The Student with Allergies: Anaphylaxis Treatment & EpiPen Use Kathy Stinely, RN, BSN Booth Fickett K8 Magnet School

PRESENTATION OBJECTIVES The 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 STATISTICS 6-8% 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 8 The Big Eight account for 90% of food allergies. Peanuts Tree Nuts Milk Egg Soy Wheat Fish Shellfish

OTHER ALLERGENS (TRIGGERS) Other foods outside of the Big 8 (seeds, fruits, vegetables, meats) Bee sting Medication Latex – gloves, balloons, etc Exercise induced (rare)

SO WHAT IS AN ALLERGY An 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 ANAPHYLAXIS Anaphylaxis 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 COULD YOU SAVE A LIFE? Think F.A.S.T…. 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. FACE: Rash, hives, swelling of lips, tongue, eyes, face AIRWAY: Difficulty breathing, swallowing or talking STOMACH: Abdominal pain, nausea, vomiting, diarrhea TOTAL BODY: Rash/hives, weak, pale, sense of doom, loss of consciousness Then ACT!

ALLERGY OR ANAPHYLAXIS? Anaphylactic Reactions Swelling (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 Allergic reactions can progress into full anaphylaxis Anaphylactic Reactions can involve many symptoms or just one severe symptom

HOW YOUNGER STUDENTS MAY DESCRIBE SYMPTOMS My mouth or tongue is hot, burning, tingling or itching It (my tongue) feels like there is hair on it My mouth feels funny There’s a frog or there’s something stuck in my throat My tongue feels full (or heavy) My lips feel tight It feels like there are bugs in there (to describe itchy ears) My throat feels thick It 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 PREPARED Be able to identify your students with serious allergies Look 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’s Allergy Action Plan

PREVENTION: THE FIRST LINE OF DEFENSE Be aware of the students in your classes with life threatening allergies Know what the student is allergic to Be familiar with the Allergy Action Plan Have student info in sub folder Prohibit sharing of foods Do not serve foods for class activities that contain possible allergens Have 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 diffuse Usually treated with Benadryl as listed in student’s Allergy Action Plan.

TREATMENT OF ANAPHYLAXIS If 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 REACTION Call the School Nurse: give the student’s name & that they are having an allergic reaction DO NOT ATTEMPT TO WALK TO THE HEALTH OFFICE Ask if the student has an EpiPen with them and assist/ administer if they do Call 911 as directed by the nurse Stay with the student Remember 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 Medication Quickly constricts blood vessels to raise blood pressure Relaxes smooth muscles in the lungs to improve breathing Stimulates heartbeat Works to reverse hives and swelling around the face and lips Wears 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 ADMINISTRATION RIGHT STUDENT: Verify that the student has a known allergy, check allergy action plan RIGHT MEDICATION: EpiPen, EpiPen Jr, Twinjet RIGHT DOSE: EpiPen for students approximately 66lbs and over EpiPen 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 REMEMBER Remove 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 TRIPS You 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 TRIPS The 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 STEP Please 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.