Kathy Stinely, RN, BSNBooth Fickett K8 Magnet School

PRESENTATION OBJECTIVESThe participant will understand the prevalence

and types of life threatening allergies and be able to identify common triggers

The participant will be able to recognize the signs and symptoms of anaphylaxis

The participant will demonstrate competency in Epinephrine administration (EpiPen)

The participant will be able to state ways to reduce the risk of life threatening allergic reaction

ALLERGY STATISTICS6-8% of U.S. school age children have identified

food allergies. 40-50% of those persons with a diagnosed food

allergy are judged to have a high risk of anaphylaxis (a life-threatening allergic reaction).

“Researchers believe that the prevalence of food allergies is increasing and the number of deaths from food allergy induced anaphylaxis is growing, and children are the largest group of the population affected by food allergies.”

THE BIG 8The Big Eight account for 90% of

food allergies.PeanutsTree NutsMilkEggSoyWheatFishShellfish

OTHER ALLERGENS (TRIGGERS)Other foods outside of the Big 8

(seeds, fruits, vegetables, meats)Bee stingMedicationLatex – gloves, balloons, etcExercise induced (rare)

SO WHAT IS AN ALLERGYAn allergy is an abnormal response to a

normal substance due to an over reactive immune system. This is the body’s attempt to defend itself against substances that are perceived by the body to be harmful (an allergen).

Contact with the allergen starts a series of events in the cells of the immune system resulting in release of chemical mediators such as histamine . These chemicals trigger inflammatory reactions in the skin, the respiratory system, the gastrointestinal system, and the cardiovascular system.

WHAT IS ANAPHYLAXISAnaphylaxis is the life threatening form

of an allergic reaction.According to the American Lung

Association, it is a “sudden, severe allergic response that usually produces breathing difficulties, collapse and possible death.”

Usually occurs 1-15 minutes after exposure, but can occur up to 2 to 4 hours later.

Life threatening emergency. Requires immediate action – EpiPen

POSSIBLE SYMPTOMS OF AN ALLEGIC REACTION

Skin: Hives, itching, swelling.Eye/Ear/Nose/Throat: Itchy/scratchy lips, tongue, mouth and/or throat, difficulty swallowing, throat tightness or closing, red, watery eyes.Respiratory: Swelling, change of voice, coughing, wheezing, difficulty breathing, shortness of breath,.Gastrointestinal: Vomiting, stomach cramps.Cardiovascular: Fainting or loss of consciousness, flushed, pale skin, cyanotic (bluish) lips and mouth.Neurologic: Dizziness, change in mental status, fainting or loss of consciousness, sense of doom.

COULD YOU SAVE A LIFE?Think F.A.S.T….

Then ACT!

FACE: Rash, hives, swelling of lips,

tongue, eyes, face

AIRWAY: Difficulty breathing, swallowing or

talkingSTOMACH:

Abdominal pain, nausea, vomiting,

diarrhea

TOTAL BODY: Rash/hives, weak, pale, sense of doom,

loss of consciousness

ALLERGY OR ANAPHYLAXIS?Anaphylactic

ReactionsSwelling (face, lips,

tongue, throat, upper airway)

Difficulty breathing (chest tightness)

Vomiting, diarrhea, cramping

Difficulty swallowing, repeat throat clearing, voice changes

Weakness, paleness, sweating

Feeling of impending doom

Allergic Reactions

•Runny Nose

•Itchy, Red, watery eyes

•Hives, itchy rash

•Local reaction to sting, UNLESS known to be allergic to venom

Anaphylactic Reactions can involve many symptoms or just one severe symptom

Allergic reactions can progress into full anaphylaxis

HOW YOUNGER STUDENTS MAY DESCRIBE SYMPTOMS My mouth or tongue is hot, burning, tingling or itchingIt (my tongue) feels like there is hair on itMy mouth feels funnyThere’s a frog or there’s something stuck in my throatMy tongue feels full (or heavy)My lips feel tightIt feels like there are bugs in there (to describe itchy

ears)My throat feels thickIt feels like a bump is on the back of my tongue (throat)

BE SAFE, NOT SORRY!Every child is different. Some students may

complain of stomach pain first, others will start with a rash or hives, yet others will immediately have breathing problems.

Take ALL complaints from students with a food allergy very, very seriously.

Reactions can be unpredictable. Mild reactions can rapidly turn into full blown anaphylaxis.

BE PREPAREDBe able to identify your students with serious

allergiesLook for situations that may put them at risk

(students offering to share food, PB&J sandwiches at a peanut free table, students playing where bees are concentrated) and take action

Know the signs and symptoms of an allergic reaction and have a plan based on the student’sAllergy Action Plan

PREVENTION: THE FIRST LINE OF DEFENSEBe aware of the students in your classes with

life threatening allergiesKnow what the student is allergic toBe familiar with the Allergy Action PlanHave student info in sub folderProhibit sharing of foodsDo not serve foods for class activities that

contain possible allergensHave wipes and hand sanitizers/hand

washing facility available

SEVERE ALLERGY TREATMENT

Student usually develops rash/hives. May also see swelling, itching.May spread, become larger or diffuseUsually treated with Benadryl as listed in

student’s Allergy Action Plan.

TREATMENT OF ANAPHYLAXISIf possible, remove student from allergen

(remove bee stinger by brushing with ID, wash allergen off if skin contact)

Have the student sit or lie down. Keep him calm and quiet

Must first be treated with Epinephrine (EpiPen, Twinjet), then may use Benadryl as per plan

Do not hesitate to use the EpiPen if you think the student is having an allergic reaction

Most allergic reaction deaths occur because Epinephrine was not given

WHAT TO DO IF YOUR STUDENT HAS AN ANAPHYLACTIC REACTIONCall the School Nurse: give the student’s name

& that they are having an allergic reactionDO NOT ATTEMPT TO WALK TO THE HEALTH

OFFICEAsk if the student has an EpiPen with them and

assist/ administer if they doCall 911 as directed by the nurse Stay with the studentRemember the EpiPen is intended to buy time

to get to emergency care, it doesn’t take it’s place

WHAT DOES EPINEPHRINE DO?EpiPen® = Epinephrine MedicationQuickly constricts blood vessels to raise

blood pressureRelaxes smooth muscles in the lungs to

improve breathingStimulates heartbeatWorks to reverse hives and swelling around

the face and lipsWears off in 10-20 minutes, sometimes

requires a second dose, so it is critical that 911 is called and student transported to emergency room!

5 RIGHTS OF EPIPEN ADMINISTRATIONRIGHT STUDENT: Verify that the student has a

known allergy, check allergy action planRIGHT MEDICATION: EpiPen, EpiPen Jr, TwinjetRIGHT DOSE:

EpiPen for students approximately 66lbs and overEpiPen Jr for students under 66 lbs

RIGHT ROUTE: EpiPen is to be injected into the large outer thigh muscle

RIGHT TIME: As soon as possible after a reaction is identified based on symptoms and the student’s allergy action plan

EPIPEN VIDEOS http://www.nationwidechildrens.org/epipen http://www.auvi-q.com/auvi-q-demo-video

DON’T FORGET:The “Good Samaritan Law” protects all

individuals who administer an EpiPen from liability.

STEPS TO REMEMBERRemove autoinjector from box or container after

checking the name on the label to make sure it is for the RIGHT student.

Pull off the blue activation cap.Hold orange end near outer thigh.

Do not put fingers over orange end.Swing and jab firmly into outer thigh at a 90° angle

until autoinjector mechanism functions. You will hear a click.

Hold in place and count to 10. Remove device (the needle will be covered) and massage area for 10 seconds.

Give autoinjector to nurse or paramedics.

FIELD TRIPSYou must notify the nurse at least one week before

the field trip. The nurse will identify all students with health issues, medications and allergies.

If there is a student with an EpiPen, the nurse will review that student’s Allergy Action Plan with you, answer any questions. A copy of the plan and student emergency contact card will accompany the EpiPen.

You should meet with the student to explain that you have their EpiPen and will be available throughout the trip.

FIELD TRIPSThe EpiPen must be available at all times, it

should not be left on a bus or anywhere away from the student.

If the student routinely carries an EpiPen of their own, the Allergy Action Plan should still be reviewed with the nurse and you must check to make sure that the student has the EpiPen with them at all times.

Remember that you must also have a cell phone or phone access available at all times in case of emergency.

LAST STEPPlease see Kathy with your completed quiz

for a quick hands on practice, return demonstration and chance to get any questions answered to complete your training.