This document provides an overview and training on life-threatening allergies and emergency epinephrine administration in school settings. It begins by outlining the goals of the training which are to provide understanding of food allergies, review significance in schools, explain anaphylaxis and emergency plans. It then covers topics like the rising prevalence of food allergies in schools, common allergic foods, avoiding allergens, recognizing reaction symptoms, and enacting emergency plans which include administering epinephrine. The training emphasizes that strict avoidance and immediate epinephrine treatment are critical for life-threatening allergic reactions.

1. Life-Threatening Allergies
in the School Setting
including
Epinephrine Injection Training
Prepared by the South Portland School Department
Health Services
Developed- August 2011 Updated November 2014

2. COMPETENCY
This power point and concluding
competency test will satisfy the
knowledege portion of life-threatening
allergies in the school setting and
Epinephrine Injection medication training.
To complete the medication skills training,
you will need to demonstrate your
EpiPen® and Auvi-Q™ administration
skills which will be verified and
documented by the school nurse.

3. Presentation Goals
 Provide basic understanding of life-threatening
allergies: definition, common allergens, treatment
 Review the significance of life-threatening allergies
in the school setting and avoidance management
 Explain anaphylaxis: definition, signs & symptoms
and treatment
 Explain Emergency Plan and Medications used for
allergic reactions and treatment plan
 Describe technique for administering EpiPen® and
medication

4. Food Allergies are Rising!
School personnel are encountering more children
with life-threatening allergies.
18% increase from 1997-2007!
AND
Recent research study presented in 2010 found
significant food allergy knowledge gaps exist
among school and child care providers.
Source: Study by researchers at Children’s National Medical Center, Johns Hopkins and Safe@School Partners cited in: Food Allergy News
Special Issue for School Nurses, Spring 2011

5. Study findings…
 Overall knowledge was fair. In several areas,
knowledge was poor!
 68% were unaware that hand sanitizer is not
effective in removing food residue after eating.
 63% incorrectly believed that epinephrine is an
extremely dangerous drug.
 78% were unaware that a 2nd dose of epinephrine
could be safely administered if allergic symptoms
did not improve 10 minutes after the first dose.
 42% incorrectly responded that Benadryl® or other
antihistamine should always be the first medication
given to a student experiencing a food allergic
reaction.

6. C.A.R.E. for Kids with Food Allergies
C. A. R. E.
COMPREHEND
Food Allergy Basics
AVOID
The Allergen
RECOGNIZE
Allergic Reactions
ENACT
Emergency Plan
Source: How to C.A.R.E for Students with Food Allergies-What Every Educator Should Know
Visit www.allergyready.com for more information

7. C
COMPREHEND!
Food Allergy
Basics

8. What is a Food Allergy?
A food allergy is an abnormal
response by the immune system to
an otherwise harmless food protein.
 When the food is eaten, the immune system
incorrectly identifies the food protein as a “threat”
and attempts to attack it.
 Immune system OVER-REACTS, releasing
chemicals into the blood…causing an allergic
reaction.

9. Food Allergies vs. Intolerance
Food allergies are different than food intolerances
and other allergies (i.e. cat, pollen).
 Food intolerances are the body’s inability to
process or digest a particular food, such as
lactose, celiac. Immune system is not involved.
 Seasonal and Animal Allergies while
uncomfortable, usually do not cause major
medical problems because the immune system
reactions are more limited, such as sneezing
and watery eyes.

10. What foods cause allergic
reactions?
People can be allergic to almost any food, but most
food allergy reactions are caused by 8 foods:
Peanuts
Eggs
Soy
Tree Nuts
Milk
Wheat
Fish Shellfish
Source: * Food Allergy Network, Five Steps Forward for Food Allergy, 2008

11. Common Causes cont.
 Other Allergens:
Insect Stings
Latex
Medications (penicillin, sulfa drugs, etc.)
Exercise-induced (less common)

12. Food Allergy Facts
 The food does not have to be ingested to
cause a reaction; skin contact or inhalation of
the protein can sometimes trigger reactions.
 Even trace, not visible, amounts can cause a
reaction.
 Some food allergies (milk, soy, egg, wheat)
can be “outgrown,” but most food allergies
are life long.
 Peanut and Tree Nut allergies are more likely
to produce a life-threatening allergic
response.

13. Treatment
1. There is NO cure for life-threatening
allergies.
2. Strict avoidance of allergens is
ONLY way to prevent allergic
reactions!

14. A
AVOID!
The Allergen

15. AVOID
 Know which students have life threatening allergies
 Review alternatives for lessons or celebrations involving
food
 Check labels on products: art supplies, hand lotions, etc
 K-5 level
 Classroom snack restrictions
 Student education lessons: hand washing, food sharing
 Parent notifications home
 Nut Restricted cafeteria tables
 Prevent cross-contact concerns
 Hand washing to remove food residue
 Read food labels

16. AVOID: Hand Cleaning!
Hand Washing: Hand wipes, liquid soap, and bar soap removed the
peanut allergen effectively.
Surfaces: Sanitizing wipes, spray cleaners effective, dishwashing liquid
not as effective.
Source: Distribution of peanut allergen in the environment. Perry TT, Conover-Walker MK,
Pomes A, Chapman MD, Wood RA. J.Clin Immunol, Vol. 113, No. 5.

