1. Sally Schoessler, MSEd, BSN, RN, AE-C
Director of Education
Allergy & Asthma Network
Topics in Allergy Care The Allergic March Latex in YOUR School Atopic Dermatitis: Issues and Concerns

2. My Nursing Journey School Nurse School Nurse Teacher
State School Nurse Consultant – New York State
Director of Nursing Education – National Association of School Nurses
Director of Education – Allergy & Asthma Network

3. What We Believe
Together, we can work to end the needless death and suffering due to asthma, allergies and related conditions.

4. Allergy & Asthma Network
Outreach
Education
Advocacy
Research
Fulfill our mission by working with leading experts in the field
Supports school nurses!
Founded in 1985
Grassroots organization
Patient - centered care teams

5. Objectives
Participants will be able to identify the 5 main areas of atopy in the allergic march.
Participants will be able to identify the 8 top food allergens.
Participants will be able to identify common sources of latex in the school setting. Participants will be able to identify cross- reactive foods in latex allergic students.
Participants will review signs & symptoms of AD as well as school nurse management of issues.

6. What is the allergic march and why is it so important?

7. Poll Question Food allergies are one step in the “Allergic March”.
True or False:
You can expect to see 1 – 2 students in every classroom in the United States with a food allergy.
True?
False?

8. The Allergic March Asthma Seasonal allergies Ear infections
Skin irritation
Food Allergies
Ear infections
Seasonal allergies
Asthma
Inflamed airways in the lungs
Environmental allergies – allergic rhinitis
Otitis media
Top 8 allergens & more
Including hives & eczema

9. Development of allergies
Often begins with eczema around age 6 months
Not always caused by allergic disease
If allergic disease – often first site of evidence
Research indicates that there may be a window of time to treat the eczema and prevent or delay the development of allergies
Reducing contact with dust mites may be helpful
Pet dander? Research is mixed

10. Development of allergies
Allergies do not cause ear infections in babies, but may play a role in ear infections in children ages 3 – 6
Food allergies also a risk factor for allergic rhinitis (hay fever) and asthma
Asthma risk higher for those with multiple food allergies

11. So how do we help build a strong immune system?
Protective benefits
Strong immune system has protective benefits
So how do we help build a strong immune system?

12. Strategies Eat a variety of healthy foods
Stay active – exercise regularly
Spend time outdoors and soak up Vitamin D
Avoid allergy & asthma triggers
Maintain a healthy weight
Get plenty of sleep

13. Immunotherapy
Allergen immunotherapy – patients are given small, increasing doses of an allergen in order to:
Build tolerance
Reduce symptoms
May prevent the progression of allergic rhinitis to asthma
May stop new allergies from developing
Encourage families to talk to an allergist

14. How many things contain latex? How do I know how to prevent exposures?
Latex in YOUR School

15. Poll Question
Many foods cross-react with latex and can cause anaphylaxis in a student with a latex allergy. Which of the following foods does NOT typically cross react with latex?
A. Banana
B. Peanut
C. Apple
D. Chestnut

16. Diagnosis
A latex allergy is diagnosed in patients who have experienced signs or symptoms of allergic reaction (skin rash, hives, eye tearing or irritation, wheezing, itching, difficulty breathing) when exposed to latex or natural rubber products

17. Latex Sensitivity Allergy Irritant Contact Dermatitis
Red, itchy skin at site of latex contact
Appears 12 to 24 hours after contact
Warning that an allergy may develop
Immediate reaction where contact occurs
IgE and histamine-mediated response
Systemic reaction
Precipitated by latex proteins

18. Managing Latex - Sensitivity & Allergy
Identify and remove latex item or remove person having reaction from area
Mild reaction: Benadryl (antihistamine) for redness, rash, itching, swelling, eye symptoms
Severe reaction: Use Epinephrine autoinjector, call 911 for difficulty breathing, wheezing, any suspicion of airway involvement

20. Cross reactivity: Foods and latex allergy
35% of those with latex allergy react to at least one food.
High: Banana, avocado, chestnut, kiwi
Moderate: Apple, carrot, celery, papaya, raw potato, tomato, melon

21. Help Students Manage Their Allergy
Wear medical alert identification
Always carry epinephrine
Epinephrine First, Epinephrine FAST!
Encourage student to tell people about their allergy
Avoid exposures
Encourage student to talk to their allergist

22. What Can the School Nurse Do?
Maintain a Safe Environment – Educate Students –
Practice Prevention - Prepare for an Emergency Response
Educate Staff & Administration
Ban Latex Balloons
What Can the School Nurse Do?

23. Atopic Dermatitis: Issues and Concerns
Isn’t this just itchy and scaly skin? What can we do at school?
Atopic Dermatitis: Issues and Concerns

24. Poll Question
Appropriate treatment for atopic dermatitis that may be prescribed for a patient include all of the following EXCEPT:
A. Corticosteroid – topical or oral
B. UV Light Treatment
C. Sauna Treatment
D. Wet Wrap Therapy

25. Atopic Dermatitis A type of eczema
Dry, red unbearably itchy skin
1 out of 10 people have atopic dermatitis
Most common in children

26. Eczema Refers to a number of skin conditions
Many related to allergy
Atopic dermatitis (AD) is the most common
Triggered by food or environmental allergens
Need to prevent exposures to allergens & irritants that set it off

27. Infants & Young Children
Common Areas Affected
Infants & Young Children
Older Children, Teens
Scalp
Behind the ears
Cheeks
Folds of elbows
Wrists
Knees
Eyelids
Face, Neck
Arms
Wrists
Hands
Back of knees
Feet

28. 6 Most Common Triggers for AD
Dry skin
Best prevention for eczema flare: keep skin moisturized
Food Allergies
In children under 2, often associated with milk or egg allergy
Can be any food
Environmental Allergies
Children over 2 – tend to have eczema related to:
Pollen, mold
Pets, dust mites
Skin testing help identify specific allergens

29. 6 Most Common Triggers for AD
Contact Allergies
Adult onset usually set off by contact
Jewelry, Latex
Chemicals in cosmetics
Skin products
Workplace allergen
Allergist can do patch test
Skin Irritants
Not allergens
Soaps, detergents
Fragrances, Wool
Synthetic clothing
Cigarette smoke
Heat
Dries out skin
Causes sweating

30. The Itch – Scratch Cycle

31. Treatments Moisturize!!
Bathe in lukewarm water, pat dry, apply ointment or cream
Wet Wrap therapy
Prescription ointments
Corticosteroids
Oral
Injectable
Biologic medication
Phototherapy

32. Corticosteroids Topical Vary according to: Active ingredient Dosage
Formulation
Type of application

33. Impact on Quality of Life
Unbearable, persistent itch
Sleep disruption
Embarrassment by appearance of rash
Anxiety and depression
Dating and intimacy

34. What Can We Do? Parents Teachers Talk to your school nurse
Talk to your child’s teacher
Talk to your child
Avoid telling child not to scratch
Set up a signal and action plan

35. Messages for Classmates
Eczema is not contagious like a cold. You can’t catch it. It’s like an allergy, such as hay fever, except it affects your skin instead of your nose.
Messages for Classmates

36. Allergy & Asthma Network Resources

37. Allergy & Asthma Network Resources

38. Key Messages
Promoting strategies for developing a strong immune system can help to deter the allergic march.
Latex is everywhere – work to create a safe environment for students with a latex allergy.
Atopic dermatitis is not contagious and has a high impact on a student’s quality of life.

39. Allergy & Asthma Network Website:
Online Learning HQ:
Sally Schoessler
Director of Education, Allergy & Asthma Network