Life-threatening allergies plan

Plan for the Management of Students with Life-Threatening Allergies

Hamilton School District
July 2018

Introduction

The incidence of severe and life-threatening allergies has been rising over the past several years. Anaphylaxis is a severe systemic allergic reaction from exposure to allergens that is rapid in onset and can cause death.

Although nearly any food can trigger an allergic reaction, there are eight common foods that cause the majority of reactions. The most common food allergens include: milk, egg, peanut, tree nuts, soy, wheat, fish and shellfish. Other allergens include: latex, insect venom (e.g. bee stings) and medications.  An allergic reaction can occur within minutes (most common) to 1-2 hours after exposure; death has been reported to occur within minutes. It is important that students, parents, physicians and school personnel work collaboratively to create a safe learning environment for all.

The purpose of this document is to provide guidelines to support students with life- threatening allergies, minimize the risk of accidental exposure to allergens and have a plan to recognize and manage allergic reactions and anaphylaxis at school.

This Plan is adopted by the Hamilton School District Board of Education pursuant to Wis. Stat. §118.2925(2)(a).  District personnel, District students, and parent/guardians must review and comply with all applicable guidelines outlined in the Plan for the Management of Students with Life-Threatening Allergies.   This Plan will be provided to District students and parent/guardians annually during the registration process in Infinite Campus. Copies of the Plan shall be available in each school office of the District and will be provided to students and parents/guardians upon request. This Plan is also available on the Internet at https://www.hamilton.k12.wi.us/

Glossary of Terms

The following is a list of terms which provide some helpful background information regarding life-threatening allergies.

Acute – Symptoms that occur suddenly and can be severe.

Adrenaline – Synonymous for epinephrine

Allergen – A substance that can cause an allergic reaction. The most common allergens are:

peanuts, shellfish, fish, tree nuts, eggs, milk, soy, wheat, insect venom, latex and medications.

Allergic Reaction – An immune system response to a substance that itself is not harmful but that the body interprets as harmful. When exposed to an allergen, the allergic student produces histamine. Once the histamine is released in the body it causes chemical reactions which trigger inflammatory reactions in the skin (itching, hives, rash), the respiratory system (cough, difficulty breathing, wheezing) the gastrointestinal tract (vomiting, diarrhea, stomach pain), and the cardiovascular system (lowered blood pressure, irregular heartbeat, shock).  Each person with an allergy reacts to the allergen differently including the symptoms and severity.

Anaphylactic Reaction – Synonymous for Anaphylaxis

Anaphylaxis – It is an immediate potentially life threatening allergic reaction. The most dangerous symptoms include breathing difficulties, and a drop in blood pressure or shock, which can be fatal. Asthmatic students are at an increased risk for anaphylaxis. Anaphylaxis often involves several areas of the body at once such as the skin (itching, hives, rash), the respiratory system (cough, difficulty breathing, wheezing) the gastrointestinal tract (vomiting, diarrhea, stomach pain), and the cardiovascular system (lowered blood pressure, irregular heartbeat, shock). The drug to immediately use to abate anaphylaxis is Epinephrine (contained in an Epi- Pen or Epi-Pen Jr.).

Antihistamine – A drug that stops histamine from being released in the body during an allergic reaction. Usually given as an oral medication.

Asthma – A disease of the lungs in which there is widespread narrowing of airways. The airways become clogged with mucus. Students with asthma and allergies appear to be at an increased risk for fatal anaphylaxis. Epinephrine is the first-line of defense for an anaphylactic reaction even with a child with asthma medicine.

Cross Contamination – When an allergen comes in contact with a pan, utensil, surface or food that is allergen free it contaminates it. The allergen free object is now unsafe for an allergic student.

Epi-Pen- Epinephrine Auto-Injector – In this document, Epi-Pen is used to refer to any of the Epinephrine Auto-Injectors from various manufacturers / trade names.  An Epi-Pen abates allergic symptoms for 15-20 minutes. Symptoms may reappear if prompt medical attention is not given to the allergic student. Always call 911 when epinephrine is given.

Epi-Pen Jr. – It is the same as an Epi-Pen only a smaller dose.