17. AVOID: Read Food Labels!
http://www.foodallergy.org/doc
ument.doc?id=133

18. Label

19. INGREDIENTS:Enriched wheat
flour (wheat flour, niacin, iron,
thiamin, riboflavin, folic acid),
water, canola oil, potato flour, salt,
oat fiber, yeast, soda.
Allergy Information: Produced in a
facility that handles peanut butter.
Label
INGREDIENTS:Enriched wheat flour (wheat
flour, niacin, reduced iron, thiamin
mononitrate, riboflavin and folic acid), corn
oil, salt, corn syrup, ammonium
bicarbonate, and malt extract.
CONTAINS A WHEAT INGREDIENT.
No preservatives

20. Food Allergy Deaths do occur…
Majority are from
accidental ingestion of a
food allergen.
January 4, 2012
Chesterfield, Virginia
A 7 year old student with a peanut and egg allergy
died at school of an accidental peanut ingestion.

21. TAKE HOME POINTS!
 Strict avoidance is the only way to
prevent allergic reactions.
 Check all food items used in the
classroom and notify parents in
advance.
 Handwashing is best.

22. R
RECOGNIZE!
Signs & Symptoms
of Allergic Reactions

23. Allergic Reactions look like…
Heart
● Dizziness
● Pale
● Fainting
Gut
● Nausea ● Vomiting
● Cramping ● Abdominal pain
● Diarrhea
Lung
● Coughing
● Difficulty Breathing
● Wheezing
● Chest tightness
Throat
● Tightness
● Hoarse voice
● Trouble swallowing
Mouth
● Lip swelling
● Tongue
swelling
● Funny taste
Skin
● Hives
● Itchy rashes
Symptoms may begin anywhere from several minutes to 2 hours after eating an offending food,
but life-threatening reactions may get worse over a period of several hours.

24. Pictures
Difficulty Breathing
Hives
Swelling
Nausea, Vomiting, Cramping

25. What is Anaphylaxis?
A serious allergic reaction that is rapid
in onset and may cause death.
 Collection of symptoms often affecting multiple body
systems
 Can occur immediately or delayed 2-4 hours following
allergen exposure
 History of asthma and eczema increase the chance of
anaphylactic reactions
 Each exposure has the potential to cause anaphylaxis.
 Cannot predict what type of allergic symptoms a
student may have after allergen exposure.

26. TAKE HOME POINTS!
 EVERY allergic reaction is different.
 Signs of Allergic reactions can
 Be delayed up to 2 hours after ingestion
 Have mild symptoms that quickly progress to severe
symptoms
 Have immediate severe symptoms of anaphylaxis
 A student experiencing anaphylaxis
may show NO skin symptoms.

27. E
ENACT!
Emergency Plan

28. ENACT Emergency Plan!
 Follow emergency plan
 Follow student’s food allergy action plan.
 Copy with Classroom Teacher
 Copy in Medication Envelope
 Administer Epinephrine, if necessary
 Always Call 911 if Epinephrine is given.

29. Emergency Plan
 Ask if there has been exposure to known allergens. If in doubt,
treat as allergic reaction.
 Adult to stay with student.
 Immediately access Emergency Allergy Action Plan, Benadryl®
and Epinephrine by contacting School Nurse (or Secretary if Nurse
is unavailable).
 Administer emergency medication(s) per Allergy Action Plan, note
time given.
 Call 911, tell operator Epi was given and request ambulance with Epi.
Due to possible delayed wave of symptoms in 2-4 hours, emergency
medical care must be obtained (includes ambulance and hospital
care)!
 Notify parent/guardian.
 Monitor status of symptoms.
 Administer 2nd dose of epinephrine in 5 minutes or more if
symptoms persist or recur.
 Remain with student while awaiting ambulance transport to hospital.
 If severe reaction, keep student lying on back with legs raised.

30. Allergy Emergency Action Plan

31. Treatment
Medication can help treat and stop
allergic reactions.
Early recognition & treatment
saves lives!

32. Benadryl®
 Use: to treat only MILD allergic symptoms,
cannot stop anaphylaxis!
 Dose: 12.5mg-50mg depending on weight.
Prescribed dose indicated on Allergy Action
Plan
 Action: antihistamine
 Forms: capsule, liquid, dissolving tablet
 Common Side Effects: headache,
drowsiness, dizziness, dry mouth

33. Epinephrine
 Use: 1st line drug for any severe symptoms after
suspected or known allergen ingestion/contact
 Is a naturally occurring hormone in our bodies,
also known as adrenaline
 Dose: .15mg (Epi ) or .3 mg (Epi) depending on
weight. Prescribed dose indicated on Allergy
Action Plan
 Action: reverses anaphylaxis effects
 Common Side Effects: increased heart rate,
heart pounding sensation, sweating,
nausea/vomiting, dizziness, shakiness, headache
nervousness

34. Epinephrine Delivery Devices
EpiPen Jr.®
(green)
EpiPen®
(yellow)
Auvi-Q Jr™
(blue)
Auvi-Q™
(red)

35. TAKE HOME POINTS!
 Follow Allergy Action Plan for instructions-BUT…
when in doubt, it is better to give epinephrine
& seek medical attention!
 Give Epi & then Call 911
 Fatalities occur when epinephrine is withheld
or delayed!
Be prepared…every second counts.

