Life Threatening Allergies and Anaphylaxis
Anaphylaxis: An acute and potentially lethal multisystem reaction. Unlike common allergy, anaphylaxis onset may be sudden and requires instant action to prevent fatality. Anaphylaxis can be presented as severe symptoms in at least one body system OR it can be presented as a combinations of symptoms in two or more body systems.
Epinephrine is the first line choice for treatment of anaphylaxis. ALL student that receive epinephrine should be sent to the emergency department for further evaluation. “It is now recommended that children who normally have epinephrine in the school in case of emergency have at least two doses on hand. Twelve percent of children who needed on dose of epinephrine needed a second dose,” (Selekman2013). A second dose is recommended if symptoms are not resolved within 5-20 minutes (consult student’s provider order).
Dosing Guidelines of Epinephrine
<66 pounds (second grade and lower)
Use junior dose: 0.15mg
>66 pounds (3rd grade and older)
Use adult dose: 0.3mg
“Antihistamines may be administered with epinephrine, but never instead of epinephrine…” (Selekman 2013). Consult student’s physician and guardian to develop protocol for the use of antihistamines, and document in student Emergency Care Plan.
Consider anaphylaxis treatment if any of these signs and symptoms are present and severe:
OR if there are a COMBINATION of symptoms from different body areas:
Lungs: Short of breath, wheeze, repetitive cough
Heart: Pale, blue, faint, weak pulse, dizzy, confused.
THROAT: Tightness, hoarse, trouble breathing/swallowing.
MOUTH: Obstructive swelling (tongue and/or lips)
SKIN: hives over body
SKIN: hives, itchy rashes, swelling (eyes, lips)
GUT: Vomiting, cramping pain, diarrhea
HEENT: Runny nose, sneezing, swollen eyes, phlegmy throat
OTHER: Confusion, agitation, feeling of impending doom.
Guidelines for administering Epinpehrine (taken from the sample protocol developed by the Epinephrine Policies and Procotols Workgroup of the National Association of School Nurses, 12/2014)
Planning Care for Students with Life Threatening Allergies
- Identify students diagnosed with allergies
- Obtain history from parents on their history of anaphylaxis.
- Establish Emergency Care Plan. Consider IHP or 504 for accommodations.
- Obtain orders for student’s medications (epinephrine autoinjector, Benadryl). Students may self-carry emergency medication with MT Self Carry Authorization form filed. (See Appendix)
- Medication: Where will medication be stored? “It is now recommended that children who normally have epinephrine in the school in case of emergency have at least two doses on hand. Twelve percent of children who needed on dose of epinephrine needed a second dose,” (Selekman2013)
- Accommodations: does this student need special diet order? Do they need a “nut free” table? Are their airborne issues with their allergen? What will the child do when there is a class party? Can they have classroom snacks? Are their items in art class or other classrooms that may cause an allergic reaction.
- If your school is going to have a “nut free classroom” or “nut free policy” make sure that all parents are aware. Letters should be sent home. Administrators may choose to have parents sign and return letters.
- Make sure teachers and other team members are familiar with child, their allergies, and their ECP.
- Plan appropriately for field trips and extracurricular activities.
- Train staff in use of epinephrine autoinjector.
- Communicate with transportation department if child rides the bus.
- Consider sending letter home to parents. (Sample letter)
Laws and Regulations
§ 20-5-420, MCA Self-administration or possession of asthma, severe allergy, or anaphylaxis medication
§ 27-1-714, MCA Limits on liability for emergency care rendered at scene of accident or emergency
§ 20 USC 1232 Family Education Rights and Privacy Act
According to MCA 20-5-420 Section 2 it is legal for Montana schools to possess a stock supply of epinephrine auto injectors . “Approximately 20-25% of epinephrine administration in schools involve individuals who allergy was unknown at the time of the reaction,” (NASN SCHOOL NURSE. “The Case for stock Epinephrine in Schools. Vol. 27. No 4. July 2012). Stock epinephrine is to be used in the event that an individual (student, staff, visitor, etc) is having an allergic reaction. Many of these incidents will be first time exposures.
Sample MT Stock Epinephrine Policy: See Appendix or attachment
Free epinephrine auto-injectors are currently available at www.epipens4schools.com
See Appendix ___
- Montana Authorization to possess or Self-Administer Asthma, Severe Allergy, or Anaphylaxis Medication
- Sample Stock Epinephrine Policy
- Sample Anaphylaxis Emergency Plan