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A Parent Guide for Schools
How to Manage Life-Threatening Food Allergies in School.
A Parent Guide for Child Care
How to Manage Life-Threatening Food Allergies in Child Care
Camp
Guidelines ANAPHYLAXIS
"Preventing Life-Threatening Food Allergy Emergencies at Camp:
A Resource for Camp Nurses and Directors"
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ANAPHYLAXIS
"Preventing Life-Threatening Food Allergy Emergencies at Camp:
A Resource for Camp Nurses and Directors"
When camp opens this year, we hope you will be prepared to deal with life-threatening food allergies by taking steps to prevent exposures to foods that cause allergies in any of your campers, and by being prepared to manage an emergency if one occurs.
In the winter of 2000 we surveyed New England camp directors to determine how they managed food allergies, and in June 2001 we sent out results of that survey. At the March 2001 Tri-State Camping Conference in New York, we arranged for an allergist to conduct a workshop on the subject. Now we have prepared these guidelines, which are based on guidelines that we developed for school nurses, but adapted for the camp setting.
Please call us if you would like more information on asthma and allergies – or visit our website.
1. Anaphylaxis is a life-threatening allergic reaction.
Allergies to foods, stinging insects, medications, latex, and even to exercise after eating may result in a severe life-threatening reaction known as anaphylaxis. Because anaphylaxis occurs quickly, sometimes within minutes, it is important to:
An estimated 2% - 3% of the general population is at risk for an anaphylactic reaction to foods, insect stings, medications or latex. The rates are even higher in young children.
Failure to act quickly and treat appropriately may result in permanent disability or death.
2. What is anaphylaxis?
Definition: Anaphylaxis is an immediate systemic hypersensitivity reaction affecting multiple systems of the body, including cardiovascular, respiratory, gastrointestinal and cutaneous tissue.
Symptoms: The onset and course of anaphylaxis is variable. Symptoms may include:
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Sense of impending doom
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Generalized warmth or flush, tingling, itching, hives, swelling
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Upper respiratory complaints: lump in throat, a feeling that the throat is closing or tightening, hoarseness, difficulty swallowing, nasal congestion, runny nose, fullness in the ears.
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Lower respiratory symptoms: difficulty breathing in, chest tightness, wheezing or shortness of breath
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Cardiovascular symptoms: lightheadedness, faintness, palpitations, low blood pressure.
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Gastrointestinal symptoms: nausea, abdominal cramps, bloating, , or diarrhea
Swelling of the larynx and cardiovascular collapse are the most frequent causes of death from anaphylaxis.
Patients who do not have life-threatening symptoms initially may progress to life threatening anaphylaxis, with time. Adequate warning signs, such as hives, are not always present before serious reactions develop. The first warning signs may be only "a funny feeling in the mouth" or abdominal discomfort in the case of food allergy.
The most common causes of anaphylaxis in children include allergies to:
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Foods (Peanuts, tree nuts, fish, shellfish, soy, milk, egg, and wheat are the most common, although any food is a possible allergen.)
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Insect stings (e.g., yellow jackets, bees, wasps and hornets)
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Medications
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Latex (natural rubber products such as latex gloves, balloons, medical tubing)
How can exposures to these allergens occur?
·Tasting · Ingesting · Inhaling ·Touching · Being injected or stung
3. How is allergy with a risk of anaphylaxis diagnosed?
· By a patient's history of reactions and possible causative agents, confirmed with appropriate testing (e.g., skin and/or blood tests, food challenges and/or elimination diets) by a trained allergy specialist.
· Previous mild reactions to allergens do not preclude subsequent life-threatening reactions.
4. How can camps help prevent anaphylaxis emergencies?
The camp needs to develop systems to prevent accidental contact with a life-threatening allergen at camp and conduct a camp-wide food allergy education plan. Protecting a camper from exposure to an offending allergen(s) is the most important way to prevent life-threatening anaphylaxis. Most anaphylactic reactions occur when a child is accidentally exposed to an offending food or is stung by a bee.
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Identify the Child’s Needs: Children with existing life-threatening allergies should be identified on a signed medical form. The form should include the child’s name, photo, specific offending allergens (peanuts, bee stings, etc.), warning signs of reactions and emergency treatment. (See sample form attached). It is useful for the child to wear a Medic-Alert bracelet or necklace or carry a card
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Develop an Individual Health Care Plan (IHCP): Based on the child’s medical form, the camp nurse should develop a written IHCP for action, including steps to avoid accidental exposures to allergens and steps for emergency treatment.
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Conduct a Team Meeting to educate and plan with camp staff: Before camp starts, the camp nurse and camp director should convene a team meeting of all the camp personnel that will have responsibility for the child. The camp nurse should give an overview of food allergies, anaphylaxis, and the child’s Individual Health Care Plan and then discuss prevention and management of life-threatening allergies. The team should include, but not be limited to:
Every camp with a child at risk for anaphylaxis needs a fulltime camp nurse. The camp nurse should be an advocate for the child at risk for anaphylaxis and work with the child's parents, counselors, food service staff, bus drivers and camp trip planners to provide training and devise avoidance measures and emergency procedures.
5. Some steps to avoid accidental exposures to foods.
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Provide a "peanut-free" table in every camp dining hall or other eating area that serves a child with peanut allergy, as this is an extremely potent and often hidden ingredient.
