Managing Food Allergies in School April 9, Maria Crain, RN, CPNP Amy Arneson, RN, BSN Food Allergy Center Children s Medical Center Dallas
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1 Managing Food Allergies in School April 9, 2011 Maria Crain, RN, CPNP Amy Arneson, RN, BSN Food Allergy Center Children s Medical Center Dallas
2 -None Conflict of Interest
3 Learning Objectives -Define food allergy and the common allergens -Differentiate between an allergic reaction and anaphylaxis -Describe key parts of an emergency food allergy action plan -List family and school responsibilities for a student with food allergies -List ways to prevent an allergic reaction in school -List 5 steps necessary to give an Epipen injection
4 What is a food allergy? - A food allergy is an abnormal response by the immune system to a food protein - When the food is eaten, the immune system thinks the food is harmful and releases histamine and other chemicals to attack the enemy Food Allergy & Anaphylaxis Network, 2010
5 Pathophysiology -Food protein binds to IgE on effector cells (mast cells or basophils) -The cell releases chemical mediators -Results in inflammation and allergic response
6 Review of literature -4-6% of children have food allergies -From , children with peanut allergy doubled -44% of school nurses reported an increase in students with food allergies over a 5-year period -In one study, more than one third of nurses had 10 or more food allergic students -4 of 6 fatalities occurred in school -Fatalities associated with significant delay in treatment with Epipen Sicherer et al 2003 Munoz-Furlong et al 2009 Sampson et al 1992
7 Review of Literature -Several studies find schools have inadequate emergency plans -In 32% of cases school personnel did not recognize symptoms of an allergic reaction -Children had more reactions in the classroom with school projects that contained food than in the cafeteria Young et al 2009 Sicherer et al 2001
8 Common Food Allergies 90% of food reactions are caused by: -Milk -Egg -Nuts -Seafood -Soybean -Wheat
9 Reactions -Reactions usually occur within minutes after a child has eaten and no later than 4 hours -Reactions can occur from contact and inhalation but these are rare Young et al 2009
10 Types of reactions Cutaneous -Hives -Swelling -Rash -Pruritis
11 Types of Reactions Gastrointestinal -Abdominal pain -Nausea/vomiting
12 Types of Reactions Respiratory -Coughing -Wheezing -Throat tightness -Trouble breathing -Children with asthma or previous anaphylaxis are more likely to have severe allergic reactions Young et al 2009
13 Types of Reactions Cardiac -Hypotension -Loss of consciousness -Cyanosis -Tachycardia
14 What is Anaphylaxis? -Term used to describe a serious allergic reaction that is rapid and may cause death -Food Allergy is most common (81%) cause of anaphylaxis in children -Treatment of choice is Epinephrine Jarvinen 2009
15 Treatment -There is no cure for food allergy -Treatment includes: Medications Avoidance Education -Follow child s food allergy action plan
16 Treatment Antihistamines (ex. Benadryl) -Benadryl (1-1.5 mg/kg by mouth every 4-6 hours as needed) -Liquid or fast melts are recommended because quick onset of action -Used to treat rash, hives, itching, swelling
17 Treatment Epinephrine (Epipen) -Intramuscular injection to the outer mid-thigh -Hold for 10 seconds, massage area, call 911 -Dose may be repeated in 10 minutes -Used for treatment of anaphylaxis or severe reactions affecting multiple organ systems
18 Treatment -Important that Epipens are in an unlocked location -Should be able to administer emergency medications within minutes of a reaction -Safe to use, side effects are minimal, may be used through clothing -When in doubt, use the Epipen! *Morbidity has shown to be lower in children who received epinephrine early Gold et al 2000
19 Treatment The Joint Task Force of the American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma and Immunology; the American Academy of Pediatrics; and the National Association of School Nurses all recommend emergency action plans (EAPs) that direct therapy of allergic reactions in children Pulcini et al 2010
