1. Allergies & Anaphylaxis

2. 2 What is an Allergy? Allergies occur when the immune system becomes unusually sensitive and overreacts to common substances that are normally harmless. Examples are: Foods – eggs, milk, peanuts/nuts, shellfish, fish, wheat, soy, sesame and some food additives Stings from bees, wasps, hornets and some ants Medications – penicillin, sulfa drugs Exercise Latex (gloves/medical devices)

3. 3 What is Anaphylaxis? Occurs when a person is exposed to an allergen causing a severe, life-threatening allergic response Reactions can occur within seconds of exposure to an allergen, but can be delayed for 2-3 hours Affects various organ systems including the skin, respiratory, cardiovascular and gastrointestinal

4. 4 Why is this life-threatening? Causes airway obstruction/lack of oxygen to the brain Increases risk of SHOCK, which leads to widespread tissue damage, organ failure and eventually death

5. 5 Prevention = Having a Plan Check the School Medical Alert List to familiarize yourself with students in your school/class who have medical conditions and allergies Note all students who require single dose auto-injectors and where these are stored for each student. Ensure auto-injectors are immediately available Review emergency care plans for individual students Recognize allergy sources and triggers Know when and how to administer the auto-injector

6. 6 Common Symptoms Skin – hives, swelling, itching, warmth, redness, rash Respiratory (breathing) – wheezing, shortness of breath, throat tightness, cough, hoarse voice, chest pain/tightness, nasal congestion or hay fever-like symptoms (runny itchy nose and watery eyes, sneezing), trouble swallowing

7. 7 Common Symptoms Gastrointestinal (stomach): nausea, pain/cramps, vomiting, diarrhea Cardiovascular (heart): pale/blue colour, weak pulse, passing out, dizzy/lightheaded, shock Other: anxiety, feeling of “impending doom”, headache, uterine cramps in females

8. 8 Hives and Swelling of face Important: Not all reactions have hives Before giving EpinephrineAfter giving Epinephrine www.natureshomoeo.com.au/image/student.JPG

9. 9 Swollen lips/face and hives present www.sovereign-publications.com/.../ANAPHYL.jpg

10. 10 health.yahoo.com/media/healthwise/h9991075.jpg

11. 11 Anaphylaxis: What should I do? 1. Administer single dose auto-injector 2. Call 911 3. Notify Parent/Guardian 4. Administer second single dose auto-injector in 5 to 15 minutes after first dose is given IF symptoms do not improve or if symptoms recur 5. Have ambulance transport student to hospital *Epinephrine is the only way to reverse the effects of anaphylaxis & therefore needs to be given ASAP **Remember, the Epinephrine may only last for 15 minutes, calling 911 is very important

12. 12 Anaphylaxis: What should I do? Symptoms of anaphylaxis can be as simple as tingling of the lips or as severe as cardiac arrest. When in doubt, administer epinephrine If a person says they are having a reaction it is important to believe them, and immediately administer epinephrine regardless of the symptoms present

13. 13 What is a Single Dose, Epinephrine Auto-injector? A single dose auto-injector is an easy way to give epinephrine/adrenaline to someone having an allergic reaction E.g. EpiPen ®, Twinject ®

14. What is in an EpiPen®? Single dose of epinephrine Source: www.epipen.cawww.epipen.ca Easy-to-read instructions Easy-grip body Built-in needle protection Labeled orange needle cover contrasts with blue safety release for easy orientation* **Old style: may still see in schools 14

15. 15 Using the EpiPen® Auto-Injector (Old Style) 1.Remove the device from the plastic protective container GREY cap 2.Remove the GREY cap from device 3.Press BLACK tip to thigh until a loud “click” is heard 4.Hold in place for 10- 15 seconds

16. 16 Using the EpiPen® Auto-Injector (Old Style) 5.Remove the pen from the thigh 6.The needle can now be seen, place auto- injector back in protective case 7.Apply pressure to injection site with a tissue or bandage if there is bleeding 8.Follow Standard Precautions for your safety (e.g. wear gloves, be careful when handling exposed auto-injector needle)

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18. 18 What is Twinject®? Contains two doses of epinephrine in a single device First dose of epinephrine is administered by auto- injection, just like the EpiPen®.

19. 19 Using the Twinject® Auto-Injector 1.Pull off GREEN end cap labeled “1” 2.Pull off GREEN end cap labeled “2” 3.Press RED cap into outer thigh until unit activates

20. 20 Using the Twinject® Auto-Injector 4.Hold Twinject® in place for 10 seconds 5.Apply pressure to injection site with a tissue or bandage if there is bleeding 6.Follow Standard Precautions for your safety (e.g. wear gloves, be careful when handling exposed auto-injector needle) **Remember, staff are not recommended to give dose two (manual IM injection of epinephrine)

21. 21 What to do after giving a single dose auto-injector? Have student lie still on his or her back with feet higher than the head Loosen tight clothing and cover student with blanket If there is vomiting, turn student on side to prevent choking Don’t give anything to drink Send auto-injector with student to hospital

22. 22 Conclusion: Follow the three A’s Awareness –Know the triggers –Know the emergency plan and how to administer epinephrine via the single dose auto-injector Avoidance –Avoid contact with allergens, make classrooms safe Action –Give single dose auto-injector and call 911. –Don’t delay!

23. 23 Resources For more information contact your Public Health Nurse www.aaia.ca (Allergy/Asthma Information Assoc.) www.anaphylaxis.org (Anaphylaxis Canada) www.epipen.ca (EpiPen®) www.twinject.ca (Twinject®) www.medicalert.ca www.bchealthguide.org/healthfiles

24. 24 References AAIA Anaphylaxis Reference Kit (2007) by the Allergy and Asthma Information Association, Health Canada Anaphylaxis in Schools & Other Settings (Second Edition, 2009) by the Canadian Society of Allergy and Clinical Immunology.

25. 25 Any Questions?