This document provides information about allergies, anaphylaxis, epinephrine auto-injectors (EpiPens), and how to use an EpiPen. It defines allergies and anaphylaxis, lists common allergic triggers and symptoms, and explains that EpiPens are prescribed for those with severe allergic reactions. It describes how to recognize symptoms requiring an EpiPen, the proper procedures for administering an EpiPen including holding it against the thigh and calling for help, and monitoring the person until emergency help arrives. The document emphasizes to always use an EpiPen if a reaction is suspected rather than waiting.

1. Allergy & Epi-Pen Mandatory Training

2. 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 – most common tree nuts, especially peanuts and fish; also, eggs, milk, wheat, soy, sesame and some food additives Stings from bees, wasps, hornets and some ants Medications – penicillin, sulfa drugs Exercise Latex (gloves/medical devices)

3. What is Anaphylaxis? Occurs when a person is exposed to an allergen causing a severe, life-threatening allergic response Reactions can occur within seconds of exposure to an allergen, but can be delayed for 2-3 hours Affects various organ systems including the skin, respiratory, cardiovascular and gastrointestinal

4. Why is this life-threatening? Causes airway obstruction/lack of oxygen to the brain Increases risk of SHOCK, which leads to widespread tissue damage, organ failure and eventually death

5. 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 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” and headache If a child is allergic to nuts and he smells them, he may develop symptoms, but not a life-threatening reaction

6. FACTS ABOUT EPINEPHRINE Many people who are subject to severe allergic reactions are prescribed an epinephrine auto-injector by their physician to use when such a reaction occurs. Some examples of severe allergies: bee stings, peanut, nut and food allergies, latex products and shell fish

7. SYMPTOMS OF A SEVERE ALLERGIC REACTION Swelling of the face, tongue and/or lips Irritability Loss of consciousness Breathing difficulty, wheezing or both Bluish color to the skin (cyanosis) Dizziness, faintness Flushing of face, chest, etc. Tightness of throat and chest Hard-to-find or weak pulse (circulatory collapse) Seizures

8. Mild to Moderate Allergic Reaction : Hives and Swelling of face

10. Anaphylaxis: What should I do? Symptoms of anaphylaxis can be as simple as tingling of the lips or as severe as cardiac arrest. When in doubt, administer epinephrine If a person says they are having a reaction it is important to believe them, and immediately administer epinephrine regardless of the symptoms present After giving the epinephrine, call the office to get the nurse and have them call 911-do not wait for the nurse It is an emergency and the epinephrine must be given and 911 must be called

11. What is a Single Dose, Epinephrine Auto-injector? A single dose auto-injector is an easy way to give epinephrine/adrenaline to someone having an allergic reaction E.g. EpiPen®, Twinject® Trainers are available for practice using- please see your school nurse.

12. FACTS ABOUT EPINEPHRINE Epinephrine has been prescribed for patients who are susceptible to severe allergic reactions. Epinephrine is a hormone produced by the body. When given as a medication, it will help to raise the blood pressure and improve profusion along with helping to open the airway and improve respiration.

13. EPINEPRHINEAUTO-INJECTOR Adult/Child Dosage Called the Epi-Pen and contains 0.30 mg of epinephrine Small Child Dosage: Called the Epi-Pen Jr. and contains 0.15 mg of epinephrine. The appropriate dosage for the student will be written by his/her doctor or advanced practice nurse.

14. Epi-Pen THERE ARE NO CONTRAINDICATIONS WHEN EPINEPHRINE IS USED IN A LIFE THREATENING EMERGENCY SIDE EFFECTS: Increased heart rate, pallor, dizziness, chest pain, headache, nausea, vomiting, excitability and anxiety

15. IF NOT SURE TO USE EPI-PEN If you are not sure, but the individual seems uncomfortable or in distress – USE THE EPI-PEN It is safer to use the Epi-Pen than to wait

16. EPI-PEN PROCEDURE Have someone else call 911 and notify the parents. (In a school setting you should have a student inform the main office to alert school officials) Check the Epi-Pen solution color – must be clear to use Remove the gray safety cap from the Epi-Pen

17. EPI-PEN PROCEDURE Hold the Epi-Pen with the black tip against the outer (lateral) area of the thigh muscle - this is the onlyarea where the Epi-Pen is to be used If accidentally injected into your hand or foot – go immediately to the emergency room

18. EPI-PEN PROCEDURE Apply moderate pressure to hear the “click” then hold for 10 seconds. How the Epi-Pen delivers the medication: Pushing the Epi-Pen against the outer (lateral) thigh releases a spring-activated plunger, pushing the concealed needle into the thigh muscle and delivering a dose of epinephrine

19. EPI-PEN PROCEDURE Remove the Epi-Pen and massage the site (to prevent tissue damage) If necessary, the Epi-Pen can be used directly through clothing Be prepared to begin C.P.R.

20. EPI-PEN PROCEDURE Stay with the individual, keeping them warm and resting until emergency medical help arrives IMPORTANT: send the Epi-Pen along with the E.M.T.’s Make sure the parent/guardian has been called

21. EPI-PEN The effects of the injection can wear off after 10-20 minutes. Symptoms can recur.

22. What to do after giving a single dose auto-injector? Make sure someone stays with the person Have person lie still on his back with feet higher than the head Loosen tight clothing and cover person with whatever is available-coat/blanket If there is vomiting, turn person on side to prevent choking Don’t give anything to drink Send used auto-injector with student to hospital A Twinject has two doses-one on each end-staff may only give one

23. Who Can Give the Epi-Pen? All staff are required to be able to give the epi-pen when needed Epi-Pen trainers are always available to borrow and practice or get 1:1 training by the nurse-they are easy to use once trained Students with anaphylaxis and epi-pens keep their epi-pens with them or in the main office/Nurse’s office Epi-pens must go on all field trips that an anaphylactic student attends See the school nurses for a refresher course or to practice using Epi-Pen