. And it is important to continue treating someone who is having anaphylaxis with another device if it is a device is accidentally injected.

The 2026 action plan is essentially unchanged in terms of how mild to moderate and mild to moderate reactions and anaphylaxis is managed. Completely unchanged from previous versions. The 2025 and 2026 action plans are considered valid for anybody that has a 2023 action plan or earlier. It is important that you start talking to those families about the fact that they need to start planning to get those action plans updated sooner rather than later. Document the conversations that you're having in their communication plans. But and GP's. It's important to note also that GP's can write new action plans for children who have action plans. They don't need to go back necessarily to their treating allergist. Appointments are not that easy to come by in a lot of cases.

So there's been lots of changes with the adrenaline devices this year. So everybody's familiar with the EpiPen. The EpiPen Junior with a green label is recommended for children 7.5 to 20 kilos, which covers children in the early childhood services. This should be the EpiPen, sorry, the first aid EpiPen for early childhood services, the preschool ages 0 to 5.

The EpiPen, which is double the dose, it's got a yellow label is for everybody over 20 kilos. And this should be the first aid device for OOSHs and out of school, sorry, OOSHs and vacation care.

The new device that we have coming into Australia is called Jext. It has PBS and TGA approval. However, there is absolutely no supply in Australia as of the time of recording. The great thing about Jext is it's very similar to EpiPen. So, it comes in the same doses. So Jext Junior is for 7.5 to 20 kilo people and just is for everybody over 20 kilos.

It is very similar in terms of the way you administer it. That the EpiPen. So you form a fist around the Jext and you pull off the yellow cap, place that black needle tip against the outer mid thigh with or without clothing. You push firmly against the outer mid thigh until the click is heard or felt, and you hold for 3 seconds and then you remove Jext.

So in terms of administration, it's really easy. Same as EpiPen. The colours are different and the shape is different. It is round. Then the safety cap is yellow and the needle end is black. We don't know when we're getting supply into Australia. It could be any day. So don't be surprised if you start to see Jext filtering through into the service.

So the new device that we have in Australia is called Neffy and it's an intranasal adrenaline device. So it's needleless, which is great news for everybody. There are 2 doses. There's a one milligram dose, which is for people 15 to 30 kilos. You need to be 4 years of age, so you need to have had your fourth birthday to be prescribed this device.

And a two milligram dose for everybody over 30 kilos. Neffy has TGA approval, but it doesn't have PBS approval. So people will be paying full price for this device, which is about 100 and, 90 something dollars, $94, I think, for two devices. So you won't see too much of it filtering through as yet. We're hoping for PBS approval later on in the year.

It comes in a 2 pack in the blister packs that you can see on your screen.

So the way to administer Neffy is fairly simple. You hold the device between your 2 fingers and your thumb, as you can see on the screen. Now pre spraying. So a lot of people are familiar with nasal sprays for allergic rhinitis and things like that where you might have to prime it. None of that for the Neffy.

It's really important that it's not primed. There is only one dose per device. You then place the nozzle of the nasal spray into the nostril until fingers touch the nose and you point it straight up towards the forehead. For smaller nostrils, you just place the tip of the device into the nostril. You then press the plunger firmly until it clicks and it actually, sprays the dose, and then you continue on following the action plan.

If a further dose is required, 5 minutes between doses. So you’re still following the action plan and 5 minutes between doses, then you can give a second Neffy if you have Neffy as a second dose into the same nostril. If a second dose is required and there is no Neffy available, you can use any other adrenaline device that is available.

So if you're using, if you have an EpiPen in your first aid device, absolutely give that instead. Adrenaline devices are interchangeable.

So in summary, the key points. The 2025 and 2026 action plans are considered valid. Anything prior to that you need to start having conversations with families about getting a replacement, and it can be by the GP. Definitely at the next review from a treating doctor, they should be presenting you with a new action plan, a 2026 action plan.

Neffy, the new intranasal device is for children 4 years of age and 15 kilos only, so it's not for everybody in the preschool age group. The first aid or the center adrenaline device remains EpiPen for now. We'll see what happens in the future. If you are presented with an unfamiliar adrenaline device, take a brief moment to write the instructions for use.

And if you remain unsure, use the first aid device that you are familiar with. That is absolutely fine to do that. It's also fine to use different devices if further doses are required. So if more than one dose is required, and if you used a Neffy for the first dose, you can use say EpiPen or Jext or something else for the second dose and so on and so forth. They are interchangeable in that way.

If you have any questions, please don't hesitate to seek more information. The ASCIA website has some great information, and their website is allergy.org.au. There are some great pages on the ASCIA action plans and on the particular updates for 2026 and they’re on your screen there. You can also contact the NSW Early Learning Commission.

