Life-Threatening Allergies

Life-Threatening Allergies
Why and How to Create a District Management Plan
Peg Stanish BSN RN 10/23/14
What it IS:
• Immune system response to a harmless substance (food)
that the body senses is an invader.
What it ISN’T:
• Food poisoning--organism
• Food intolerance—does not involve the immune system—
localized signs such as gas, bloating, etc.
• Aversion—texture, etc.
• Phobia
Most common allergies in children are:
• Peanuts
• Tree nuts
• Milk
• Eggs
• Soy
• Fish
• Wheat
Most common allergens in adults are:
• Fish
• Shellfish
• Peanuts
• Tree nuts
Individual response to the “invader”
varies. Some people may develop
hives just from touching a substance.
• A sudden and severe reaction which
involves several areas of the body,
• Itchy eyes/throat
• Hives
• Tingly lips/throat
• Eczema
• Swelling
• Redness
• Wheezing
• Shortness of breath
• Cough
• Stuffy or runny nose
• Nausea
• Vomiting
• Abdominal cramping
• Diarrhea
• Decreased B/P
• Elevated heart rate
• Chest pain
• Feeling of impending doom
ALL reactions need prompt attention. Untreated
anaphylaxis may result in death.
Do NOT hesitate to give appropriate medication
or call for EMS to assist.
Medications work to reduce symptoms:
• Epinephrine (adrenaline)—injection--Epi Pen or AuviQ—
drug of choice for anaphylaxis. Always call EMS if this
drug is administered. Person may need assistance giving
the shot.
• Antihistamines—give after epinephrine.
• Inhaler—for asthma or respiratory symptoms after epi
How to Begin
• Child Nutrition Supervisor and District RN come together to
meet and discuss feasibility in a particular district.
• Make commitment to meet and learn together, put dates on
• Utilize current, official resources to form framework.
• Consider sustainability as the plan takes shape.
• Acknowledge that subject is emotional for parents with
students going to school.
• Anticipate parent requests.
Prior to managing LTAs, your district may have a
defining moment that causes you to realize you need
a program…and FAST!
Procedures for handling food allergies may be as easy
as 3 simple words:
• Health conditions received in the clinic,
nurse notifies Child Nutrition of food allergy.
Packet is sent home to parent for completion
and doctor signature on emergency care
• Child Nutrition restricts allergen in computer
so that student cannot choose the harmful
item(s) in cafeteria line.
• When completed paperwork is returned, the School Nurse
reviews orders, oversees education for/training of staff, RN
develops individual health plan, monitors emergency
medications, and periodically assesses effectiveness of
program for each student, in conjunction with Child
• CN receives orders and assists with daily management
through menus and building staff training. Both
departments speak with parents and attend conferences, if
AVOID (the cornerstone)
• Minimize ingestion of or contact with
the specific allergens, as is reasonably
possible in a public school setting.
• Avoid means of cross-contamination in
the kitchen and classroom.
• Plan for emergencies, field trips, etc.
• Practice frequent and thorough
handwashing. Soap and water is
preferred method.
• Follow instructions on the student’s
emergency care plan, as trained to perform.
• DO NOT HESITATE to act—help or
administer medication and contact nurse or
EMS, depending on setting. Follow protocol
per district procedure for food allergies.
What We Learned
• Parents are very concerned about the safety of their students. Parents
want to be heard. Take time to listen.
• Meeting a parent in person is always time well-spent.
• Having a scientific approach will lead to an evidence-based program
that will serve you well. Separate emotion and fear from the science
and research. Use current research. Consistency is key. Reasonable
accommodations do not cost money.
• Include latex and insect stings in the plan.
• Encourage your principals to provide adequate time for training.
• A team approach that begins with Child Nutrition and Nursing is
amazing! Student safety is the result.
Bits and pieces:
• Each child’s plan is unique, but the
common goal of avoidance is by ingestion.
• Allergists trump general or ER MDs.
• Most children eat a school meal (or two!),
even though the safest option is for meals
to come from home. 97%+ of our students
eat school meals.
• We cannot guarantee that a food reaction
will never happen but we will be prompt in
our actions to keep the students safe.
• So…..
• YOU are an important part of the plan to keep kids safe and to act,
should a food reaction occur. Action may be as simple as calling
for help or 911.
• Keep up the good work, and thanks for ALL you do each and every
• I have included The FTCSC plan in the handouts, which also
includes the packet we give parents—2-way release, the USDA form
(MD orders), responsibilities of parents and students. Other
responsibilities are available on the CDC site.
• And now a word from Carol Gelatt, BSN, RN, Coordinated School
Health Specialist for IDOE, who will speak briefly about the new IN
epinephrine in schools law.
Great Resources:
CDC—Voluntary Guidelines for Schools
FARE—Food Allergy Research and Education
FAME—Food Allergy Management and Education Manual—St. Louis
Children’s Hospital
NASN—National Assoc. of School Nurses
NSBA—National School Boards Association
Contact Information:
Peg Stanish BSN RN
Supervisor of Health Services
Franklin Township Schools
6141 S. Franklin Rd.
Indianapolis, IN 46259
[email protected]

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