2. New Providence School District Trish Kalinger, R.N. Carol McCabe, R.N. Jan Miller, R.N. SEVERE ALLERGY GUIDELINES FOR SCHOOL STAFF

3. Guidelines were developed for management of life- threatening food allergies in schools to educate school staff. N.J.S.A. 18A:40-12.3-6 Revised by legislature in 2006

4. A rapid, severe, possibly life-threatening, allergic response that occurs when a person is exposed to an allergy-causing substance

5. Allergens enters body by: Ingestion Inhalation Skin contact Injection Allergens enters body by: Ingestion Inhalation Skin contact Injection

6. Tree Nuts Eggs Soy Seafood Peanuts Milk Wheat Fish

7. About Food Allergies Occurs in 2-2.5% of population CDC: 12 deaths in 2004 Reasons for increase? Environment Hygiene hypothesis Genetics Increased awareness Better diagnosis Fear of legal consequences

8. Yellow jackets* Wasps Hornets Bees Fire ants

9. Rubber gloves Balloons Goggles Science/P.E. equipment Clothing Medical equipment

10. Exercise Pesticides Herbicides Cedar chips Idiopathic ( no apparent cause )

12. Tingling, itching &/or swelling Mouth Tongue Lips Throat Tingling, itching &/or swelling Mouth Tongue Lips Throat

13. Hives Itchy rash Swelling of face & extremities Swollen, red, watery eyes Hives Itchy rash Swelling of face & extremities Swollen, red, watery eyes

14. Nausea Vomiting Diarrhea Abdominal cramps Nausea Vomiting Diarrhea Abdominal cramps

15. Violent sneezing Severe, sudden runny nose Tightness in throat/chest Wheezing Frequent, tight cough Shortness of breath Violent sneezing Severe, sudden runny nose Tightness in throat/chest Wheezing Frequent, tight cough Shortness of breath

16. Dizziness Weakness Paleness Fainting Weak or rapid pulse Low blood pressure Blueness Dizziness Weakness Paleness Fainting Weak or rapid pulse Low blood pressure Blueness

17. Restlessness Panic Chills Sudden fatigue Sense of impending doom Restlessness Panic Chills Sudden fatigue Sense of impending doom

18. Assess symptoms. Do not leave student alone. Alert Emergency Response Team and Building Principal. Direct someone to call 911. DIAL 9-911 - any building phone Assess symptoms. Do not leave student alone. Alert Emergency Response Team and Building Principal. Direct someone to call 911. DIAL 9-911 - any building phone Procedure

19. The Student Reassure. Allow to sit upright. * If faint, lie flat and elevate legs. If faint or unconscious & vomiting, position on side.

20. Goal: Recognize and promptly treat a reaction REMEMBER: No way to predict if the allergic reaction will progress to anaphylaxis. Symptoms may: Occur slowly and worsen gradually Occur quickly and severely Improve with medication but return in minutes or hours (“bi-phasic”)

21. Epinephrine Drug of choice – only by injection Works rapidly EpiPen

22. Any student who receives an EpiPen must be transported by the EMS for medical care.

23. Risk Reduction Student Considerations Encourage students to eat only food that their parents have provided. No food sharing or trading Wash hands after eating. Consider planning an allergy awareness lesson for classmates.

24. Risk Reduction Classroom Considerations Do not open lunches in the classroom. Do not use allergens in classroom. Avoid use of food as a reward. Plan parties with allergy parent input. Be alert for the unexpected!  Special visitors who bring food/prizes  Unplanned snacks/treats  Large group refreshments

25. Risk Reduction Cafeteria Considerations Plan seating with parent input. Consider assigned seating. Designate an allergen-free table. Clean tables with disposable towels and detergent between each lunch. Place garbage cans away from allergen-free tables.

26. The 3 R’s: Recognize symptoms. React quickly. Review cause & plan.