FARE – Acronym for the Food Allergy Research and Education that has educational material on food allergies. http://www.foodallergy.org/

504 Plan – A plan developed to ensure that a student with a disability identified under Section 504 of the Rehabilitation Act of 1973 is provided with appropriate educational services designed to meet the individual needs of the student to the same extent as the needs of students without disabilities are met.

Food Allergy – An immune system response to a certain food. Upon ingestion, the body creates antibodies to that food. When the antibodies react with the food, histamine and other chemicals are released from cells. The release of those chemicals may cause hives, difficulty breathing, or other symptoms of an allergic reaction.

Health Care Plan (Allergy) – Document created by the District Nurse in conjunction with parent and student’s physician which describes the allergy, past reactions and steps to take in the event of an exposure to the allergen.  Document is reviewed and updated as needed, annually.

Histamine – A chemical released by the body during an allergic reaction. It causes the symptoms listed above in Allergic Reaction.

Hives- Itchy, red, mosquito-like bumps that may appear anywhere on the skin and are usually a symptom of an allergic reaction.

Latex – A milky fluid produced by a rubber tree. This natural ingredient is found in a variety of health care products, rubber bands, gym, art supplies, and balloons. It can cause a severe life threatening allergy to sensitized people.

Life Threatening Allergy – Students with allergies have over reactive immune systems. The immune system produces chemicals and histamine which can cause the severe symptoms in the body (e.g., swelling, breathing difficulty or shock). Epinephrine found in the Epi-Pen is the recommended treatment.

Medic Alert Bracelet/Necklace – A necklace or bracelet worn by an allergic student that states the allergens and gives a telephone number for additional information.

Guidelines for Allergies
Food, Latex or Insect Venom

Responsibilities for Parents and Guardians

  • Inform the school of your child’s allergies during the registration process prior to the school year or immediately after initial diagnosis.
  • Participate in developing a Health Care Plan and update yearly prior to the start of the school year or immediately after initial diagnosis.
  • Parents and guardians requesting that medication be administered to their child must complete a District Medication Permission Form and must follow all applicable procedures outlined in Board policy 453.4 – Rule Administering Medication Procedures.
  • Provide annual updates on your child’s allergy status including details of symptom.
  • Provide the school with current phone numbers and emergency contacts at the start of each school year and as changes are made.
  • Provide up-to-date Epi-Pens and other necessary medications at the start of each school year or immediately after initial diagnosis and refill as necessary.
  • Consider providing your child with a medic alert bracelet.

Food Allergy

  • Review school lunch menus and send cold lunch with your child on days when eating a school hot lunch may not be a safe choice. Teachers are not responsible for monitoring ingredients of hot lunches.
  • If your child requires special arrangements for lunch seating (e.g. “allergy-aware” table) discuss with school personnel and/or District Nurse.
  • Teach your child to recognize safe and unsafe food items and advise them not to share snacks, lunches or drinks with others.

Latex Allergy

  • Teach your child to recognize products that may contain latex and/or food items that are considered cross-reactive foods. Advise them to avoid these products and food items.
  • Teach your child to report any symptoms of an allergic reaction to their teacher and/or supervising adult immediately.
  • If your child carries his/her own Epi-Pen or Inhaler on them (i.e. backpack or purse), notify school staff of its location. Parents are encouraged to keep a “back-up” Epi-Pen in the school health office as well.  Epi-Pens should not be stored in cars or lockers where they are not easily accessible and exposed to cold or heat.  Parents and guardians requesting that their child be permitted to carry and self-administer an Epi-Pen or inhaler must complete the applicable Consent form and follow all procedures outline in Board Policy 453.4- Rule Administering Medication Procedures.

Responsibilities for Student with Allergies

Food Allergy

  • Do not trade or share food or utensils.
  • Do not eat anything with unknown ingredients.
    • Wash hands or use hand wipes before and after eating. Hand sanitizers will not eliminate allergens.
    • Notify a teacher or other school personnel if they eat something they believe may contain the food to which they are allergic.

Latex Allergy

  • Refrain from handling items that may contain latex (health care products, rubber bands, gym, art supplies, and balloons).
    • Notify teacher or other school personnel if come into contact with an item that contains or may contain latex.

