Why do I need Food Allergy Training? Senate Bill 27: Guidelines require training for all school personnel Purpose of training: To provide to all school staff basic knowledge and skills to identify students with a possible allergic reaction to food and the appropriate emergency actions for an allergic reaction

Food Allergy Statistics & Facts Nearly 6 million or 8% of children have food allergies Nearly 6 million or 8% of children have food allergies 16%-18% of children with food allergies have had allergic reactions to accidental ingestion of food allergens while in school 16%-18% of children with food allergies have had allergic reactions to accidental ingestion of food allergens while in school 25% of anaphylactic reactions in schools occur among students without a previous food allergy diagnosis 25% of anaphylactic reactions in schools occur among students without a previous food allergy diagnosis Approximately people die annually from food allergy reactions or anaphylaxis Approximately people die annually from food allergy reactions or anaphylaxis Peanut allergy among children appears to have tripled between Peanut allergy among children appears to have tripled between There is no cure for food allergies There is no cure for food allergies Strict avoidance of allergens is critical to the safety of children with food allergies Strict avoidance of allergens is critical to the safety of children with food allergies

Food Intolerance vs Food Allergy Food Intolerance: an unpleasant reaction to a food, that unlike a food allergy, DOES NOT involve the immune system response or the release of histamine. Food Allergy: a group of disorders characterized by immunological responses to specific food proteins. Food allergies can put students at risk for anaphylaxis. Food intolerance – does not put a student at risk for anaphylaxis.

Foods Associated with Allergies 8 common foods account for 90% of food allergic reactions PeanutsMilk Tree NutsEggs WheatFish SoyShellfish Other less common foods can also cause allergic reactions. Reactions can range from mild to deadly.

Symptoms of Allergic Reactions

ANAPHYLAXIS A serious allergic reaction that is rapid in onset and may cause DEATH DEATH

SEVERE Allergic Reaction Signs and Symptoms Body SystemSign or Symptom MouthTingling, itching, swelling of the tongue, lips or mouth: blue/grey color of the lips ThroatTightening of the throat; tickling feeling in back of throat; hoarseness or change in voice, repetitive throat clearing Nose/Eyes/EarsRunny, itchy nose; redness and/or swelling of eyes; throbbing in ears, redness of ears LungShortness of breath; repetitive shallow cough; wheezing StomachNausea; vomiting; diarrhea; abdominal cramps SkinItchy rash; hives; swelling of face or extremities; facial flushing HeartThin weak pulse; rapid pulse; palpitations; fainting; blueness of lips, face or nail beds; paleness

Epinephrine  First-line treatment in the case of anaphylaxis  It works by opening the airways, improving blood pressure, and accelerating heart rate  After 20 minutes, may need a repeat injection

Epinephrine auto-injectors ( Epi-pen )  Two Doses › Epi=pen   Junior for students (green label) lbs  Regular for students ≥ 66 lbs (yellow label)

Administration of Epinephrine  Medication Authorization – must be on file in the nurses office for any student prescribed an Epi-pen  Epi-pen is stored in an unlocked cabinet in the clinic  Some students may carry their Epi-pens with them to class and school activities

Administration of Epinephrine Administration Do’s: Right Student Right Student Right Medication Right Medication Right Dose Right Dose Right Route Right Route Right Time Right Time Location of Epinephrine: ( Epi-pen) o Kept in clinic in unlocked cabinet o Student may carry the auto-injector 911 must be called when epinephrine is administered!

How to use an Auto-injector (Epi-pen) =tjILFYPE3Uw =tjILFYPE3Uw

Post Epinephrine Injection  911 must be called (Call 911 before parents, you don’t want to delay the arrival of EMS) (Call 911 before parents, you don’t want to delay the arrival of EMS)  Notify the parents Documentation  The student’s reaction to the allergen  Medication administration  The student’s reaction to the epinephrine

Self-Administration of Epinephrine  Per Federal law, students may carry their epinephrine with them in the classroom and on school activities  If a student uses their epinephrine in your classroom: o Immediately contact the nurse (if nurse is not available, notify the front office) o Monitor the student’s respiratory status o Note the student’s reaction to the allergen and the time the epinephrine was administered

Students with Diagnosed Food Allergies Every student with a diagnosed food allergy: Every student with a diagnosed food allergy: o Should have a Food Allergy Action Plan o Is eligible for 504 accommodations Notification of a student with diagnosed food allergies: Notification of a student with diagnosed food allergies: o Once notification is received by the school nurse appropriate school personnel will be notified.

