7/17/2020 - showmeecho.org · 7/17/2020 6 Aerosolized proteins –not odors cause allergic reactions, can be fatal Science experiments involving burning/heating of allergens create

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FOOD ALLERGIES FOR THE NEW SCHOOL NURSE“WHAT DO I DO NOW?!?”

Sally Schoessler, MSEd, BSN, RN, AE-C

Director of Education, Allergy & Asthma Network

MY NURSING JOURNEY

School Nurse

School Nurse Teacher

State School Nurse

Consultant –New York

State

Director of Nursing

Education –National

Association of School Nurses

Director of Education –Allergy & Asthma

Network –

Asthma Educator

Sally Schoessler

A FEW FACTS

TO GET US

GOING -

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FOOD ALLERGY 101ALLERGENS, ALLERGIES & INTOLERANCES

WHAT HAPPENS IN A FOOD ALLERGY REACTION?

An abnormal

immunologic response

to a food protein

NO reaction at first

exposure

Subsequent exposures –

degranulation of mast

cell – release of

histamine

Allergic reaction occurs

TOP 8

ALLERGENS

Sesame is commonly

considered the 9th top

allergen

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IS IT A FOOD ALLERGY OR

FOOD INTOLERANCE?

Example: Milk

Allergy or Lactose

Intolerance?

Food

Intolerance

Food Allergy

Where reaction takes

place

Digestive System Immune system

Intensity of reaction Mild to moderate

discomfort

Can be life-threatening

Symptoms Gastrointestinal Multiple body systems:

skin, respiratory, heart

and/or gastrointestinal

Reaction time May be delayed Usually immediate

(within 30 – 60

minutes)

Action to take See healthcare provider Call 911 if anaphylaxis

occurs

WHAT SHOULD THE SCHOOL NURSE DO?

First Year Nurse

Identifies students at risk for a life-threatening

allergic reaction

Obtains documentation from Healthcare

Provider (Allergy identification, Emergency

Care Plan, medication orders)

Meets with parents and student to assess

history and understanding of allergy

Future Considerations

Coordinates care between home, school and medical home

Provides education tailored to student developmental abilities, understanding of allergy and ability to self-monitor allergy management

Collects data on prevalence of food allergy at individual school

Advocates for least restrictive educational environment

SCHOOL PARTNERSHIPS

Inform staff with a "need to know" in a confidential manner

Inform teachers & staff with supervisory role with student of allergy – No health lists – provide an Emergency Care Plan (ECP)

Red folder system – ECPs in red folder in each teacher’s upper right hand desk drawer – substitutes should know to find them there

Can post sign with symptoms over phones in each classroom

BUILD BRIDGES – Whenever possible, get to your principal with an issue before a parent or teacher does

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AMERICAN ACADEMY

OF PEDIATRICS

Allergy & Anaphylaxis

Emergency Plan

PREVENTION AT SCHOOLTHE GOAL IS TO NEVER HAVE AN EXPOSURE OR EMERGENCY

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PREVENTION

Different Risks with different routes of exposure

• Oral

• Skin

• Inhalation

Relevant concepts, practical challenges and practical interventions for each

ORAL EXPOSURE

Allergens, hidden ingredients, cross-contact – most allergic reactions start in classroom

Younger students: passing saliva, supervision during meals and snacks

Older students: risk-taking, peer pressure, bullying, kissing

Labels must be read, should offer meals without allergens, assist students with choices

No sharing of food, drink or utensils, no unlabeled food –nonfood celebrations

Strategies to avoid cross-contact, food free classrooms only when necessary

Periodic check-ins with students and staff

SKIN EXPOSURE

Isolated contact on intact skin = no severe or systemic response –skin reactions

Both children & adults touch eyes, nose & mouth regularly

Soap & water best – commercial hand wipes good – Hand sanitizer is not

Nonedible items contain some food allergens – finger paint, play dough, shaving cream

For young children – skin exposure can quickly become mucosal or oral exposure

HAND WASHING! Have a cleaning protocol, curricular activities should be food free

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Aerosolized proteins – not odors cause allergic reactions, can be fatal

Science experiments involving burning/heating of allergens create risk

Use caution when cooking with food, flours, powders & other small particles of food that can go up in the air

Avoid food in curricular classroom activities

Field trips – a mine field of issues for students with allergies –food, activities & more

Some require prior assessment from the school nurse for special accommodations

Law: All students go on the field trip or no students go on the field trip

INHALATION

WHAT SHOULD THE SCHOOL NURSE DO?

