Managing Allergies

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Managing Allergies Anaphylaxis At School
Sandra Montgomery
Superintendent of Special Services
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ANAPHYLAXIS PROTOCOL GUIDELINES 2006
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Sabrinas Law

• Sabrina Shannon had a severe allergy to dairy
  products
• She died after eating french fries at school
• Bill 3 is intended to protect
• students with deadly food allergies
• January 1st 2006 legislation

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What does Bill 3 mean for school boards?

• Create anaphylaxis policy
• Educate students and parents on cross
  contamination
• Implement plans to reduce the risk of exposure to
  allergens ie. thorough hand washing is a key to
  risk reduction
• Creating allergen aware environments and
  individual student plans
• It is about expectations for parents, students,
  principals, staff and volunteers
• It is NOT about banning products

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Bill 3 - Liability

• Section c.7 s.3 (4)
• Ensures that no damages will be instituted with
  respect to any act done in good faith in response
  to an anaphylactic reaction (Unless damages are
  the result of gross negligence)

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Allergies occur when your immune system becomes
unusually sensitive and overreacts to common
substances such as pollen, mould, dust or food.
When these substances cause an allergic reaction,
they are called allergens.
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Allergens enter the body through
The Mouth
The Nose
Touch
Injection
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Allergic reactions can occur in the

• upper respiratory system
• lower respiratory system
• skin
• digestive system
• as a generalized reaction called anaphylaxis

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Anaphylaxis is a sudden, severe, potentially
life-threatening allergic reaction that may
involve the skin, respiratory tract,
gastrointestinal tract and/or cardiovascular
system.
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Common Causes ofAnaphylaxis

• Food
• Medications
• Insect Venom
• Exercise
• Latex

EpiPen
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Symptoms of AnAnaphylactic Reaction

• The most distinctive symptoms include
• hives
• swelling of the throat, lips, tongue or around
  the eyes
• difficulty breathing or
• swallowing

Hives may be entirely absent, especially in
severe or near-fatal cases of anaphylaxis.
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Symptoms of AnAnaphylactic Reaction

• Other common symptoms include
• a metallic taste or tingling in the mouth
• flushing, itching, or redness of the skin
• nausea, vomiting, or diarrhea
• dizziness or lightheadedness
• increased heart rate
• feelings of fear or panic
• loss of consciousness

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Remember

• It takes only 1 to 2 minutes for a mild allergic
  reaction to escalate to anaphylaxis

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When is anaphylaxis most likely to occur?

• New situations
• Normal daily routines are interrupted eg.
  birthday parties and school trips
• During teenage years
• (increasing independence,
• relaxed precautions,
• reluctance to carry
• medication)

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Preventing Anaphylaxis

• 1. Awareness
• Know causes and triggers
• Know emergency plan
• 2. Avoidance
• Do not let student come in contact with allergen
• Check ingredients every time
• if unsure, do not let student eat it
• offer students an alternative choice in food
• Do not let students share lunches, snacks,
  containers or utensils
• Avoid bulk foods
• Be aware of cross-contamination - wash surfaces
  with board approved solutions
• 3. Action
• Administer EpiPen Call 911

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Have An Emergency Plan

• A child with a life-threatening allergy should
  carry an EpiPen at all times.
• An additional EpiPen(s) should be easily
  accessible
• It is important to have one EpiPen available for
  every 10 -20 minutes

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Have An Emergency Plan

• Display At Risk posters in high traffic areas
• Keep students medical information with their
  EpiPen.
• Ensure student has
• Medic Alert identification
• that indicates their specific
• allergens.

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The EpiPen
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What is an EpiPen?

• An EpiPen is a disposable drug delivery system
  with a spring-activated, concealed needle
  designed for emergency administration.
• EpiPens are available in 2 strengths
• EpiPen Jr Smaller amount of
  epinephrine
• EpiPen Larger amount of epinephrine

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What is in an EpiPen?