The student’s Food Allergy Action Plan:  Provides directions on what to do if a student with a diagnosed food allergy is having a reaction in your classroom  Should be taken on field trips  A copy should be placed in your sub folder

Food Allergy Action Plan

Food Allergy Action Plan, page 2 Food Allergy Action Plan, page 2

Exposure Reduction at School Campus Wide: Allergy aware :Cafeterias do not serve peanut or nut products on elementary or middle school campuses Allergy aware :Cafeterias do not serve peanut or nut products on elementary or middle school campuses Allergy Free Area: Students without the allergen in their lunches may sit in the allergy free area in cafeteria (i.e. peanuts) Allergy Free Area: Students without the allergen in their lunches may sit in the allergy free area in cafeteria (i.e. peanuts)Classrooms: Food:Use non-food items as rewardsor manipulatives Eliminate foods that contain allergens from classroom Food:Use non-food items as rewardsor manipulatives Eliminate foods that contain allergens from classroom Parties:Avoid foods that contain the allergen. Allow only pre- packaged food items with readable ingredient list Parties:Avoid foods that contain the allergen. Allow only pre- packaged food items with readable ingredient list Hand washing:Wash hands before and after meals or use hand wipes. Alcohol based hand gel is not effective in eliminating the allergen. Hand washing:Wash hands before and after meals or use hand wipes. Alcohol based hand gel is not effective in eliminating the allergen.

Exposure Reduction at School Field Trips: o Notify school nurse at least 2 days prior to field trip for necessary preparations. o Invite parent(s) to attend field trip o Don’t leave for field trip without the student’s prescribed Epi-pen o Be aware of foods offered on field trip (may need to contact facility in advance). Transportation: o Strictly enforce no eating on the bus if there is a student with food allergies who is at risk for anaphylaxis riding the bus

Bullying  Be aware of how the student with food allergies is being treated  Ensure classmates avoid endangering, isolating, stigmatizing or harassing students with food allergies  Enforce school rules on bullying and threats

Responsibilities of the Classroom Teacher/Specialist Complete Level I and/or Level II Food Allergy Training annually. Complete Level I and/or Level II Food Allergy Training annually. View students’ Food Allergy Action Plan View students’ Food Allergy Action Plan Understand and implement the Severe Food Allergy Plan for your student(s). Ask school nurse for any clarification needed regarding plan(s). Understand and implement the Severe Food Allergy Plan for your student(s). Ask school nurse for any clarification needed regarding plan(s). Ensure that all substitute individuals, pull out teachers (Special Ed, interventions, Dyslexia, etc.) are informed of the student’s food allergy. Ensure that all substitute individuals, pull out teachers (Special Ed, interventions, Dyslexia, etc.) are informed of the student’s food allergy. Eliminate identified allergens in classroom of student with food allergies at risk for anaphylaxis. Eliminate identified allergens in classroom of student with food allergies at risk for anaphylaxis.

Responsibilities of the Classroom Teacher/Specialist (continued) Send district letter to parents/guardians of classmates of a food–allergic student who is at risk for anaphylaxis, explaining any restricted allergen foods in the classroom. Send district letter to parents/guardians of classmates of a food–allergic student who is at risk for anaphylaxis, explaining any restricted allergen foods in the classroom. Inform parents and campus nurse of any events where food will be served. Inform parents and campus nurse of any events where food will be served. Enforce district policy on bullying related to food or other allergens. Enforce district policy on bullying related to food or other allergens. Know the campus communication plan with the front office and/or campus nurse. Know the campus communication plan with the front office and/or campus nurse. Ensure that student suspected of having an allergic reaction is accompanied by an adult (preferable) or student to the clinic. Ensure that student suspected of having an allergic reaction is accompanied by an adult (preferable) or student to the clinic. Do not put a student on the bus if there are any signs or symptoms of an allergic reaction. Do not put a student on the bus if there are any signs or symptoms of an allergic reaction.

Next Steps: If you… have a student with a history of severe food allergy have a student with a history of severe food allergy are a cafeteria monitor who has a student with a history of severe food allergy are a cafeteria monitor who has a student with a history of severe food allergy are assigned to cover the clinic when a nurse is absent are assigned to cover the clinic when a nurse is absent are a before or after school program sponsor and have a student with a history of severe food allergy are a before or after school program sponsor and have a student with a history of severe food allergy  See the school nurse to: Review and demonstrate proper epinephrine administration Review and demonstrate proper epinephrine administration Know where your student’s medication is kept Know where your student’s medication is kept In clinic In clinic With student With student Both Both

Questions? Please see the School Nurse!