First Year Nurse

Assess school & classroom environment to reduce possible exposures – without singling out a student

Help staff to understand how exposures can happen and how to mitigate the risk

Provide basic education for staff

Create an “allergy-aware” school environment

Future Considerations

Provide leadership at the school building and/or district level to promote and enhance allergy prevention strategies

Help student with decision-making skills to help them prevent exposure to allergen

Explore evidence-based allergy information

Resources

Journal articles

SCHOOL PARTNERSHIPS

Develop school-wide allergen avoidance practices –create a safe school environment

Assess classroom for allergens – foods, classroom supplies, instructional materials

Teach staff to read food labels – always consult with parent if unsure

Teach staff about the importance of allergen avoidance – reinforce messages regularly through newsletters, flyers, etc.

Assess cafeteria and special areas for allergens

Always provide for respectful confidentiality for student

Teach staff about student rights to confidentiality – become familiar with FERPA and discourage hallway conversations about health issues

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ANAPHYLAXIS - EMERGENCY CAREEPINEPHRINE FIRST – EPINEPHRINE FAST

TREATMENT OF ANAPHYLAXIS

EPINEPHRINE

Epinephrine First, Epinephrine FAST

Determine the correct dose

Prescriber’s order

If stock, don’t take the time to weigh the child – if you don’t know weight, use Broselow tape (prepare ahead)

When to upsize?

Antihistamine

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TREATMENT OF ANAPHYLAXIS

Stay with and observe student until EMS arrives

Maintain airway, monitor circulation, start CPR if necessary

Do not have the student arise to an upright position

Consider lying on the back with legs elevated, on side if vomiting

Observe for changes until EMS arrives

IF NO IMPROVEMENT OR IF SYMPTOMS WORSEN IN ABOUT 5 MINUTES OR MORE, ADMINISTER A 2ND DOSE OF EPINEPHRINE

Transport to Emergency Department vis EMS even if symptoms get better

WHAT SHOULD THE SCHOOL NURSE DO?

First Year Nurse

Create a medication system that keeps epinephrine accessible but secure (don’t lock it)

Know how to give epinephrine, teach designated staff members to administer an auto-injector

Keep ECPs updated

Know policies about stock epinephrine

Future Considerations

Expand medication system to include

medication accessibility during lockdowns and

building evacuations

Determine best practice for stock epinephrine

storage in your setting

Create medical emergency response team with

well defined staff goals

Lead Table Top Drills with staff

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SCHOOL PARTNERSHIPS

Know who can and will administer epinephrine if nurse is not available

Have school district protocol to back up emergency procedures

Have administration backing about emergency procedures

Give staff a chance to practice with epinephrine trainers

Be sure staff is willing and able to administer ECP.

Develop procedure to manage allergies on field trips, after school activities

QUALITY RESOURCESYOU WANT TO GET SOME OF THESE!

SCHOOL FOOD

ALLERGY

MANAGEMENT AND

PREVENTION PLAN

Page 44 – CDC Voluntary Guidelines

Overall School District Plan

Benchmark to see how your school is

doing with food allergy management

A place to begin!

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FAMEST. LOUIS CHILDREN’S HOSPITAL

Different sections for unique stakeholders

• Families

• Schools

• Healthcare Professionals

ALLERGY & ASTHMA NETWORK RESOURCES

ALLERGY & ASTHMA NETWORK RESOURCES

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FIRST YEAR DO’S AND DON’TS

DO

DO implement 1 – 2 things now

DO add 1 – 2 more strategies for

the next school year

DO develop a vision for where you

want to go

DO ask for help when you need it

DON’T

DON’T feel like you need to do EVERYTHING all at once

DON’T write care plans too long for you to do

DON’T Panic

DON’T judge yourself too harshly

SCHOOL NURSING

School Nursing is the best job you’ll ever have –

It’s hard. There are days when you wonder how you could ever have decided it’s a good idea to be responsible for the health & well-being of hundreds of people every day.

It’s fulfilling. You get to have long-term relationships with your students & you get to show them that they are worth caring about and caring for.

When you fall asleep at night, you never once have to wonder if you made a difference that day.

FOOD ALLERGIES FOR THE

NEW SCHOOL NURSE

THANK YOU FOR LISTENING – HAVE A GREAT FIRST YEAR!

SALLY SCHOESSLER – [email protected]

WWW.ALLERGYASTHMANETWORK.ORG