Life Threatening Allergies in the School Setting: Pittsfield Public Schools Faculty Review August 2012

Objectives  Life Threatening Allergy (LTA) Policy passed in  Define LTAs and anaphylactic process by symptoms.  Learn how to administer an EpiPen.  Discuss hand washing and desk surface cleaning and Safe Food Zones vs No Food Zones to decrease potential exposure to allergens.  Allergy management is a partnership among parent/guardian(s), the student, the physician and the school system.  Life Threatening Allergy (LTA) Policy passed in  Define LTAs and anaphylactic process by symptoms.  Learn how to administer an EpiPen.  Discuss hand washing and desk surface cleaning and Safe Food Zones vs No Food Zones to decrease potential exposure to allergens.  Allergy management is a partnership among parent/guardian(s), the student, the physician and the school system.

Pittsfield’s School Epi Pen Breakdown 2011/2012  Allendale- 10 Stearns-6  Capeless-8 Williams-10  Conte-9 Herberg-20  Crosby-12 Reid- 9  Egremont-13 PHS- 11  Morningside-6 THS- 9  Allendale- 10 Stearns-6  Capeless-8 Williams-10  Conte-9 Herberg-20  Crosby-12 Reid- 9  Egremont-13 PHS- 11  Morningside-6 THS- 9

PPS School Facts based on 2011/2012 stats  During 2011/2012 SY 4 Epi Pens were given in PPS. (2) Food related and (2) other.  4 were given in Pittsfield this past year to students 2 food related, 2 for other….all by School Nurses DPH data shows us the prescription rate has climbed over the last 9 years. In 2001, 7.2/1000 students needed prescriptions. In 2010, 20.5/1000 students needed prescriptions. Food allergies 42.9/1000, Bee stings 5.6/1000 and Latex 2.1/1000.  During 2011/2012 SY 4 Epi Pens were given in PPS. (2) Food related and (2) other.  4 were given in Pittsfield this past year to students 2 food related, 2 for other….all by School Nurses DPH data shows us the prescription rate has climbed over the last 9 years. In 2001, 7.2/1000 students needed prescriptions. In 2010, 20.5/1000 students needed prescriptions. Food allergies 42.9/1000, Bee stings 5.6/1000 and Latex 2.1/1000.

What is a Life-Threatening Allergy?  People with LTA have an over-reactive immune system that react to otherwise harmless elements in our diet and environment.  During an allergic reaction, a sequence of events in the cells of the immune system occurs resulting in the release of chemical mediators such as histamine. This triggers inflammatory reactions in the tissues of the skin, respiratory system, gastrointestinal tract and the cardiac system.  Wide-spread and systemic symptoms are termed anaphylaxis.  People with LTA have an over-reactive immune system that react to otherwise harmless elements in our diet and environment.  During an allergic reaction, a sequence of events in the cells of the immune system occurs resulting in the release of chemical mediators such as histamine. This triggers inflammatory reactions in the tissues of the skin, respiratory system, gastrointestinal tract and the cardiac system.  Wide-spread and systemic symptoms are termed anaphylaxis.

Eight That Aren’t Great  Eight foods are responsible for most reactions.  Peanut * Fish  Tree nut * Shellfish  Milk * Soy  Egg * Wheat Any… Remember… Any… food can cause a serious allergic reaction.  Eight foods are responsible for most reactions.  Peanut * Fish  Tree nut * Shellfish  Milk * Soy  Egg * Wheat Any… Remember… Any… food can cause a serious allergic reaction.

Symptoms By System  Skin-Swelling, hives, rash, itching.  Resp.-Wheezy, short of breath,throat tight, can’t swallow and voice change.  Gastro.- itchy tongue, itchy throat, vomiting, abdominal pain and diarrhea.  Cardiac- fainting, flushed or pale skin blue lips/mouth and dizzy.  Other- sense of impending doom, anxiety.  Skin-Swelling, hives, rash, itching.  Resp.-Wheezy, short of breath,throat tight, can’t swallow and voice change.  Gastro.- itchy tongue, itchy throat, vomiting, abdominal pain and diarrhea.  Cardiac- fainting, flushed or pale skin blue lips/mouth and dizzy.  Other- sense of impending doom, anxiety.

