Education for a Life Threatening Allergic Reaction Anaphylaxis Education for a Life Threatening Allergic Reaction Natasha Paul BSc,BScN, RN Public Health Services

Objectives Identify participant at risk Define anaphylaxis Describe the signs and symptoms Identify triggers for anaphylaxis Discuss treatment of anaphylaxis Discuss avoidance strategies Be able to use an epinephrine auto-injector

Goal for Recreational Programs To create an “allergy-safe” environment Prevention of an allergic emergency through Education Awareness Training

Identify the Participants at Risk Recognize Particpants Picture MedicAlert® bracelet Anaphylaxis emergency plan Know the symptoms

Anaphylaxis Emergency Plan

What is Anaphylaxis? Medical Emergency A severe life threatening allergic reaction Death can occur within minutes Can involve more than one body system

What are the Signs and Symptoms? Note: Anaphylaxis can occur without hives being present

Skin hives swelling itching redness

Respiratory sneezing cough shortness of breath wheeze hoarse voice trouble speaking trouble swallowing throat tightness chest pain/tightness

Cardiovascular lightheadedness dizzy unsteady feeling faint drowsy

Gastrointestinal nausea vomiting diarrhea stomach pain

Other anxiety feeling something bad is going to happen “impending doom”

Key Messages Unpredictable Never ignore early symptoms Antihistamines do not prevent anaphylaxis Asthma medicine do not prevent anaphylaxis Assistance may be required to use the auto-injector

Triggers for Anaphylaxis Food peanut tree nuts milk egg fish/shellfish wheat soy

Triggers for Anaphylaxis Insect Stings Medication Latex

Factors that increase the risk of a severe allergic reaction Asthma No or delayed use of epinephrine If asthma is poorly controlled there is the potential for a more sever allergic reaction. Side effects are rapid heart rate, flushing or pallor, dizzy, weakness,tremors

Treatment of Anaphylaxis Epinephrine

Epinephrine Hormone that is produced naturally in the body “fright & flight” Drug of choice to treat anaphylaxis No contraindications Will not cause harm if given Possible side effects: increased heart rate,tremors,flushing pallor,dizziness

When to give Epinephrine Known exposure Any inside symptoms Generalized hives or swelling If in doubt, give epinephrine

Managing Anaphylaxis Administer epinephrine (note expiry date) Lie the person on his/her side Call 911 Call parents If reaction continues or worsens, a second dose of epinephrine may be given in 10-20 minutes

Location of the Epinephrine Auto-injector Places that are easily accessible Check expiry date located on Epi NOT in locked cupboards or drawers Individuals should carry their own auto-injector Extra auto-injectors in emergency first-aid kits (if possible)

Avoidance Strategies (Food Allergens) Do not eat the allergic food Supervision of young children while eating No trading or sharing of food, utensils, or containers Wash hands before and after eating Disposal of food items after eating Categories for avoidance : Classroom/ Cafeteria Buses General

Avoidance Strategies Table surfaces cleaned after eating Ingredient list for food purchased “No Eating” rule on buses Non-food items or special activity to reward or celebrate participants Communication or Reminders - “It is that time of year again…”via Community Center/HRM using bulletins and newsletters outlining the program’s anaphylaxis plan/expectations.

Avoidance Strategies (Insect Stings) Eat in designated areas inside the facility Carry epinephrine auto-injector Cover and empty garbage bins Replace or repair broken screens on windows

Remember: Epi pens should not be expired or close to expiration date. Inform parents if they are. If you overhear a child say he has an allergy but you are unaware of this fact – follow it up.

Legalities… (Providing Treatment) Volunteer Services Act: Chapter 497 (Revised status 1989, amended 1992 C34) An Act Respecting the Protection of Persons Who Voluntarily Render Services or Assistance

Legalities… (Providing Treatment) Volunteer Services Act: Chapter 497 (Revised status 1989, amended 1992 C34) Emergency assistance to person Where, in respect of a person who is ill, injured or unconscious as a result of an accident or other emergency, a volunteer renders services or assistance at any place, the volunteer is not liable for damages for injuries to or the death of that person alleged to have been caused by an act or omission on the part of the volunteer while rendering services or assistance, unless it is established that the injuries or death were caused by gross negligence on the part of the volunteer, and no proceeding shall be commenced against a volunteer which is not based upon his alleged gross negligence. R.S., c. 497, s. 3.

Legalities… Canadian Charter of Rights and Freedoms provides: (s.15) “15. (1) Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability. individual is equal before and under the law and has the right to equal protection and equal benefit of the law without discrimination and in particular, without discrimination based on …physical disability.”

Canadian Charter of Rights and Freedoms provides: (s.15) Legalities… Canadian Charter of Rights and Freedoms provides: (s.15) (2) Subsection (1) does not preclude any law, program or activity that has as its object the amelioration of conditions of disadvantaged individuals or groups including those that are disadvantaged because of race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.

How to use the EpiPen® Remove EpiPen Auto-Injector from carrier tube Hold firmly with orange tip pointing downward Remove blue safety release (cap) Push Orange tip firmly into mid-outer thigh until you hear a “click” Hold on thigh for several seconds (count to 10) Built in needle protection (orange needle protector extends to cover needle to protect you from a needle stick injury) Remove and return to storage container Bring to hospital for disposal

How to use the EpiPen® www.epipen.ca

How to use the Twinject™ Pull of Green cap #1 to see a red tip Pull of Green cap #2 Press GREY tip against mid outer thigh until a click is heard Hold in place for a count of 10 Remove

How to use the Twinject™ Suggestion: Start taking Second dose apart now and make it available. Once Ambulance arrives, place Second Dose or unused Epinephrine in case and give to Ambulance Attendants.

How to use the Twinject™

Website Resources www.allergysafecommunities.ca www.epipen.ca www.twinject.ca www.anaphylaxis.org www.foodallergy.org

Anaphylaxis in Schools & Other Settings Reference Anaphylaxis in Schools & Other Settings (2nd Edition, 2009) Can be purchased for $15 (plus applicable taxes and shipping and handling) from any of the following organizations: Allergy/Asthma Information Association (AAIA) Anaphylaxis Canada Association québécoise des allergies alimentaires (AQAA) Canadian Society of Allergy and Clinical Immunology (CSACI) The proceeds from the sale of this document will help these non-profit organizations continue their work in anaphylaxis education, support, and research.

HRM Recreational Policy 2005 Questions HRM Recreational Policy 2005