Insect Venom Allergy

  • Notify a teacher or other school personnel immediately if stung by an insect (bee, wasp or other insect with venom).
  • Learn to recognize symptoms of an allergic reaction.
  • Notify a teacher or other school personnel immediately if an allergic reaction occurs.
  • Wear a medic alert bracelet, if provided by your parents.
  • Notify a teacher or other school personnel if they are being picked on or threatened by other students as it relates to their allergy.
  • Know how to administer own Epi-Pen and/or inhaler (if permitted to carry and self-administer an Epi-Pen or inhaler under Board Policy 453.4 Rule Administering Medication Procedures).
  • Notify school personnel, school office, health room personnel, or the activity supervisor immediately if an Epi-Pen is used, as 911 will be contacted and you will be taken to the hospital.
  • Keep authorized Epi-Pen and/or inhaler in designated location and do not share medications with others.

Responsibilities for Building Administrators

  • Follow all applicable federal laws, including Americans with Disabilities Act, Section 504 of the Rehabilitation Act of 1973, FERPA, Individuals with Disabilities Education Act, as well as all state laws and district policies and procedures that may apply to students with life-threatening allergies, including but not limited to Board Policy 453.4 and 453.4 Rule and policies/procedures pertaining to the confidentiality of student records. (Board Policy 347, 347 Rule).
  • Have knowledge of all Health Care Plans for students with life-threatening allergies in their building.
  • When appropriate, familiarize teachers with the Health Care Plans of their students and any other staff member who has contact with the student on a need-to-know basis.
  • Reinforce with staff the need to develop a cleaning protocol to minimize the risk of exposure to food and latex allergens.
  • Reinforce a no-food and no-utensil trading/sharing best practice.
  • Post allergy alert signs in buildings as appropriate.
  • Establish a system for notifying food service staff of students with a life-threatening allergies. Provide a copy of the Health Care Plan when appropriate.
  • Establish a communication plan for school activities including physical education, playground, and field trips that involve a student with life-threatening allergies.
  • Establish a system for assuring appropriate staff have access to Health Care Plans within the classroom.
  • Establish a system for the storage and monitoring of Epi-Pens in the health office. They should be periodically checked for expiration dates and parents notified of need for refills.
  • Establish a system for sending Epi-Pens and Health Care Plans on field trips.

Responsibilities for the School Nurse

  • Review and retain all forms and documents submitted by parents and medical professionals related to students with life-threatening allergies.
  • Develop a Health Care Plan for students with a life-threatening allergy in collaboration with parents and health care provider as needed.
  • Assist the building administrator in providing information about students with life- threatening allergies to staff as needed.
  • Provide copies of complete Health Care Plans (paper or electronic) to each building prior to the beginning of the school year and update as needed during the school year.
  • Update Infinite Campus conditions during registration and as needed when the parent or medical provider submits information regarding an allergy health condition.
  • Provide DPI-approved training to authorized school personnel and authorized contract employees (e.g. bus company), including:
    • Recognizing the signs and symptoms of anaphylaxis
    • Responding to allergic reactions
    • Use of an Epi-Pen
    • Follow up procedures needed after an allergic reaction, anaphylaxis, and/or use of an Epi-Pen
  • Maintain records of all staff trainings related to students with life-threatening allergies.
  • Work with the bus company re: students who may require the assistance of the bus driver to transport an Epi-Pen.

Responsibilities of the Teachers

  • Review the classroom health concerns list prior to the start of school which includes Health Care Plans of any student identified with life-threatening allergies.
  • Participate in any meetings for students with life-threatening allergies as needed.
  • Never question or hesitate to act immediately if a student reports signs or symptoms of an allergic reaction.

Classroom Considerations

  • Use allergen free products for classroom activities (i.e. arts and crafts, science projects, math manipulatives, cooking, celebrations). Modify class materials as needed.
  • Consider the use of stickers, pencils or other non-food items as rewards.