Treatment  Symptoms indicating need for EpiPen:  rapidly developing hives  difficulty breathing or wheezing  Swelling of the tongue or face  If in doubt give epinephrine !!  Symptoms indicating need for EpiPen:  rapidly developing hives  difficulty breathing or wheezing  Swelling of the tongue or face  If in doubt give epinephrine !!

EpiPen  Disposable drug delivery system for Epi.  Spring activated, concealed needle.  Designed for self-administration in emergencies.  Dose based on body weight. Child under 66 lbs 0.15mg Child/ Adult over 66 lbs 0.3mg Medication is the same for food, bee sting or any severe allergy.  Disposable drug delivery system for Epi.  Spring activated, concealed needle.  Designed for self-administration in emergencies.  Dose based on body weight. Child under 66 lbs 0.15mg Child/ Adult over 66 lbs 0.3mg Medication is the same for food, bee sting or any severe allergy.

EpiPen: Directions for Use  Hold in dominant hand.  Remove the safety cap (may be grey or blue) from the end of the device.  This “opens the unit” for use.  Hold EpiPen about 6 inches from outer thigh in your clenched fist, the tip pointing toward the outer thigh.  Swing or jab EpiPen into outer thigh, press hard into thigh until you should hear a “click” hold for 10 seconds, remove EpiPen and discard safely.  Massage area for 10 seconds.  Hold in dominant hand.  Remove the safety cap (may be grey or blue) from the end of the device.  This “opens the unit” for use.  Hold EpiPen about 6 inches from outer thigh in your clenched fist, the tip pointing toward the outer thigh.  Swing or jab EpiPen into outer thigh, press hard into thigh until you should hear a “click” hold for 10 seconds, remove EpiPen and discard safely.  Massage area for 10 seconds.

EpiPen  Constricts blood vessels  Relaxes smooth muscles in lungs to improve breathing  Stimulates heart beat  Reverses hives and swelling  Effect only last 10-15minutes  EMS must be called in conjunction with EpiPen administration.  Constricts blood vessels  Relaxes smooth muscles in lungs to improve breathing  Stimulates heart beat  Reverses hives and swelling  Effect only last 10-15minutes  EMS must be called in conjunction with EpiPen administration.

Plan ahead !  Familiarize yourself with students who have LTAs. Are they in your class ?  Know the Individualized Health Plan for your student. School Nurse will provide a copy for trips.  Give your School Nurse at least 2 weeks notice prior to any field trip.  Know where the closest Hospital is when field trip planning. Exchange phone contact info with your SN.  Ensure there is a designated Staff member to carry the Epi Pen.  Familiarize yourself with students who have LTAs. Are they in your class ?  Know the Individualized Health Plan for your student. School Nurse will provide a copy for trips.  Give your School Nurse at least 2 weeks notice prior to any field trip.  Know where the closest Hospital is when field trip planning. Exchange phone contact info with your SN.  Ensure there is a designated Staff member to carry the Epi Pen.

Questions ?? / Practice Time References: Life Threatening Allergies in School Settings by MA Nurse Leader Joan E.Schleeweis-Connor 2009 Managing Life-Threatening Allergies in School by Hanover Public Schools Health Services Dept Mass Dept of Health: School Health Unit National Association of School Nurses American Academy of Allegry, Asthma. References: Life Threatening Allergies in School Settings by MA Nurse Leader Joan E.Schleeweis-Connor 2009 Managing Life-Threatening Allergies in School by Hanover Public Schools Health Services Dept Mass Dept of Health: School Health Unit National Association of School Nurses American Academy of Allegry, Asthma.