Life Threatening Allergies Julie Cacciatore RN

Food Allergies Food allergies are on the rise. 6-7 Million Americans have food allergies that can trigger anaphylaxis (Food Allergy Network). Eight foods account for 90% of food allergies.

What is a Food Allergy? An interaction between food and the immune system. Food proteins are recognized as invaders by the immune system. The immune system launches an attack against the invader with an antibody: IgE. IgE antibodies fight the invader by releasing histamines and other chemicals that produce the symptoms of an allergic reaction.

What is a Food Intolerance? A food intolerance is usually a more delayed reaction to a food. Reactions often involve the digestive tract and while they cause discomfort, they are not life threatening. Some common food intolerances include Lactose intolerance or wheat intolerance AKA Celiac Sprue Disease.

8 Major Food Allergens Cow’s milk Eggs Wheat Peanuts Tree Nuts Soy Fish Shellfish

How Much is TOO Much? The amount of an allergen needed to cause a reaction varies for each individual. Some individuals can ingest small amounts of allergen without a reaction. Other people are extremely allergic to even the most minute amount of allergen. There is no way to predict how a reaction will develop.

Symptoms of a Food Allergy Itching/burning/ swelling around mouth Tightness/swelling in throat Runny or stuffy nose/ itchy/watery eyes Breathing difficulties/ /wheezing/coughing Nausea/vomiting/ diarrhea abdominal pain Skin rash/hives Drop in blood pressure Increased heart rate Weakness Feeling of impending Doom

Anaphylaxis The most serious type of allergic reaction is called anaphylaxis or “shock”. Left untreated, anaphylaxis can result in death! For some, reactions begin slowly and gradually worsen. For others, reactions develop quickly & rapidly become life threatening. All reactions, no matter how minor, need to be taken seriously & treated promptly.

Children with Known Life Threatening Allergies Avoidance is the only way to prevent a reaction. Precautions must be taken to prevent exposure in the classroom. Each child with a known allergy should have a written emergency plan. Staff should be familiar with this plan. Emergency medications should be readily accessible to staff and never locked away!

School Modifications Action/Emergency Plan created to meet needs in the school setting in collaboration with teachers, parents, physician, school nurse etc. Posting of allergic foods in appropriate areas. Classroom parents are made aware of the allergy & advised to send in only commercially prepared items with the ingredient labels attached. Parent/guardians send in snacks and lunch. If the child is allowed to purchase items in the cafeteria, staff is fully informed about what items are allowed. Shared snack is not allowed. Education of all staff members regarding allergic reactions and the administration of emergency medications.

Medications used for Treatment of Allergic Reactions Antihistamines taken by mouth Albuteral inhaler Epinephrine by injection, usually in the form of an Epi-Pen.

Emergency Epi-Pens Epi-pens are kept in the student’s class room. Back up Epi-pens are kept in the clinic. If a child has been exposed to an allergen, call the front office for immediate assistance. Follow each child’s emergency plan. Be prepared to inject with the Epi-Pen. The emergency plan must be made available to substitute teachers. The classroom teacher and duty aids have been trained to administer the Epi-Pen. 911 must be called if an Epi-Pen is administered. Epi-Pens must accompany the child on field trips.

How to use the Epi-Pen Take a deep breath & breathe out. Remove grey cap. Hold at 90% angle against outer thigh. Press firmly & hold for the count of ten.

Additional Tips About the Epi-Pen There is one dose in each pen. There are no buttons to press; activation occurs by pressure against the leg. Store at room temperature. Fluid should be clear. An expired pen is better than none at all. Epi-Pen trainers “click”, but real pens do not. Can be injected through clothing if necessary. Arrows show direction of injection.

Side Effects From the Epi-Pen Restlessness Apprehension Headache Tremors Nausea/Vomiting Increased heart rate None of these side effects have very serious consequences. It is better to give the Epi-Pen than not to give it.

Summary Know if a child has a food allergy. Be very familiar with the Emergency Plan. Communicate with other staff about the allergic child. Avoidance is the first treatment for food allergy. Make class parents aware of the food allergy and request only commercially prepared treats (with intact ingredient labels) for classroom events.

Know where the Epi-Pen is in the classroom. Remember, it must go on field trips with the child. If you suspect a child has come in contact with an allergen- call for help, better safe than sorry. The responsibility for an allergic child with a history of a serious reaction can seem overwhelming at times. But common sense and planning can help prevent or minimize any emergencies. Summary continued