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Train food service workers to identify all ingredients in foods and identify all the ingredients on food labels.
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Train food service workers to avoid cross-contamination of foods (e.g., cooking or serving, different foods with the same utensils and dishes – and cleaning up with the same sponges or cloths.)
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Avoid serving a child any food to which the child is allergic. Provide alternative foods for the child, if necessary.
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Prohibit sharing of food and utensils
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“The routine use of latex gloves by food handlers, housekeeping … should be discouraged as latex sensitization or anaphylaxis can be precipitated” among staff as well as campers. “Alternative types of gloves can be considered.” (From 7/21/97 joint statement of the two national professional societies of allergists.)
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Prohibit the sending of food to camp.
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Prohibit food in bunks.
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Prohibit or avoid the use of foods in activity areas such as arts and crafts, games, and nature. At a minimum, avoid the foods to which a camper is known to be allergic.
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Educate all campers and their counselors, and other staff about the risk of anaphylaxis.
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Prohibit foods on camp buses and other vehicles used for transport.
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Staff members who accompany an allergic camper on camp trips should be trained by the camp nurse and assigned the task of watching out for the camper’s welfare and handling any emergency.
6. What emergency plans for treatment of anaphylaxis should be in place?
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There should be a written action plan describing steps to take in an emergency.
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For children known to be at risk for anaphylaxis a physician's order for epinephrine in case of emergency should be obtained. Camp staff should have written instructions from the physician, signed by the parents, on file. (See attached AAAAI Position Statement, page 174 re: epinephrine).
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For any child with no previous history of anaphylactic reaction, discuss with the camp physician/medical advisor the importance of having a standing order to enable the immediate emergency use of epinephrine.
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Plan to call 911 as soon as epinephrine is administered. (In some anaphylactic reactions, the initial symptoms are followed by a delayed wave of symptoms later. Therefore, it is imperative that the child be transported by emergency medical services to the nearest emergency department, even if symptoms appear to have resolved.)
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Conduct an emergency drill. (e.g., Do local EMTs carry epinephrine? Is the epinephrine in the camp quickly available for use - not locked in a cabinet? Are appropriate staff members adequately trained to use it?)
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Make certain that a functioning communication device (walkie-talkie or cell phone) is available for use wherever there is a child at risk for anaphylaxis (e.g., bunk, dining hall, all activities and trips).
"Epinephrine is the first drug that should be used in the emergency management of a child having a potentially life-threatening allergic reaction…There are no contraindications to the use of epinephrine for a life-threatening allergic reaction."
"All individuals receiving emergency epinephrine should immediately be transported to a hospital even if symptoms appear to have resolved… Further treatments may be required, and therefore observation in a hospital setting is necessary. . Additional epinephrine should be available during transport."
From American Academy of Allergy, Asthma and Immunology (AAAAI) Position Statement: Treatment Strategies, page 174.
All individuals responsible for the care of children (including counselors, camp nurses, bus drivers, coaches, lifeguards, etc.) need to have familiarity with basic first aid and resuscitative techniques. This should include additional formal training on how to use epinephrine devices. (AAAAI Position Statement, page 175).
7. Other issues to plan for, e.g.:
· Re-entry to camp after a traumatic incident
· Peer education to avoid endangering, isolating, stigmatizing, bullying or harassing children with food allergies.
· Confidentiality concerns
Review your existing policies and procedures and create new ones if necessary.
Resources:
Asthma & Allergy Foundation of America/New England Chapter (AAFA/New England)
220 Boylston Street, Chestnut Hill, MA 02467
Ph: 617-965-7771 Toll-free: 1-877-2-ASTHMA Fax: 617-965-8886 email: aafane@aol.com
www.asthmaandallergies.org and www.aafa.org
Wide range of educational materials on asthma and allergies, including anaphylaxis and food allergies, rhinitis (hay fever), eczema and atopic dermatitis.
Food Allergy and Anaphylaxis Network (FAAN)
10400 Eaton Place, Suite 107, Fairfax, VA 22030-2208
Ph: 703-691-3179. Toll-free: 800-929-4040 Fax: 703-691-2713
faan@foodallergy.org
www.foodallergy.org
FAAN School Manual, newsletters, food alerts, how to read food labels.
American Academy of Allergy, Asthma and Immunology
611 Wells St., Milwaukee, WI 5302-3889
Ph:414-272-6071 Toll-free: 800-822-2762 Web Site: www.aaaai.org
Professional medical society. The Journal of Allergy and Clinical Immunology is the AAAAI’s official journal. See web site for information, referrals, position statements. Position Statement on Anaphylaxis in schools and other child-care settings includes a form for an Emergency Health Care Plan for anaphylaxis.
American College of Allergy, Asthma & Immunology
85 West Algonquin Rd., Arlington Heights., IL 60005
Ph: 847-427-1200 Web site: www.allergy.mcg.edu
Professional medical society. See web site for information, referrals, position statements.
(Disclaimer: AAFA/New England Chapter, including all parties to or associated with this resource packet, will not be held responsible for any action taken by readers as a result of their reading of this packet. Readers are encouraged to discuss medical treatment with the camp physician and the campers’ physicians. This document is adapted from "Preventing Life Threatening Allergy Emergencies in Schools: A Resource Packet for School Nurses and Administrators", Copyright 1999. All rights reserved.
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