1. Managing Allergies & Anaphylaxis At School Sandra Montgomery Superintendent of Special Services

2. ANAPHYLAXIS PROTOCOL & GUIDELINES 2006

3. Sabrina’s Law  Sabrina Shannon had a severe allergy to dairy products  She died after eating french fries at school  Bill 3 is intended to protect students with deadly food allergies January 1 st 2006 legislation

4. What does Bill 3 mean for school boards?  Create anaphylaxis policy  Educate students and parents on cross contamination  Implement plans to reduce the risk of exposure to allergens ie. thorough hand washing is a key to risk reduction  Creating allergen aware environments and individual student plans  It is about expectations for parents, students, principals, staff and volunteers  It is NOT about banning products

5. Bill 3 - Liability  Section c.7 s.3 (4)  Ensures that no damages will be instituted with respect to any act done in good faith in response to an anaphylactic reaction (Unless damages are the result of gross negligence)

6. Allergies occur when your immune system becomes unusually sensitive and overreacts to common substances such as pollen, mould, dust or food. When these substances cause an allergic reaction, they are called allergens.

7. Allergens enter the body through: The MouthThe Nose TouchInjection

8. Allergic reactions can occur in the:  upper respiratory system  lower respiratory system  skin  digestive system  as a generalized reaction called anaphylaxis

9. Anaphylaxis is a sudden, severe, potentially life-threatening allergic reaction that may involve the skin, respiratory tract, gastrointestinal tract and/or cardiovascular system.

10. Common Causes of Anaphylaxis Food Medications Insect Venom Exercise Latex EpiPen

11. Symptoms of An Anaphylactic Reaction The most distinctive symptoms include:  hives  swelling of the throat, lips, tongue or around the eyes  difficulty breathing or swallowing * Hives may be entirely absent, especially in severe or near-fatal cases of anaphylaxis.

12. Symptoms of An Anaphylactic Reaction Other common symptoms include:  a metallic taste or tingling in the mouth  flushing, itching, or redness of the skin  nausea, vomiting, or diarrhea  dizziness or lightheadedness  increased heart rate  feelings of fear or panic  loss of consciousness

13. Remember… It takes only 1 to 2 minutes for a mild allergic reaction to escalate to anaphylaxis

14. When is anaphylaxis most likely to occur?  New situations  Normal daily routines are interrupted eg. birthday parties and school trips  During teenage years (increasing independence, relaxed precautions, reluctance to carry medication)

15. Preventing Anaphylaxis 1. Awareness  Know causes and triggers  Know emergency plan 2. Avoidance  Do not let student come in contact with allergen  Check ingredients every time if unsure, do not let student eat it offer students an alternative choice in food  Do not let students share lunches, snacks, containers or utensils  Avoid bulk foods  Be aware of cross-contamination - wash surfaces with board approved solutions 3. Action  Administer EpiPen & Call 911

16. Have An Emergency Plan  A child with a life-threatening allergy should carry an EpiPen at all times.  An additional EpiPen(s) should be easily accessible  It is important to have one EpiPen available for every 10 -20 minutes

17. Have An Emergency Plan  Display “At Risk” posters in high traffic areas  Keep student’s medical information with their EpiPen.  Ensure student has Medic Alert identification that indicates their specific allergens.

18. The EpiPen

19. What is an EpiPen? An EpiPen is a disposable drug delivery system with a spring-activated, concealed needle designed for emergency administration. EpiPens are available in 2 strengths:  EpiPen Jr Smaller amount of epinephrine  EpiPen Larger amount of epinephrine

20. What is in an EpiPen?  EpiPens are an effective way to administer a drug called Epinephrine (Adrenaline)  Epinephrine by injection is the treatment of choice for anaphylactic reactions.  Epinephrine works quickly to: constrict blood vessels relax smooth muscles in the lungs to improve breathing stimulate the heart beat reverse hives and swelling around the face and lips.

21. Who can I give the EpiPen to?  It is expected that parents would provide proprietary medication with appropriate consent  Under the new legislation an emergency EpiPen should be on site

22. Using an Epi-Pen  Grasp EpiPen with the black tip pointing down( 911 is being called at same time)  With your other hand pull off the gray safety cap.

23. Using an Epi-Pen  Hold the black tip near the outer thigh.  Swing and jab firmly into the outer thigh.

24. Using an Epi-Pen  Hold firmly in thigh for approx. 10 seconds (Count to 10).  Remove Epi-Pen and massage injection area.

25. Check the Tip  If the needle is exposed, you have given the dose.  There may be a kick back effect so make sure your grip is firm  Bend the needle back against a hard surface after administration.  Carefully put the unit (needle first) back into the carrying tube.

26. After the Administration of the EpiPen  Seek emergency medical attention as EpiPen is being administered  If symptoms return or there is no improvement in 10-20 minutes a second dose may be required.  Side effects of Epinephrine include: Nervousness Increased heart rate Sweating Nausea / Vomiting Headache Dizziness

27. Special Tips About Using EpiPens If you suspect an anaphylactic emergency, administer the EpiPen and call 911 The effects of epinephrine when not needed:  Increased Heart Rate  Nervousness The possible effect of not administering epinephrine in anaphylaxis:  Death *Always seek medical attention after the administration of an EpiPen

28. Special Tips About Using EpiPens  Never put fingers over the black tip when removing the safety cap, or after the safety cap has been removed.  Periodically check the expiry date and condition of stored EpiPens.  Keep EpiPens at room temperature. Do not expose them to extreme cold, heat or direct sunlight.  Place the EpiPen on bare skin if possible. In an emergency, the EpiPen can be used directly through clothing.

29. Executive Summary Now a policy of TCDSB Immunity is enshrined in the legislation Updated committee list

30. Executive Summary Revised School Responsibilities Creating allergen aware environments Minimizing risk Ensure thorough hand washing Store medication in a readily accessible, organized manner A generic EpiPen can now be used

31. Executive Summary Parent/Student Responsibilities Parent to alert school Student to carry EpiPen on their person at all times

32. Executive Summary Staff Inservices Semi annually or as required for all staff who may be new to the school Copy of sign in sheets for in-service to be forwarded to the school superintendent Books and videos are now available for loan

33. References Anaphylaxis Canada 416 Moore Ave., Suite 306, Toronto, Ontario M4G 1C9 Telephone: 416-85-566 E-mail: network@anaphylaxis.orgnetwork@anaphylaxis.org www.gosafe.ca Canadian School Boards Association 130 Slater Street, Suite 350, Ottawa, Ontario K1P 6E2 Telephone: 613-235-3724 E-mail: admin@cds\nsba.orgadmin@cds\nsba.org Allergy Asthma Information Association (National Office) P.O. Box 100, Etobicoke, Ontario M4K 5K9 Telephone: 416-679-9521 E-mail: national@aaia.ca, www.aaia.canational@aaia.cawww.aaia.ca Canadian Society of Allergy & Clinical Immunology 774 Echo Dr., Ottawa, Ontario K1S 5N8 Telephone: 613-730-8177 E-mail: csaci@rcpsc.educsaci@rcpsc.edu The Hospital for Sick Children 555 University Ave, Toronto, Ontario Telephone: 416-813-5300 E-mail: www.sickkids.on.cawww.sickkids.on.ca Collins Consulting E-mail: collins.judy@sympatico.cacollins.judy@sympatico.ca Toronto Catholic District School Board Superintendent of Special Services Telephone: 416-222-8282 ext. 2486

34. Questions or Comments