20 Treatment Food Allergy Action Plan -Clear plan of action for child with allergies -Includes student s name, birth date, picture, allergies and history of asthma -Symptom chart that indicates when medications should be administered -Food Allergy and Anaphylaxis Network plan is preferred by most allergists
21
22 Treatment Avoidance in school -Eliminating school projects with food -Hand washing/cleaning if necessary -Using allergy friendly areas in the cafeteria for children with allergies -Using safe foods in class or working with families for safer alternatives
23 School s Responsibilities -Be knowledgeable and follow laws -Review student s health records -Include food allergic students -Identify a team to work with family -Assure staff is aware -Practice plan in advance -Make sure medications are properly stored
24 School s Responsibilities -Designate personnel responsible -Review plan and events after allergic reactions -Work with district transportation administrator -Recommend all buses have way to communicate -Enforce no eating policy on school buses
25 School s Responsibilities -Discuss field trips with family -Follow laws -Take threats and harassment against an allergic child seriously
26 Family s Responsibilities -Notify school of food allergies -Work with school team -Provide written documentation -Provide labeled medications -Educate their child in self-management (depends on age)
27 Be prepared -Emergency action plans -Prevention strategies in place -Recognize allergic reactions -Medications readily available -Educate staff -Work with families
28 Case studies A student comes to the nurse s office with a documented peanut allergy. About 10 minutes ago, she accidentally ingested a piece of his friend s peanut butter sandwich. She has no history of asthma. She is coughing and complaining of difficulty breathing. What should the nurse do?
29 Case studies 1.Follow the emergency plan and give Epipen 2.Call Monitor vital signs 4.Notify family
30 Case studies A child presents to the nurse s office with complaints of itchy skin, and the nurse observes a few hives on the arms. The child recently ate in the cafeteria but he doesn t remember what he ate. What should the nurse do?
31 Case studies 1.Give Benadryl by mouth based on plan 2.Continue to monitor student in office 3.Monitor vital signs 4.Have Epipen ready in case symptoms progress 5.Notify family
32 Resources Food Allergy and Anaphylaxis Network (FAAN) Food Allergy Initiative (FAI) Children s Medical Center
33 References -Food Allergy and Anaphylaxis Network. Available at Accessed May Gold MS, Sainsbury, R. First aid anaphylaxis management in children who were prescribed an epinephrine auto injector device (EpiPen). Journal of Allergy and Clinical Immunology 2000; 106: Jarvinen, KM, Amalanayagam, S, Shreffler, WG, Noone, S, Sicherer, SH, Sampson, HA, Nowak-Wegrzyn, A. Epinephrine treatment is infrequent and biphasic reactions are rare in food-induced reactions during oral food challenges in children. Journal of Allergy and Clinical Immunology 2009; 124 (6). -Munoz-Furlong, A, Weiss, Christopher. Characteristics of food allergic patients placing them at risk for a fatal anaphylactic episode. Current Allergy and Asthma Reports 2009; 9: Pulcini, JM, Sease, KK, Marshall, DD. Disparity between the presence and absence of food allergy action plans in one school district. Allergy and Asthma Proceedings 2010; 31 (2): Sampson HA, Mendelson L, Rosen JP. Fatal and near fatal anaphylactic reactions to food in children and adolescents. New England Journal of Medicine 1992; 327: Sicherer SH, Munoz-Furlong A, Sampson, HA. Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: A five-year follow-up study. Journal of Allergy and Clinical Immunology 2003; 112: Sicherer SH, Furlong TJ, DeSimone J., Sampson HA: The US peanut and tree nut allergy registry: characteristics of reactions in schools and day care. Journal of Pediatrics 2001, 138: Young, MC, Munoz-Furlong, A, Sicherer, SH. Management of food allergies in schools: A perspective for allergists. Journal of Allergy and Clinical Immunology 2009; 124 (2).
34 Epinephrine Auto-Injectors GROUP ACTIVITY
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