Allergies and Anaphylaxis Epi Pen Training

In the School Setting

Why do I need Food Allergy Training?

Senate Bill 27 (82nd Legislative Session):

Requires training for all school personnel

Purpose of training:

To provide all school staff basic knowledge and skills to

identify students with a possible allergic reaction to food

and the appropriate emergency actions for an allergic

reaction

Allergies occur when your immune system overreacts to a common substance.

When these substances cause an allergic reaction, they are called allergens.

Allergens can enter the body through: mouth, nose, skin, injection

Food Intolerance vs Food Allergy

Food Intolerance: an unpleasant reaction to a food, that unlike a

food allergy, DOES NOT involve the immune system response or

the release of histamine.

Food intolerance – does not put a student at risk for anaphylaxis.

Food Allergy: a group of disorders characterized by immunological

responses to specific food proteins.

Food allergies can put students at risk for anaphylaxis.

Food Intolerance:Usually comes on graduallyMay only happen when you eat a lot of the foodMay only happen if you eat the food oftenIs not life-threatening

Food Intolerance Symptoms: Nausea, Vomiting, Gas, cramps, or bloating, Heartburn, Headaches

Food Allergy:Usually comes on suddenlySmall amount of food can triggerHappens every time you eat the foodCan be life-threatening

ANAPHYLAXIS IS A, SERIOUS,

POTENTIALLY LIFE

THREATENING ALLERGIC

REACTION. THE REACTION

CAN TAKE PLACE WITHIN A

FEW MINUTES TO SEVERAL

HOURS AFTER EXPOSURE.

Common causes of allergies include: Foods: (peanuts, tree nuts, eggs, fish, shellfish), Soy, Wheat,

Dairy Products, scents, Medication, Insect Venom, Latex

Anaphylaxis affects multiple parts of the body: skin, mouth, nose, lungs,

cardio vascular system, stomach and intestines.

Signs & Symptoms of Anaphylactic Reaction Include but are not limited to:

swelling of throat, lips, tongue, eyes, difficulty breathing or swallowing, hives, flushed skin, itching, nausea, increased

heart rate, paleness, fainting

Body System Sign or Symptom

Mouth Tingling, itching, swelling of the tongue, lips or mouth: blue/grey color of the lips

Throat Tightening of the throat; tickling feeling in back of throat; hoarseness or change in voice

Nose/Eyes/Ears Runny, itchy nose; redness and/or swelling of eyes; throbbing in ears

Lung Shortness of breath; repetitive shallow cough; wheezing

Stomach Nausea; vomiting; diarrhea; abdominal cramps

Skin Itchy rash; hives; swelling of face or extremities; facial flushing

Heart Thin weak pulse; rapid pulse; palpitations; fainting; blueness of lips, face or nail beds; paleness

Signs & Symptoms of Anaphylactic Reaction

Include but are not limited to: In the case of a life-threatening reaction, more than one system of the body can be involved.

Have an emergency plan!

Treatment: Epinephrine is the first life treatment for anaphylaxis.

Medication: EpiPen

What is an Epi Pen?It is an effective way to administer a drug

call Epinephrine.

Epinephrine works quickly to:

*constrict blood vessels

*relax smooth muscle to improve breathing*stimulate heart

*reverse hives *decrease swelling

Remember the 5 rights!

1. Right Student –check label on medication

2. Right Medication – do you have an order

3. Rights dose –Epi Pen (for students who weigh 66 pounds or more), Epi Pen Jr. ( for students who weigh 33-66 pounds)

4. Right route – outer thigh

5. Right time – quickly!

Location of Epi Pen:

* Kept in nurses office.

*If student has a physician order, student may carry epi pen with them at school.

* 911 must ALWAYS be called when epi pen used.

*If student is having reaction but does not have epi pen, call 911 immediately.

Do not use another student’s medication.

