Allergies

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Allergies Anaphylaxis
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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/nuts, shellfish,
  fish, wheat, soy, sesame and some food additives
• Stings from bees, wasps, hornets and some ants
• Medications penicillin, sulfa drugs
• Exercise
• Latex (gloves/medical devices)

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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

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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

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Prevention Having a Plan

• Check the School Medical Alert List to
  familiarize yourself with students in your
  school/class who have medical conditions and
  allergies
• Note all students who require single dose
  auto-injectors and where these are stored for
  each student. Ensure auto-injectors are
  immediately available
• Review emergency care plans for individual
  students
• Recognize allergy sources and triggers
• Know when and how to administer the auto-injector

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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

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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

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Before giving Epinephrine
After giving Epinephrine
Mild to Moderate Allergic Reaction Hives and
Swelling of face
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Moderate Allergic Reaction Swollen lips/face
and hives present
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health.yahoo.com/media/healthwise/h9991075.jpg
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Anaphylaxis What should I do?

• Administer single dose auto-injector
• Call 911
• Notify Parent/Guardian
• Administer second single dose auto-injector in
  10 to 15 minutes, or sooner IF symptoms do
  not improve or if symptoms recur
• Have ambulance transport student to hospital
• Epinephrine is the only way to reverse the
  effects of anaphylaxis therefore needs to be
  given ASAP
• Remember, the Epinephrine may only last for 15
  minutes, calling 911 is very
  important

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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

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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

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What is in an EpiPen?
Single dose of epinephrine
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Using the EpiPen Auto-Injector

• Remove the device from the plastic protective
  container
• Remove the GREY cap from device
• Press BLACK tip to thigh until a loud click is
  heard
• Hold in place for 10-15 seconds

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Using the EpiPen Auto-Injector

• Remove the pen from the thigh
• The needle can now be seen, place auto-injector
  back in protective case
• Apply pressure to injection site with a tissue or
  bandage if there is bleeding
• Follow Standard Precautions for your safety (e.g.
  wear gloves, be careful when handling exposed
  auto-injector needle)

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What is Twinject?

• Contains two doses of epinephrine in a single
  device
• First dose of epinephrine is administered by
  auto-injection, just like the EpiPen.

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Using the Twinject Auto-Injector

• Pull off GREEN end cap labeled 1
• Pull off GREEN end cap labeled 2
• Press RED cap into outer thigh until unit
  activates

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Using the Twinject Auto-Injector

• Hold Twinject in place for 10 seconds
• Apply pressure to injection site with a tissue or
  bandage if there is bleeding
• Follow Standard Precautions for your safety (e.g.
  wear gloves, be careful when handling exposed
  auto-injector needle)
• Remember, staff are not recommended to give
  dose two (manual IM injection of epinephrine)

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What to do after giving a single dose
auto-injector?

• Have student lie still on his or her back with
  feet higher than the head
• Loosen tight clothing and cover student with
  blanket
• If there is vomiting, turn student on side to
  prevent choking
• Dont give anything to drink
• Send auto-injector with student to hospital

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ConclusionFollow the three As

• Awareness
• Know the triggers
• Know the emergency plan and how to administer
  epinephrine via the single dose auto-injector
• Avoidance
• Avoid contact with allergens, make classrooms
  safe
• Action
• Give single dose auto-injector and call 911.
• Dont delay!

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Resources

• For more information contact your Public Health
  Nurse
• www.aaia.ca (Allergy/Asthma Information Assoc.)
• www.anaphylaxis.org (Anaphylaxis Canada)
• www.epipen.ca (EpiPen)
• www.twinject.ca (Twinject)
• www.medicalert.ca
• www.bchealthguide.org/healthfiles

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References

• AAIA Anaphylaxis Reference Kit (2007) by the
  Allergy and Asthma Information Association,
  Health Canada
• Anaphylaxis in Schools Other Settings (2005) by
  the Canadian Society of Allergy and Clinical
  Immunology.

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Any Questions?