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    Caring for Kids at Risk of Anaphylaxis: A Guide for Teachers and Staff

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    Food Allergies Are Growing Health Concern for Schools

    Almost 5 million school-age children in this country suffer from food allergies. These children must watch every single bite they eat or risk suffering a potentially life-threatening reaction known as anaphylaxis. Each year, food allergies claim over 200 lives and are responsible for over 30,000 emergency room visits.

    Students with food allergies are a growing health concern in schools across the country. The incidence of peanut allergy – the deadliest of all the food allergies – fully doubled in children over the five-year period from 1997-2002. A 1992 New England Journal of Medicine article reported on 6 young patients who died as a result of an anaphylactic reaction. Of these 6, 4 experienced the fatal allergic reaction in school.

    According to the National Association of School Nurses (NASN):

    • Education and planning are key to establishing and maintaining a safe school environment for all students.
    • Those responsible for the care and well being of children must be aware of the potential dangers of allergies.
    • Prevention of allergy symptoms involves coordination and cooperation within the entire school team.
    • Early recognition of symptoms and prompt interventions of appropriate therapy are vital to survival.

    NASN Position Statement on Anaphylaxis, Nov. 2001.

    CARE Training for Teachers and Staff with Food-Allergic Students

    To help schools create a safe environment for food-allergic kids, we have developed guidelines for training teachers and staff who supervise students at risk of anaphylaxis. School nurses are uniquely positioned to implement and/or supervise this training program. Teachers and staff who supervise food-allergic students should receive training from the school on the following topics:

    1. Comprehending the basics about food allergies.
    2. Avoidance of the food allergen.
    3. Recognizing the symptoms of an allergic reaction.
    4. Emergency Action Plan!

    The Facts about Food Allergies

    The following five statements provide a simple yet comprehensive introduction to the basic medical facts about food allergies:

    • An allergy is an overreaction of the immune system that can affect any system of the body, including the respiratory, cardiovascular, gastrointestinal, and skin systems.
    • Ingestion of even a minute amount of the allergenic food can trigger this overreaction and cause a variety of symptoms ranging from mild nausea or itching to anaphylaxis.
    • Anaphylaxis is a systemic allergic reaction that can kill within minutes.
    • There is no cure for food allergies. Strict avoidance of the allergenic food is the only way to prevent a potentially life-threatening reaction.
    • Because the severity of an allergic reaction is unpredictable and can range from mild to life-threatening, early recognition of symptoms and prompt intervention are critical for saving lives. Deaths have occurred in schools due to failure to recognize and promptly treat anaphylactic reactions.

    Avoidance of the Food Allergen

    Because strict avoidance of the allergen is the only way to prevent reactions, it is crucial that teachers and staff be given practical information on how to make the classroom/lunchroom/play-ground safe for food-allergic students. They should be taught:

    • How to read food ingredient labels. (Demonstrations with actual labels are especially helpful.)
    • How to check the ingredients in art supplies and in other products that may contain allergens, such as soaps or hand lotions.
    • How to use proper cleaning methods for tables and other surfaces.
    • The importance of teaching students to wash hands before and after contact with food.
    • Recognizing the symptoms of an allergic reaction.

    Early recognition of symptoms saves lives. Every allergic reaction is different and may not involve hives or other skin symptoms.

    Teachers and staff must be taught to watch for:

    • Mouth – Itching, tingling, or swelling of lips, tongue, mouth
    • Skin – Hives, itchy rash, swelling of the face or extremities
    • Gut – Nausea, abdominal cramps, vomiting, diarrhea
    • Throat – Hacking cough, tightening of throat, hoarseness
    • Lung – Shortness of breath, repetitive cough, wheezing
    • Heart – Thready pulse, low blood pressure, fainting, pale, blueness
    • Mental– Sudden quietness or decreased responsiveness

    Emergency Action Plan!

    Every school should have its own emergency protocol. Teachers and staff must be trained on what to do in an anaphylaxis emergency, including the protocols in place for:

    • Administering the epinephrine auto-injector (Epipen™ or Twinject ™).
    • Calling 911 (Emergency Rescue).