• EpiPens are an effective way to administer a drug
  called Epinephrine (Adrenaline)
• Epinephrine by injection is the treatment of
  choice for anaphylactic reactions.
• Epinephrine works quickly to
• constrict blood vessels
• relax smooth muscles in the
• lungs to improve breathing
• stimulate the heart beat
• reverse hives and swelling
• around the face and lips.

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Who can I give the EpiPen to?

• It is expected that parents would provide
  proprietary medication with appropriate consent
• Under the new legislation an emergency EpiPen
  should
• be on site

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Using an Epi-Pen

• Grasp EpiPen with the black tip pointing down(
  911 is being called at same time)
• With your other hand
• pull off the gray safety cap.

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Using an Epi-Pen

• Hold the black tip near the outer thigh.
• Swing and jab firmly into the outer thigh.

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Using an Epi-Pen

• Hold firmly in thigh for approx. 10 seconds
  (Count to 10).
• Remove Epi-Pen and massage injection area.

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Check the Tip

• If the needle is exposed, you have given the
  dose.
• There may be a kick back effect so make sure your
  grip is firm
• Bend the needle back against a hard surface after
  administration.
• Carefully put the unit (needle first) back into
  the carrying tube.

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After the Administration of the EpiPen

• Seek emergency medical attention as EpiPen is
  being administered
• If symptoms return or there is no improvement in
  10-20 minutes a second dose may be required.
• Side effects of Epinephrine include
• Nervousness
• Increased heart rate
• Sweating
• Nausea / Vomiting
• Headache
• Dizziness

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Special Tips About Using EpiPens

• If you suspect an anaphylactic emergency,
  administer the EpiPen and call 911
• The effects of epinephrine when not needed
• Increased Heart Rate
• Nervousness
• The possible effect of not administering
  epinephrine in anaphylaxis
• Death
• Always seek medical attention
• after the administration of an EpiPen

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Special Tips About Using EpiPens

• Never put fingers over the black tip when
  removing the safety cap, or after the safety cap
  has been removed.
• Periodically check the expiry date and condition
  of stored EpiPens.
• Keep EpiPens at room temperature. Do not expose
  them to extreme cold, heat or direct sunlight.
• Place the EpiPen on bare skin
  if possible. In an
  emergency,
  the
  EpiPen can be used directly
  through clothing.

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Executive Summary

• Now a policy of TCDSB
• Immunity is enshrined in the legislation
• Updated committee list

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Executive Summary

• Revised School Responsibilities
• Creating allergen aware environments
• Minimizing risk
• Ensure thorough hand washing
• Store medication in a readily accessible,
  organized manner
• A generic EpiPen can now be used

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Executive Summary

• Parent/Student Responsibilities
• Parent to alert school
• Student to carry EpiPen on their person at all
  times

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Executive Summary

• Staff Inservices
• Semi annually or as required for all staff who
  may be new to the school
• Copy of sign in sheets for in-service to be
  forwarded to the school superintendent
• Books and videos are now available for loan

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References
Canadian Society of Allergy Clinical
Immunology 774 Echo Dr., Ottawa, Ontario K1S 5N8
Telephone [phone] E-mail
csaci_at_rcpsc.edu The Hospital for Sick
Children 555 University Ave, Toronto,
Ontario Telephone [phone] E-mail
www.sickkids.on.ca Collins Consulting E-mail
collins.judy_at_sympatico.ca Toronto Catholic
District School Board Superintendent of Special
Services Telephone [phone] ext. 2486

• Anaphylaxis Canada
• 416 Moore Ave., Suite 306, Toronto, Ontario
• M4G 1C9 Telephone [phone]
• E-mail network_at_anaphylaxis.org
• www.gosafe.ca
• Canadian School Boards Association
• 130 Slater Street, Suite 350, Ottawa, Ontario
• K1P 6E2 Telephone [phone]
• E-mail admin_at_cds\nsba.org
• Allergy Asthma Information Association
• (National Office)
• P.O. Box 100, Etobicoke, Ontario
• M4K 5K9 Telephone [phone]
• E-mail national_at_aaia.ca, www.aaia.ca

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Questions or Comments