ANAPHYLAXIS

WHAT IS AN ALLERGY? Allergies occur when the immune system becomes unusually sensitive and overreacts to common substances that are normally harmless. Examples are:  Foods – eggs, milk, peanuts, tree nuts, seafood, wheat, soy, sesame seeds, sulphites and mustard  Insect bites – bees, wasps, hornets and some ants  Medications – penicillin, sulfa drugs  Exercise  Latex – gloves/medical devices Reference: Anaphylaxis Canada (2013) 2

WHAT IS ANAPHYLAXIS?  Occurs when a person is exposed to an allergen causing a severe, life-threatening allergic response  Reactions occur within minutes or, more rarely, up to a few hours after exposure Reference: Anaphylaxis Canada (2013) 3

COMMON SYMPTOMS  Skin – hives, swelling, itching, warmth, redness, rash  Respiratory (breathing) – wheezing, shortness of breath, throat tightness, cough, hoarse voice, chest pain/tightness, nasal congestion or hay fever-like symptoms (runny itchy nose and watery eyes, sneezing), trouble swallowing Reference: Anaphylaxis Canada (2013) 4

COMMON SYMPTOMS  Gastrointestinal (stomach): nausea, pain/cramps, vomiting, diarrhea  Cardiovascular (heart): pale/blue colour, weak pulse, passing out, dizzy/lightheaded, shock  Other: anxiety, feeling of “impending doom”, headache, uterine cramps in females, metallic taste Reference: Anaphylaxis Canada (2013) 5

 Trouble breathing caused by airway swelling  A drop in blood pressure causing dizziness, light-headedness, feeling faint or weak, or passing out Reference: Anaphylaxis Canada (2013) 6 MOST DANGEROUS SYMPTOMS

7 Hives and Swelling of face Important: Not all reactions have hives Anaphylactic ReactionNormal Appearance

8 Swelling of the lips/faces and hives may occur

9 health.yahoo.com/media/healthwise/h jpg

 Increased independence  Increased risk taking  Eating unsafe food and eating out  Not carrying auto injector  Not telling friends  Not wearing a medical alert ID Reference: Allergy Safe Communities (2013) 10 WHY ARE TEENS AT HIGHER RISK?

PREVENTION = HAVING A PLAN  Ensure the medical alert list is up-to-date and familiarize yourself with students who have medical conditions and allergies  Review emergency care plans for each student  Note where auto-injectors are stored for each student. Ensure auto-injectors are immediately available  Recognize allergy sources and triggers  Know when and how to administer the auto-injector  Prepare for outdoor and off school ground activities  Encourage students to wear medical alert identification 11

WHAT SHOULD I DO? WHAT SHOULD I DO? 1. Administer single dose auto-injector 2. Call Notify parent/guardian 4. Administer second auto-injector in 5 to 15 minutes after first dose is given IF symptoms do not improve or if symptoms recur 5. Have ambulance transport student to hospital *Epinephrine is the only way to reverse the effects of anaphylaxis. Give ASAP **Remember, the epinephrine may only last for 15 minutes, call 911 after administering auto-injector Reference: BC Anaphylactic and Child Safety Framework (2007) 12

WHAT I DO? WHAT SHOULD I DO?  When in doubt, administer epinephrine. Symptoms of anaphylaxis can be as simple as redness or as severe as cardiac arrest.  If a person says they are having a reaction it is important to believe them, and immediately administer epinephrine regardless of the symptoms present  Antihistamines and asthma medication must not be given as first line treatment for anaphylaxis 13

WHAT IS AN EPINEPHRINE AUTO- INJECTOR?  An auto-injector is an easy way to give epinephrine to someone having an allergic reaction  There are three auto-injectors available in BC:  EpiPen ® TM  Allerject TM  Twinject ®  *Please note that Twinject® is currently not available on the market. 14

WHAT IS AN EPIPEN ® ? 15 Reference: A disposable, pre-filled automatic injection device that administers a single dose of epinephrine

 Hold firmly with ORANGE tip pointing downward  Remove BLUE safety cap by pulling straight up  Swing and push ORANGE tip firmly into mid- outer thigh until you hear a “click”  Hold on thigh for several seconds 16 Built-in needle protection When EpiPen ® is removed, the ORANGE needle cover automatically extends to cover the injection needle Reference: HOW TO USE EPIPEN ® ?

 A disposable, pre-filled automatic injection device that administers a single dose of epinephrine  Talks users through each step 17 Reference:

18 Pull Allerject™ from the outer case Pull off RED safety guard Do not touch the BLACK base of the auto- injector, which is where the needle comes out Place BLACK end against the middle of the outer thigh, then press firmly and hold in place for five seconds Once the injection is complete, replace the outer case Reference:

19 WHAT IS TWINJECT ® ? A disposable, pre-filled automatic injection device that contains two doses of epinephrine in a single device First dose of epinephrine is administered by auto-injection, just like the EpiPen® and Allerject TM *Remember, staff are not recommended to give dose two (manual intramuscular injection of epinephrine) Reference:

HOW TO USE TWINJECT ® ?  Pull off GREEN end cap labeled “1”. Never put thumb, finger or hand over the RED tip.  Pull off GREEN end cap labeled “2”  Press RED cap into outer thigh until unit activates. Hold Twinject® in place for 10 seconds 20 Reference:

21 WHAT TO DO AFTER GIVING EPINEPHERINE Have students lie still on their backs with their feet higher than their heads If vomiting, have the students lie on their sides to prevent choking If breathing is difficult, have the students sit up Loosen tight clothing and cover students with blanket Don’t give anything to drink Send auto-injector with students to hospital Reference: Anaphylaxis Canada (2013)

CONCLUSION: FOLLOW THE THREE A’S  Awareness  Know the triggers  Know the emergency plan and how to administer epinephrine via the auto-injector  Avoidance  Avoid contact with allergens, make classrooms safe  Action  Give auto-injector and call 911.  Don’t delay! 22

RESOURCES For more information contact your Public Health Nurse  (BC Anaphylactic and Child Safety Framework)  (Anaphylaxis Canada)  (Why Risk It)  (Allergy/Asthma Information Assoc.)  (Allerject TM )  (EpiPen®)  (Twinject®)   23

REFERENCES  Anaphylaxis Canada (2013)  AAIA Anaphylaxis Reference Kit (2007) by the Allergy and Asthma Information Association, Health Canada  Anaphylaxis in Schools & Other Settings (Second Edition, 2009) by the Canadian Society of Allergy and Clinical Immunology.  Allergy Safe Communities. (2013) 24

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