Self-Administration of Epinephrine

Per Federal law, students may carry their epinephrine with them in the

classroom and on school activities with physician order on file at school.

If a student uses their epinephrine in your classroom:

Immediately contact the nurse (if nurse is not available, notify the

front office)

911 to be called by nurse or front office

Monitor the student’s respiratory status

Note the student’s reaction to the allergen and the time the

epinephrine was administered so Epi Pen documentation form can be

completed.

How to use Epi-Pen:Have someone call 911,

If alone administer then CALL 911• Open cap and remove from storage tube

• Form fist around injector

with needle end down.

• Using other hand,

pull off safety release cap

How to use Epi-Pen cont:

• hold needle tip near outer thigh

• swing and jab firmly into thigh (at 90 degree angle-perpendicular)

• hold firmly in thigh for 10 seconds

• remove epi-pen and massage injection site

**REMEMBER**

• Save Epi-pen to give to EMS.

• Document what happened.

• Have someone help document time and location

injection given.

• Have a staff member notify parents.

Give Epi Pen and call 911 before calling parents so no delay in student receiving medication or arrival of EMS

Epi-Pen DocumentationIf Epi Pen is used have someone complete this form.

If alone administer epi pen and then call 911.

Name of School: ________________________Students Name: ________________________________________ Gender: ____________Student Date of Birth: ____________________________________Students Allergies : _____________________________________________________________Date of occurrence: ___________________ Time of onset of symptoms: _______________Location when symptoms first developed:____________________________________________Trigger that precipitated episode & Symptoms that were observed before epi pen administered: ____________________________________________________________________________________________________________________________________________________________________________________________________Skin/Mouth Itching, rash? _________ Nausea, vomiting, Abdominal pain or cramps? _______Shortness of breath, Wheezing, stridor, labored breathing? ______________________________Initial Vital Signs: Time: ________ Pulse _________ Respiratory Rate: ______________ BP: ____________Epi Pen administerd by: ____________________________________Epi Pen Dose: ________________________________Time Epi Pen administered: ____________________________Location Epi Pen administered: Right Thigh________________ Left Thigh_______________Time 911 was called: ___________________ Time Medstar arrived: _________________Medstar staff and #:_____________________________________________________________Time & Parent notified: _________________________________________________________Symptoms observed after epi pen administered: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________CPR performed? ______________________Transferred to ER? _________________________ Form Completed by:_____________________________________________________________

Side Effects of Epinephrine:

*nervousness, anxiety* increase heart rate

*sweating*nausea/vomiting

*headache*dizziness*weakness

Epi-Pen Tips & Facts:

*Single Use medication (DO Not re-inject)

*Stored at Room temperature

*Do not expose to extreme cold, heat or direct sun

*If necessary, can be used through clothing

*Check expiration date

*Never put thumb over tip

*Do not remove safety release until ready to use

*Do not use if solution in window is not clear

Students with Disclosed Food Allergies

• Notification of a student with disclosed food allergies:

o Once notification is received by the school nurse appropriate

school personnel will be notified.

• Every student with a disclosed food allergy:

o Will have an 1) Individualized Health Plan

2) Food Allergy Action Plan (signed by physician)

3) Medication Form (signed by physician)

o Is eligible for 504 accommodations

Extremely reactive to the following foods: ________________________________________________________

□ If checked, give epinephrine immediately for ANY symptoms if the allergen was likely eaten.

□ If checked, give epinephrine immediately if the allergen was definitely eaten, even if no symptoms present.

Any SEVERE SYMPTOMS after suspected or know ingestion:

One or more of the following:

Lungs: Shortness of breath, wheeze, repetitive cough

Heart: Pale, blue, faint, weak pulse, dizzy, confused

Throat: Tight, hoarse, trouble breathing/swallowing

Mouth: Obstructive swelling (tongue or lips)

Skin: Many hives over body, redness/warmth

Or combination of symptoms from different body areas:

Skin: Hives, itchy rashes, swelling (eyes, lips)

Gut: Vomiting, diarrhea, cramping pain

1. Immediately give Epinephrine

2. Call 911

3. Monitor student

4. Give additional medications*

*A second dose of epinephrine can be given 5 minutes or more after the first if

symptoms persist or recur. For a severe reaction, consider keeping student lying

on back with legs raised. Treat student even if parents cannot be reached.

