By Dana Ashe, RN, CCHC Jackson County Health Department

Severe Allergic Reaction Training Pre-Test Please fill in the blanks with F (false) and T (True) 1. _____ Anaphylaxis is a mild reaction to a substance you are allergic to. 2. _____ The Epi-Pen and Epi-Pen Jr. can be used interchangeably. 3. _____If you have never had an allergic reaction, you will probably never have one. 4._____After administering the Epi-Pen, I should only call 911 if the parents want me to. 5._____An Epi-Pen must always be kept in a locked container. 6._____The Epi-Pen is a quick and painless way to administer epinephrine and save a child’s life. 7. The body systems that are affected in an allergic reaction are: (Please Circle One) A. The Skin B. The Respiratory System C. The Gastrointestinal System D. The Sympathetic Nervous System E. A and B F. All of the above

Objectives The trainee will: Learn what anaphylaxis is Causes of anaphylaxis Signs and symptoms Treatment (antihistamine vs. EpiPen) Learn how to use the EpiPen auto injector Storage When to implement an Individualized Emergency Care Plan. When to call 911

Definition Anaphylaxis is a potentially life- threatening allergic reaction caused by exposure to specific allergen triggers. Rapid, severe, symptoms can be fatal within minutes or can take two hours or more.

Anyone can have an Anaphylactic reaction! After: ingestion Inhalation Skin Contact Or: injection of an allergen Allergens are substances that cause an overreaction of the body’s defense mechanism.

What do I look for? Mild reactions are usually more localized. The child will be able to participate in normal activities. But! Always keep in mind: It only takes 1-2 minutes for a mild reaction to escalate to severe anaphylaxis!

Physical Changes Itching of the skin/eyes (tears) Raised rash (hives) – flushing Headache Nausea & Vomiting – Abdominal Cramps Hoarseness –Cough-Wheezing Shortness of Breath

Hives

Physical Changes Swelling of the tissues of the lips, throat, tongue, hands and feet. Problem swallowing, Metallic taste Anxiety Sense of impending doom Hypotension, dizziness or loss of consciousness

Swelling of the lips

Angioedema Angio – prefix that relates to blood vessels Edema – The presence of abnormally large amounts of fluid in the intercellular tissue spaces (between the cells). Severe allergic reactions cause angioedema deep in the soft tissue of the throat and neck causing the throat to swell shut, cutting off the person’s ability to breathe.

What Causes Anaphylaxis??? Foods (leading cause outside hospital) Some insect venoms (bee stings are common cause) Medications Latex Allergy Exercise Idiopathic

Foods These 6 common foods account for 90% of reactions. Milk Eggs Peanuts Tree Nuts Soy Wheat

Other food triggers may include: Legumes Cheese Fruits Unknown? (Idiopathic)

Insects Bees Wasp Yellow Jackets Hornets Fire Ants

Medications Antibiotics *Penicillin, Cephalosporins, etc. Aspirin, NSAIDS Chemotherapeutic Agents Biological (Vaccines) Radio Contrast Media

Latex Allergy Proteins in natural rubber latex Rubber bands Elastic (undergarments) Hospital and dental equipment !!!Latex dipped products are biggest culprits --- Baloons, gloves, bandages, water bottles, etc.

Exercise Exercise induced anaphylaxis is a form of physical allergy. Although the mechanism of action is unknown, it may be related to ingestion of some medications or foods before exercise. Rare

Idiopathic Idiopathic anaphylaxis is a life threatening allergic reaction that occurs in the absence of any known allergen. IN OTHER WORDS, Nobody really knows what causes Idiopathic Anaphylaxis.

Remember Common symptoms or a reaction can range from mild to severe. The severe or life threatening reactions are called anaphylaxis. No predictable pattern. The time between exposurue to allergen and symptoms can vary depending on the allergen, exposure and sesnitivity.

Treatment Remove child from allergen contact. Refer to care plan and provide medications and treatments as indicated. Mild s/s may indicate need for antihistamine or decongestants. Severe s/s may indicate need for epipen.

Treatment Use epipen if required (per care plan instructions) – used for emergency symptoms as indicated. After epipen ---Call 911!!! Don’t delay, the EpiPen is only effective for minutes. Call parents

Treatment Child should be lying on back with feet elevated. Keep child warm and loosed tight clothing. Don’t give anything to drink. Comfort child Monitor signs and symptoms Do not leave child unattended.

Demonstration EpiPen

EpiPen Jr. Used for children – delivers one dose of 0.15mg. Epiniphrine intramuscularly.

EpiPen Should be labeled with child’s name and stored with a copy of the care plan. Store unlocked and out of reach of children. Store away from direct sunlight. Do not refrigerate. Check expiration date monthly. Check = replace if cloudy or discolored.

EpiPen If EpiPen is expired, it is better to give it in an emergency than to give nothing at all!!

Anaphylactic Prevention Screen people at risk See MD for proper diagnosis and treatment. Wear Medic-alert* accidental exposures are never planned/be prepared! Education on avoidance of allergens.

As many as 35% of people who have an anaphylactic reaction will experience a recurrence in the hours following the beginning of the reaction and will require further treatment, including addition epinephrine injections.

Management Identify children with allergies (review medical form and talk to parents). Identify specific allergen. Remove as many allergens from environment as possible. Post allergies (helpful = child’s picture)

Management Read labels – monitor ingredients Obtain written MD instructions Team approach to develop care plan Learn to recognize s/s of mild to severe allergic reactions.

Management Learn to administer emergency medications safely and appropriately. Know when and how to give meds (specific individual instructions on care plan). Develop policies for safe storage and accessibility of emergency meds. Call for help and stay calm!!

Post - Test Please fill in the blanks with F (false) and T (True) 1. ___F__ Anaphylaxis is a mild reaction to a substance you are allergic to. 2. ___F__ The Epi-Pen and Epi-Pen Jr. can be used interchangeably. 3. ___F__If you have never had an allergic reaction, you will probably never have one. 4.___F__After administering the Epi-Pen, I should only call 911 if the parents want me to. 5.___F__An Epi-Pen must always be kept in a locked container. 6.___T__The Epi-Pen is a quick and painless way to administer epinephrine and save a child’s life. 7. The body systems that are affected in an allergic reaction are: (Please Circle One) A. The Skin B. The Respiratory System C. The Gastrointestinal System D. The Sympathetic Nervous System E. A and B F. All of the above

References Refer to Caring For Our Children Standard 4.010

?????? Questions?