And you can also contact us here at the NSW Anaphylaxis Education Program and our details are also on the screen. Thank you very much for your time.

ASCIA Action Plans for Anaphylaxis (Red) are for children with medically confirmed allergies who have been prescribed adrenaline injectors. EpiPen® and Anapen® are available on the PBS in Australia.

ASCIA Action Plans for Allergic Reactions (Green) are for children with a confirmed allergy who have not been prescribed an adrenaline injector, as they are considered to be at low risk of anaphylaxis.

ASCIA Action Plans for Anaphylaxis (Orange) are general use and can be used as a poster outlining the actions if allergy or anaphylaxis presents in a child who is undiagnosed or has presented symptoms for the first time.

Regulation 168(2)(d) of the National Regulations require approved providers of ECEC services to have policies and procedures that deal with medical conditions in children.

Regulation 90 of the National Regulations outlines the practices that must be included in medical conditions policies. In particular, practices relating to the management of medical conditions, including asthma, diabetes or a diagnosis that a child is at risk of anaphylaxis. If a child enrolled at a service has a specific health care need, allergy or relevant medical condition, that service is required to have a medical management plan, risk minimisation plan and communication plan.

Regulation 91 of the National Regulations requires the approved provider to provide a copy of the medical conditions policy to the parent of a child enrolled at the service, if the provider is aware that the child has a specific health care need, allergy or other relevant medical condition.

Section 172(f) of the National Law and regulation 173(2)(f) of the National Regulations state that approved providers must ensure the following:

• In a centre-based service, a notice is clearly visible to anyone from the main entrance of the service premises stating that a child who has been diagnosed as at risk of anaphylaxis is enrolled at the service.

• In a family day care (FDC) residence or approved venue, a notice is clearly visible to anyone from the main entrance of the service premises stating that a child who has been diagnosed as at risk of anaphylaxis:
  • is enrolled at the FDC service
  • attends the FDC residence or FDC venue.

The above statements should not identify the child.

ASCIA Action Plans should be easily available to educators and other staff at all times. Parental permission should be sought and documented if a detailed ASCIA Action Plan is displayed in publicly available spaces within the service premises, for example on a classroom wall. If privacy is a concern, the action plan could be kept in a folder in public spaces and stored with the prescribed adrenaline injector.

The First Aid Action Plan for Anaphylaxis (Orange) can be displayed for reference in public areas throughout the service as it does not have children’s personal details on it.

Regulation 94 (Exception to authorisation requirement – anaphylaxis or asthma emergency) of the National Regulations states medication may be administered to a child without an authorisation in case of an anaphylaxis or asthma emergency.

Always follow an ASCIA Action Plan in the case of an allergic reaction. If the child having an allergic reaction has no known allergies, the ASCIA First Aid Plan for Anaphylaxis should be followed and the first aid adrenaline injector given if required.

If medication is administered to a child in case of an anaphylaxis emergency, all required notifications under the National Law and National Regulations must be made. This includes a notification to the parent and/or carer of the child, which would ideally occur as soon as practicable after emergency services have been called.

Regulation 136 (First aid qualifications) of the National Regulations outlines the anaphylaxis management training requirement for ECEC services.

• For centre-based services, the approved provider must ensure at least one staff member or one nominated supervisor of the service who has undertaken current approved anaphylaxis management training is:

  • in attendance at all times and any place where children are being educated and cared for by the service
  • immediately available in an emergency (regulation 136(1)(b)).

• Where the service premises is located on a school site, at least one school staff member who has undertaken current approved anaphylaxis management training must be in attendance at the school site and immediately available in an emergency (regulation 136(2)(b)).

• For FDC services, the approved provider must ensure that each FDC educator and FDC educator assistant engaged by or registered with the service has undertaken current approved anaphylaxis management training (regulation 136(3)(b)).

It is strongly recommended that as many staff as possible receive approved anaphylaxis management training to ensure that any allergic reactions are identified and treated early.

Use ACECQA’s qualification checker to check whether your anaphylaxis management training is approved under the National Quality Framework.

Adrenaline injectors do not need to be stored in locked first aid cabinets. They should be easily accessible to staff but out of reach of children.

If a child has an ASCIA Action Plan for Anaphylaxis, one of the child’s prescribed adrenaline injectors and ASCIA Action Plan must be available at the service while they are in attendance.

For older children attending OOSH or vacation care, the child may carry their own adrenaline injector. This is dependent on the parent and child’s preference and the child’s ability to manage their own medication.

It may be unreasonable to ask a family to leave an adrenaline injector at a service if this means the family will be without one at home. Procedures should be established for handover of the child’s medication.