Anaphylaxis in schools and other settings

Question 1

What are key recommendations in the emergency management of anaphylaxis?

Answer 1

1. Epinephrine is the first line medication
2. Antihistamines and asthma medications should not be used instead of epinephrine
3. All individuals receiving epinephrine must be transported to hospital immediately (ideally by ambulance) for evaluation and observation
4. Additional epinephrine should be available during transport to hospital. A second dose of epinephrine may be given as early as 5 min after the first dose if there is no improvement in symptoms.
5. Individuals with anaphylaxis who are feeling faint or dizzy because of impending shock should lie down unless they are vomiting or experiencing severe respiratory distress
6. No person experiencing anaphylaxis should be expected to be fully responsible for self-administration of an epinephrine auto-injector. Assistance from others, esp. in the case of children, maybe necessary

Question 2

What is the prevalence of anaphylaxis in Canada?

Answer 2

2% or 700 000 Canadians

Question 3

What are signs or symptoms of anaphylaxis?

Answer 3

Two or more of the following body systems or low BP alone:

• skin: hives, swelling, itching, warmth, redness
• respiratory: coughing, wheezing, SOB, cough, chest pain or tightness, throat tightness, hoarse voice, nasal congestion, hay fever-like symptoms, trouble swallowing
• GI: nausea, pain or cramps, vomiting, diarrhea
• Cardiovascular: pallor, cyanosis, weak pulse, LOC, lightheadedness, shock
• other: anxiety, sense of doom, headache, uterine cramps, metallic taste

Question 4

What are common food allergens that cases anaphylaxis?

Answer 4

1. peanut
2. tree nuts
3. milk
4. egg
5. sesame
6. soy
7. wheat
8. seafood
9. mustard

Question 5

What should be counselled for someone at risk of anaphylaxis?

Answer 5

1. avoid allergen
2. carry an epinephrine auto-injector at all times
3. wear medical identification
4. have a written anaphylaxis emergency plan
5. receive instructions on when and how to use epinephrine auto-injectors

Question 6

What factors increase the risk of severe anaphylactic reaction?

Answer 6

1. Asthma
2. Under-utilization and delay in the use of epinephrine
3. Underlying cardiac diseases
4. Under 19yo

Question 7

What are recommendations to reduce the risk of exposure for people with food allergy?

Answer 7

1. Adult supervision of young children who are eating
2. individuals with food allergy should not trade or share food, food utensils, or food containers
3. school admin, parents and foodservice staff should work closely together to ensure that food being served during lunch and snack programs is appropriate according to their policies around food
4. the use of food in crafts and cooking classes may need to be modified or restricted depending on the allergies of the children
5. alternatives to using food as a reward should be considered
6. ingredients of food brought in for special events by the school community, served in school cafeterias, or provided by catering companies should be clearly identified
7. all children should be encouraged to comply with a no eating rule during daily travel on school buses
8. all children should wash their hands with soap before and after eating
9. surfaces such as tables, toys, etc. should be carefully cleaned of contaminating foods

Question 8

What are guidelines to reduce the risk of exposure to insect stings?

Answer 8

1. keep garbage cans covered with tightly fitted lids in outdoor play areas
2. consider restricting eating areas to designated locations inside the school building during daily routine. this allows for closer supervision, avoids school yard cleanup, and helps reduce prevalence of stinging insects
3. insect nests should be professionally relocated or destroyed as appropriate
4. avoid areas where stinging insects gather
5. wear light colours
6. avoid loose flowing garments or hair that could entrap an insect
7. wear shoes
8. avoid scented products
9. drink from cups and use a straw if outdoors
10. carry an epipen
11. consider immunotherapy

Question 9

What are general recommendations?

Answer 9

1. Identify individuals at risk

2. Create a comprehensive written school anaphylaxis plan

Question 10

What are recommendations for parents/guardians?

Answer 10

1. must educate allergic children on avoidance
2. are responsible for informing the school re: updated children’s allergies and providing the school with a non-expired epinephrine auto-injector
3. complete anaphylaxis emergency plan
4. provide consent to staff to administer epinpehrine
5. should NOT sign a waiver absolving the school of responsibility if epinephrine was not injected
6. for food-allergic children, should provide non-perishable foods and safe snacks for special occasions
7. should communicate with school staff about field trip arrangements
8. should meet with food service staff to inquire about allergen management policies and menu items if their child is to eat foods prepared at school

Question 11

What are guidelines for children with anaphylaxis?

Answer 11

1. have an auto-injector with their name on it, kept in a readily accessible location which is UNLOCKED
2. carry their own auto-injector usu. by age 6-7yo
3. refrain from eating if they do not have an auto-injector with them
4. be very cautious about eating foods prepared by others
5. not share food or utensils
6. wash hands with soap and water before and after meals
7. wear medical identification
8. inform someone immediately after accidental exposure to an allergen or as soon as symptoms occur

Question 12

What are recommendations for the school community?

Answer 12

1. all school staff should be aware of children with allergies and how to treat them
2. school staff must consult with parents before posting the child’s plan and respect privacy
3. All students should be taught seriousness of anaphylaxis and how to help
4. All bullying and teasing incidents should be dealt with immediately
5. School should keep readily available auto-injectors

Question 13

What recommendations should be given to foodservice and bus companies?

Answer 13

1. ensure food service personnel are trained re: cross-contamination and should clearly identify all contents of food
2. bus companies should include anaphylaxis training and enforce no eating rules
3. all foodservice and bus companies should participate in school’s anaphylaxis training and with parental permission have access to which students have anaphylaxis and their emergency plans