APPENDIX A

Key Points for All Staff

  • You are never alone. It takes a team to ensure the best for our students.  Help is usually a phone call away.
  • Educate, Educate, Educate. This is an ongoing process that changes with the student’s needs and as the staff changes. Food bans do not work because it creates a false send of security.  Today, processed foods contain trace amounts of food items that are not always identified on the food label.  The best plan is to educate our school community about the issues that face students with life-threatening allergies.
  • Special events/Non-routine days. The greatest risk for a life threatening allergic reaction exists when the normal routine is broken.  Examples are classroom parties, field trips, a substitute teacher and after school events.  Be prepared.  Always have the Health Care Plan available and think ahead to reduce the risk accidental exposure to an allergen.
  • Symptoms vary greatly.
  • Be safe, not sorry! Take all complaints from children with life-threatening allergies very, very serious  It is important to respect the needs and rights of each student.
  • A student with a life-threatening food allergy should never eat unexamined food.
  • In the event a student has an anaphylactic reaction on school premises, during regularly scheduled school hours, during the academic school year, call 911 as soon as practicable. Authorized school personnel should follow the Health Care Plan and may do the following: a) Provide an epinephrine auto-injector to a student to self-administer in accordance with a prescription specific to the student that is on file with the school; b) Administer an epinephrine auto-injector to a student in accordance with a prescription specific to the student that is on file with the school; or c) Administer an epinephrine auto-injector (from the stock epinephrine) to a student or other person who the school nurse or other designated school personnel in good faith believes is experiencing anaphylaxis in accordance with the emergency protocol from the Hamilton School District’s Medical Advisor, regardless of whether the student or other person has a prescription for an epinephrine auto-injector. *Emergency protocol for stock epinephrine is available upon request in Special Services. (Hamilton School District has not yet received a supply of stock epinephrine for the 2018-19 school year due to a nationwide shortage).
  • Authorized school personnel should be trained to use epinephrine auto-injectors and know the location of the medication at school and on any special function. If Epinephrine is used, the student will be taken to the hospital for evaluation even if the allergic reaction symptoms   The principal, school office, health room staff and parent/guardian should be notified as soon as possible. Call 911 for all suspected anaphylactic reactions. No one can predict how a reaction will progress.  A mild reaction can blossom into a full blown anaphylactic reaction very quickly or over several hours.  A reaction can also appear to subside or even appear to be under control and can blossom again into a Life- Threatening reaction.
  • Cross contamination. It only takes a trace amount of the allergen to cause an allergic reaction.  To prevent exposure to an allergen, hand washing and washing of surfaces (tables, chairs, mixing bowls, etc.) where an allergen has been used is necessary.  Soap and warm water are most effective for cleaning surfaces.

APPENDIX B

Signs and Symptoms of Allergic Reaction

  1. Allergies can affect almost any part of the body and cause various symptoms. Anaphylaxis includes the most dangerous symptoms, including but not limited to: breathing difficulties, drop in blood pressure, and shock. Other signs and symptoms of anaphylaxis may include:
  • MOUTH: Itching and swelling of the lips, tongue or mouth
  • THROAT: Tight throat, hoarse, trouble breathing/swallowing
  • SKIN: Hives, itchy rash and/or swelling about the face or extremities
  • GUT: Nausea, abdominal cramps, vomiting and/or diarrhea
  • LUNG: Short of breath, wheeze, repetitive cough
  • HEART: Pale, blue, faint, weak pulse, dizzy
  • OTHER: Feeling something bad is about to happen, anxiety, confusion

The severity of symptoms can change quickly.   It is important that treatment be given immediately.

  1. Symptoms may occur within a few seconds of exposure or up to two or more hours later.Approximately 20-30% of people having an allergic reaction will have a “rebound” reaction, meaning after the initial treatment, they are symptoms free for a period of time (up to 3 hours) then have a second, often more severe reaction.
  1. Persons who have had previous whole body reactions (anaphylaxis) or who have asthma are at a higher risk of having a severe anaphylactic reaction.

RESOURCES

Food Allergy Research & Education             www.foodallergy.org

American Latex Allergy Association             www.latexallergyresources.org

Waunakee Community School District; Waunakee, Wisconsin

Wisconsin Department of Public Instruction; School Nursing and Health Services-Anaphylaxis document