Back-To-School With Severe Allergies

Epinephrine, Teamwork Protect Children From Life-Threatening Reactions

Source

Dey L.P.

Forums

Related Articles

The number of children with severe food allergies is as high as two million, and experts agree that this number is rising. Children with insect sting allergies are at increased risk with the spread of fire ants and africanized honey bees. Students with latex allergies face the fact that latex is common in such school supplies as erasers, rubber bands, mouse pads, balls, glues and other art supplies, not to mention the latex gloves used by some school cafeteria workers.

As a result, back-to-school can be a very stressful time for parents of these children. Once they are in school, their parents have less control over their exposure to substances that can cause anaphylaxis, a serious allergic reaction that can result in hives, swelling and itching around the mouth or throat, vomiting, diarrhea, unconsciousness, or even suffocation or a fatal drop in blood pressure. To safeguard their children, parents need to take the lead in making sure that school and daycare staff can identify anaphylaxis and administer self-injectable epinephrine, the standard emergency treatment for life-threatening allergic reactions.

Epinephrine, also known as adrenaline, can reverse the symptoms of anaphylaxis and takes only seconds to administer via an auto-injector such as EpiPen(R) or EpiPen(R) Jr. Immediate injection of epinephrine in the event of an anaphylactic episode is critical because it can take as little as one to two minutes for a mild allergic reaction to escalate to deadly anaphylactic shock, and you cannot tell at the outset of a reaction how it will progress. Consequently, it is vital that children and those who care for them have ready access to epinephrine, especially in a form that is easily administered, such as an auto-injector, whether school policy allows students to carry it or specifies that it be stored in specially designated areas.

Indeed, research reported in the New England Journal of Medicine shows that children and adolescents with severe allergies are at particular risk of dying from anaphylaxis while they are at school if they do not have the protection of epinephrine. In one study of children and adolescents with food allergies, four out of six fatal anaphylactic reactions occurred in schools. None of those who died had epinephrine with them. All of those who survived received epinephrine before or within five minutes of developing severe symptoms.

According to Judy Robinson, executive director of the National Association of School Nurses, "Parents are not alone in wanting to provide a safe environment for their children at school. Schools and school nurses count on parents to let them know when a child has an allergy that may require treatment. We urge parents to partner with their child's physicians, school nurses, teachers and administrators to ensure that school staff know about a child's allergic triggers and how to avoid them, and to develop a plan for identifying anaphylaxis, administering epinephrine and calling for emergency medical attention."

To accommodate the increase in anaphylaxis-producing allergies, especially in the wake of recent controversy over peanut bans in schools and airplanes, some schools and daycare centers have become more active in addressing the needs of allergic children. By working with parents, they are taking extra safety measures such as training staff to recognize anaphylaxis symptoms and administer EpiPen(R), creating "no food sharing" rules, and promoting student awareness of severe allergies through videos and other educational materials. Allergen avoidance is the first line of defense against anaphylaxis, but it is often difficult for children to avoid the food, stings or latex that cause their reactions, and not all exposures can be anticipated even by an adult. When a reaction does occur, the immediate administration of epinephrine can be the difference between life and death for a child with a severe allergy.

For this reason, in a recent position statement entitled "Anaphylaxis in schools and other child-care settings," the American Academy of Allergy, Asthma and Immunology (AAAAI) recommends that schools be prepared to administer epinephrine immediately in the event of an anaphylactic reaction. The AAAAI further recommends that when students have prescriptions for epinephrine auto-injectors (i.e., EpiPen(R) and EpiPen(R) Jr.), they should be stored in readily accessible places throughout the school, and all staff members should know where they are kept and how to use them properly.

Specific steps that parents should take before sending a child with severe allergies back to school or daycare include the following, as recommended by the AAAAI: