1. Anaphylaxis Recognition & Epinephrine Auto-Injector Training for High School Personnel
San Mateo Union High School District
Fall Semester, 2003
Presented by Jean Litarowsky, District Nurse
The information for this presentation was provided by , unless otherwise noted.
In addition to this presentation, training includes:
viewing “How to use the Epi-pen Auto-Injector” video (Dey), hands-on practice with Epi-pen training device, & meeting students with a documented risk of anaphylaxis

2. Anaphylaxis: Definition and Interesting Facts
Is a rapid, severe allergic response
Is not always due to an obvious cause
Is not always easy to avoid, even when the cause is known
Is not always accompanied by hives

3. The most commonly documented causes of anaphylaxis include:
Food allergies
Insect venom
Medications
Latex
Exercise & “unknown” cause are less common causes of anaphylaxis
Avoidance measures:
Ridding environment of bee hives, wasp nests, plants that attract insects
Foods- At the high school level, students are more independent and capable of avoidance (though there are hidden ingredients)
Currently, no policies limiting foods in our district.
Latex-Recommended use of vinyl gloves only in our health offices and use vinyl only in the bloodborne pathogen glove distribution.
Anaphylactic reactions due to latex and medications are rare in the school environment.
Sudden death during athletics-may be exercise induced anaphylaxis.

4. The most distinctive symptoms of anaphylaxis include:
Hives/itchy skin
Swelling of the throat, lips, tongue, or around the eyes
Difficulty breathing or swallowing
On-line video is excellent at

5. A metallic taste or itching in the mouth
Other common symptoms of anaphylaxis may include the following: [Any of these symptoms, always ask if there are “any known allergies?”]
A metallic taste or itching in the mouth
Generalized flushing, itching, or redness of the skin
Abdominal cramps, nausea, vomiting, or diarrhea
Increased heart rate, rapidly decreasing blood pressure (paleness)
Anxiety or an overwhelming sense of doom
Weakness, collapse, loss of consciousness
Obviously, if anyone is unconscious, call 911 without delay!
One study of fatalities due to nut allergies—cases implicated an association between asthma and fatal reactions ( Bock, Munoz-Furlong, & Sampson, 2001).

6. Epinephrine (AKA:Adrenaline):
Medication of choice for severe allergic reactions
Constricts blood vessels
Relaxes lung muscles to improve breathing
Reverses swelling
Increases heart rate
Think of how an “adrenaline rush” feels
Everyone can relate to the increase of heart rate with an “adrenaline rush”, when we are startled—part of our body’s “fight-or-flight” response to give us the boost needed for survival.

7. Epinephrine, continued:
Available by prescription in a single-dose auto-injector called an Epi-pen
Site of injection: thigh
Can be given through clothing
Needle should be held in place for seconds
Call 911
Epi-pen trainers will be available in each health office for practice—should be done each semester.
Recommended refresher training each semester will be to independently view the on-line animated Epi-pen movie (shows symptoms and use of Epi-pen) at and practice with Epi-pen training device.

8. Side effects of Epinephrine include:
Rapid heart rate
Palpitations
Sweating
Nausea and vomiting
Respiratory difficulty
Other cardiac (heart) problems
Some sound like what we are trying to prevent!
The importance of knowing these is mainly to reinforce the need to call 911 and notify responders of any history of any known cardiac disease.

9. Everyone experiencing a severe allergic reaction:
Is advised to have 911/emergency medical care following the administration of epinephrine
One dose of epinephrine may not be enough!!
Can have a biphasic reaction: a reoccurrence requiring additional treatment
Medic-alert bracelets or necklaces are recommended for affected students/staff, but not popular for adolescents.

10. California Education Code mandates: (Information retrieved online at www.leginfo.ca.gov)
That minimum standards of training for the administration of epinephrine in schools through use of an auto-injector (Epi-pen) includes CPR instruction and certification
Techniques for recognizing symptoms
Standards and procedures for storage and emergency use of epinephrine auto-injectors
Emergency follow-up procedures
Written materials covering the above
Delays in treatment have been associated with fatal outcomes in schools (Sampson, Mendelson, & Rosen, 1992).

11. Students in SMUHSD with a documented risk of anaphylaxis :
Will be advised to carry an auto-injector (Epi-pen) and be allowed to self-medicate as needed (if capable).
Will be sent an Anaphylaxis Care Plan to be completed.
Includes instructions & authorization for use of medication from MD and parent (example of approved care plan attached)
Will be asked to provide an extra Epi-pen to be stored in the Health Office in an unlocked storage site.
Students will also be asked to attend training sessions for the purpose of identification and to see where they carry their Epi-pen (if they self-medicate) and check the expiration date!
Glove compartment or other hot areas are not recommended for storage of Epi-pens.
“Peanut-free” schools—controversial subject—
Argument against: Creates a “slippery slope” (ban other foods as well?--), and it may create a false sense of security (Sicherer, 2002).
Argument for “Peanut-Free” schools: Children likely to share foods or carry food into play areas leading to contamination (Sicherer, 2002), appears more applicable in elementary school.
Practice policy of identification of affected students, notification & training of staff, and any “limitations” placed on an individual site basis if circumstance dictates necessity.
Care Plans will be kept in the health office (either attached to the Emergency Card or with the back-up Epi-pen/possibly both places, as well as a copy in the health file).
Confidential health memos will be sent to individual teachers when care plans are received.

12. Summary of SMUHSD response to symptoms of anaphylaxis for students with documented risk:
REACT QUICKLY: radio communication/alert
Allow student to self-medicate when possible
If incapable, administration of Epi-pen by trained personnel
Call 911-notify EMS if Epinephrine has been given
Call parent, &/or others as directed on care plan or emergency card
Document event & place in health file
Initial responder, contact health clerk
Eventually contact District Nurse.
Evaluate our response.
The majority of the parents I have spoken with have stated that they have never had to use the Epi-pen—that’s great!
But we need to be prepared to do so if needed.