36. EPI
ADMINISTRATION

37. EpiPen® Administration Steps
 Flip open cap on carrier tube.
 Slide EpiPen® out of tube.
 Grasp unit with fist, orange tip pointing down.
 Pull off blue safety release cap with other hand.
 Swing and firmly push orange tip into outer thigh until it
“clicks” so that unit is at 90° angle to thigh.
 Hold firm against thigh for 10 seconds to deliver drug.
 Remove tip from leg (protective cover extends to cover
needle) and massage injection site for 10 seconds.
 Keep used EpiPen and give to EMS/paramedic.
Note: The pen can inject through clothing.

38. EpiPen® Administration Guide

39. Auvi-Q™ Administration Steps
 Pull Cartridge from case.
 Listen to prompts and follow instructions.
 Grasp unit with fist, black tip pointing down.
 Pull off red safety guard with other hand.
 Swing and firmly push black tip into outer thigh until it “clicks” so
that unit is at 90° angle to thigh.
 Hold firm against thigh for 5 seconds to deliver drug.
 Remove tip from leg (protective cover extends to
cover needle) and massage injection site for 10
seconds.
 Keep used Epi Cartridge and give to paramedic.
Note: Device can inject through clothing.

40. Auvi-Q™ Administration Guide
Pull cartridge
from case.
Pull off RED
Safety Guard
Place BLACK end
against outer
thigh, then press
firmly and hold for
5 seconds.

41. Demonstration Videos
EpiPen® Video link
http://www.epipen.com/professionals/tools/video
Auvi-Q™ Video link
http://www.auvi-q.com/demonstration-video

42. Emergency Medications: 5 Rights
 Right Person: verify student’s name on Allergy Action
Plan and prescription label (if provided)
 Right Medication: verify the medication name
against the medication prescribed on the Allergy Action Plan
 Right Dose: verify the medication dose as prescribed on
the student’s Allergy Action Plan
 Right Time: immediate administration based on allergic
reaction symptoms
 Right Route: Epi- injection, Benadryl®- oral

43. Documentation
Every dose of medication given
needs to be documented with the:
DATE, TIME, INITIALS
of person administering the
medication on the student’s
medication envelope(s).

44. ALL SPSD staff play
an important role in the
food allergy
management team!

45. New Legislation!
School Epinephrine Act
The law uses financial incentives to encourage
states to require schools to keep “stock”
epinephrine on hand in schools -- meaning
epinephrine that is not prescribed to a specific
student but can be used for any student or
staff member in an anaphylactic emergency. It
also provides incentives for schools to ensure
school personnel are trained to use it.

46. TAKE HOME POINTS!
School Staff
 Need to C.A.R.E.
 Signs & symptoms of allergic reactions
 How to respond to allergic reactions
 They are often 1st responders to
students in distress!

47. Questions?

48. Test
 Written Post-test: 80% passing rate required
 Demonstate Epinephrine administration skill

49. THANK YOU!
Michelle Arpin, RN
Frank I. Brown Elementary School
South Portland School Department
arpinmi@spsd.org
799-5196

50. Food Allergy Research & Eductation
(www.foodallergy.org)
Food Allergy Initiative
(www.faiusa.org)
Sources

51. Sources cont.
Sicherer SH, Muñoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame
allergy: 11-year follow-up. J Allergy Clin Immunol. 2010.
U.S. Census Bureau.State and County QuickFacts. 2010. Retrieved from
http://quickfacts.census.gov/qfd/states/00000.html
Gupta RS, Springston, MR, Warrier BS, Rajesh K, Pongracic J, Holl JL. The prevalence, severity, and
distribution of childhood food allergy in the United States. J Pediatr.2011; 128.doi: 10.1542/peds.2011-0204
Centers for Disease Control and Prevention. QuickStats: Percentage of children aged <18 years with food, skin,
or hay fever/respiratory allergies --- National health interview survey, United States, 1998—2009. 2011. Retrieved
from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6011a7.htm?s_cid+mm6011a7_w
U.S. Census Bureau. State and County QuickFacts.2010. Retrieved from
http://quickfacts.census.gov/qfd/states/00000.html
Sampson HA. Update on food allergy. J Allergy Clin Immunol.2004; 113(5): 805-19.
Steinman HA, Hidden allergens in foods. J Allergy Clin Immunol. 1996;98(2): 241-250.
www.schoolnutrtion.org/foodallergies. Podcasts: Legal and regulatory requirements for managing food allergies in
schools. Guidance for managing food allergies in schools. Teamwork is key to successful food allergy management in
schools. Food safety considerations and food allergy management best practices for school food service. 2010.
USDA. Accommodating children with special dietary needs in the school nutrition programs. Fall 2001