Anaphylaxis

1. Anaphylaxis Severe food allergy Insect sting/bites

2. Anaphylaxis Anaphylaxis is the most severe allergic reaction and is potentially life threatening. Fortunately, it is rare, therefore most people will never have an anaphylactic reaction. Anaphylaxis is a sudden, severe allergic reaction that involves multiple areas of the body, simultaneously. It can cause difficulty breathing and swelling of the throat and tongue. The most common causes of anaphylaxis include foods, insect stings and medications.

3. Food Allergy *Food allergy occurs when the immune system mistakenly attacks a food protein. Ingestion of the offending food may trigger the sudden release of chemicals, including histamine, resulting in symptoms of an allergic reaction. *The symptoms may be mild (rashes, hives, itching, swelling, etc.) or severe (trouble breathing, wheezing, loss of consciousness, etc.). A food allergy can be fatal. *Scientists estimate that as many as 15 million Americans suffer from food allergies. (*Food Allergy and Anaphylaxis Network - FAAN)

4. Common Food Allergens Eight types of foods account for 90% of all food-allergy reactions: cow’s milk, eggs, peanuts, tree nuts (including walnuts, pecans, hazelnuts, almonds, cashews, pistachios, and macadamia nuts), fish, shellfish, soybeans, and wheat.4–6 (CDC) Cross contamination: Hidden Allergens / Hidden Dangers Food service must take steps to prevent

5. Symptoms As mentioned earlier, symptoms may include one or more of the following: *a tingling sensation in the mouth, lips *itching in the ears, around the mouth, *swelling of the tongue and the throat, *difficulty breathing, *hives, *vomiting, *abdominal cramps, *diarrhea, *drop in blood pressure, *loss of consciousness, and even death. Symptoms typically appear within minutes to a couple of hours after the person has eaten the food.

6. There is no cure for food allergies How do we manage/prevent? With food allergies, PREVENTION IS THE KEY 1. Identify those at risk, meet/talk with parent about student specific info (how do they react,) 2. Complete food allergy action plan 3. Have physician and parent assist in completing action plan 4. Have parent provide epipen if required 5. Meet with student and discuss in detail 6. Notify cafeteria of allergy (can be plugged in register along with PIN. 7. Notify staff, (info is entered as medical alert in Star base) 8. Post signage (classroom and cafeteria) 9. Offer/participate in annual Epipen training.

7. Insect stings/bites • The insects that most often trigger severe allergic reactions include the : • Bee • Wasp • Hornet • Yellow jacket • Fire ant

8. Reactions to stings Fortunately, most of us will have a “minor” or “normal” reaction to an insect sting. It will result in pain, swelling, and redness at the sting site and will go away in a couple of days or so. Others may react a bit more to the sting - this type of reaction may result in swelling that extends beyond the sting site. For example, a person stung on the wrist, may have swelling of the hand and arm. The site may be red and warm to touch. This type of reaction, though it may look a lot worse, is generally no more serious than a normal reaction. The most serious reaction to an insect sting is of course an anaphylactic reaction and is life threatening.

9. Symptoms of an Anaphylactic reaction due to insect sting may include: *Difficulty breathing *Hives that appear as a red, itchy rash, it spreads to areas beyond the sting site *Swelling of the face, throat, mouth *Wheezing , noisy breathing *Difficulty swallowing *Restlessness and anxiety, *Rapid pulse *Dizziness due to drop in blood pressure  *Stuffiness in the nose *Red, flushed skin

10. Treatment of Food and Insect Anaphylaxis Some types of mild food and insect allergies are treatable with an antihistamine or bronchodilator. Severe, or anaphylactic reactions, require epinephrine.

11. New state legislation requires school systems to carry “stock” Epipens, to be used on anyone in anaphylaxis. These Epipens will be kept with Epipens that are prescribed for specific students. Each school nurse will review with school staff the location of the Epipens and how to access.

12. Diphenhydramine (Benadryl)In less severe allergic reactions, diphenhydramine may be the drug of choice. There is a supply of diphenhydramine liquid in the nurses office also. There are emergency dosage instructions posted inside cabinet. “Banophen” or “Q-dryl” are the brands of diphenhydramine we are currently using. Some schools may have the brand Benadryl also.

13. Return Demonstration Sign check off sheet

14. Epipen– Points to remember: • Epipen is given directly thru clothes, in leg. • Epipen is given in side of leg, ½ way between hip and knee… • Can be given while person is sitting or standing. • Once given, hold epipen injection in place for count of 10, remove, massage area to help disperse medication. • Effects of epipen should “kick in” in several minutes, and it will last about 20 minutes… can be give along with Benadryl. • Always call 911 if you use epipen, call 911 first, then school nurse and if a student, call parents. • Stay with one receiving epipen, reassure, comfort, monitor until help arrives. • Find out where your epipens will be kept… know how to access. • Blue to the sky, orange to the thigh.