Mild symptoms only:

Mouth: itchy mouth

Skin: a few hives around mouth/face, mild itch

Gut: mild nausea/vomiting

1. Give antihistamine

2. Stay with student, call parents

3. If symptoms worsen, give

Epinephrine

4. Monitor student

Food Allergy Action PlanStudent: _______________________________ DOB:_________________________ Grade: _____________

Allergy: __________________________________________________________________________________

Weight: _______________________ History of Asthma: □ Yes (higher risk for severe reaction) □ No

MEDICATION DOSAGE AND ROUTE:

Epinephrine (brand & dose):__________________________________________________________________

Antihistamine (brand & dose):_________________________________________________________________

Other (inhaler-bronchodilator)________________________________________________________________

Parent/Guardian Printed Name: __________________________________ Phone ______________________

Parent/Guardian Signature: _____________________________________ Date: __________________

Physician’s Printed Name: _____________________________________ Phone _______________________

Physician’s Signature: _________________________________________ Date: ___________________

District Medication formA new form must be completed each school year

and include physician and parent/guardian signature

PREVENTION IS KEY!!!

1. AWARENESS- KNOW CAUSES AND TRIGGERS.

2. AVOID – CHECK INGREDIENTS, DO NOT CONTACT ALLERGENS.

Exposure Reduction at SchoolClassrooms:

• Keep FAAP with students photo accessible and prominent for substitute teachers

• Food: Avoid use of foods as rewards or class activities.

• Provide scent free and latex free classroom and school

• Parties: Avoid foods that contain the allergen

• Hand washing: Wash hands before and after meals or use hand wipes.

Alcohol based hand gel is NOT effective in eliminating allergens

• Be aware of how the student with food allergies is being treated; enforce school rules on bullying and threats.

• Ensure that a student suspected of having an allergic reaction is accompanied by an adult (preferably) or student to the clinic an notify nurse that student is on the way.

Field Trips-Any time leaving the campus:

(Grade level trips, UIL, sports etc)

o Notify school nurse at least 2 weeks prior to field trips.

o Invite parent(s) to attend field trip

o Don’t leave for field trip without the epinephrine, FAAP and physician order

o Be aware of foods offered on field trip (may need to contact facility in advance)

o Minimum of 1 person trained to use an epi pen attends field trips

Before & After School Activities: (sports, tutorials, UIL etc)

Provide school nurse with list of students participating in activities

Obtain FAAP from school nurse for students with allergies

Exposure Reduction at School cont.

Transportation:

Notify the transportation department that a student with food allergies who is at risk for anaphylaxis will be riding the bus

Obtain FAAP from school nurse for students with allergies

Prohibit food and drink on buses

Cafeteria:

No trading food with other students

Cafeteria staff read food labels and recognize food allergies

Make appropriate substitution for meals served to students with allergies

Avoid use of latex products

Avoid cross contamination

Custodial Staff:

Follow cleaning protocol to avoid cross contamination

Avoid use of latex products

Always be prepared to take emergency action for a student in the event of an allergic reaction.

If you have a student with a food allergy:

See the school nurse to:

Review and demonstrate proper epinephrine administration

Pick up FAAP/EAP and IHP

Determine where medication is keptIn clinic

With student

Both

Please contact the school nurse on your

campus for any questions or concerns!

BHS X 4321

BMS X 4525

THI X 4812

FAA X 6330

Blue Haze Elem X 6407

West Elem X 6208

North Elem X 6106

Liberty Elem X 6513