This position statement is an excellent resource that I’ve referred to time after time, year after year. It’s titled “Anaphylaxis In Schools and Other Child Care Settings”, and it was written by Dr. Milton Gold, Dr. Gordon Sussman, Dr. Michael Loubser, and Dr. Karen Binkley. Among the contributing authors are Dr. Eric Leith, Dr. Hugh Sampson, and Dr. Peter Vadas. It was published in August of 1995 on the Canadian Allergy, Asthma and Immunology Foundation (CAAIF) website, and it can now be found on the Canadian Society of Allergy and Clinical Immunology (CSACI) website. I’m publishing it here to ensure that it’s available to as many people as possible.
The document was written following two deaths from peanut allergy in Ontario during the summer of 1994. These deaths did not occur in schools, but the deaths heightened the public’s awareness regarding the potential consequences of anaphylaxis. What I love about this position paper is how strong its recommendations are about epinephrine use, and its recommendations concerning peanut allergen in schools.
Regarding epinephrine and its use in first aid treatment of allergic reactions, they state that:
- epinephrine is the ONLY drug which should be used in the emergency management of a child having a potentially life threatening allergic reaction and ALL efforts should be directed toward its IMMEDIATE use
- antihistamines, inhaled asthma medications, or steroids should NOT be regarded as first line medications and are only to be given subsequently under the supervision of a physician
- every child should have their own epinephrine auto-injector and be wearing a medical ID bracelet clearly identifying his or her allergy
- children should carry their OWN epinephrine if they are old enough to understand its proper use
- back up epinephrine should also be available in first aid kits in gyms, assembly rooms, cafeterias, lunch rooms, school yards, and school buses and MUST BE EASILY ACCESSIBLE rather than locked in cupboards or drawers
- regardless of whether or not a student is capable of self injecting, they will still require the help of others because the severity of the reaction may hamper their attempts to inject themselves, so adult supervision is mandatory
- ALL individuals entrusted with the care of children should have basic first aid and resuscitative techniques, including ADDITIONAL FORMAL TRAINING ON HOW TO USE EPINEPHRINE AUTO-INJECTORS and should be CERTIFIED in those techniques
- one should NOT be afraid to use epinephrine for fear of litigation as common law protects the care givers in life threatening situations when they provide assistance in a reasonable and acceptable manner, and the administration of epinephrine is now regarded as acceptable treatment for anaphylaxis
- parents should NEVER sign a waiver absolving the school of responsibility if epinephrine was NOT injected
- there are NO contraindications to the use of epinephrine for a life threatening allergic reaction
- because reactions are NOT predictable and adequate warning signs are NOT always present before serious reactions occur, EPINEPHRINE MUST B GIVEN AS SOON AS A CHILD DEVELOPS ANY ONE SYMPTOM* (also referred to as the “start” of the reaction) when there is known OR SUSPECTED allergen contact and the child should immediately be taken to hospital
* The symptoms to watch for are any one of the following: Hives, itching or swelling (of any part of the body), red watery eyes, runny nose, vomiting, diarrhea, stomach cramps, change of voice, coughing, wheezing, throat tightness or closing, difficulty swallowing, difficulty breathing, sense of doom, dizziness, fainting or loss of consciousness, change of color.
- in situations WHERE THERE IS A HISTORY OF A LIFE THREATENING REACTION, EPINEPHRINE SHOULD BE GIVEN IMMEDIATELY after ingestion of the offending food and BEFORE ANY REACTION HAS BEGUN (Update: Experts now agree that upon known ingestion of one’s allergen, epinephrine should be given immediately, whether OR NOT a person has had a life threatening reaction in the past.) Two excellent articles on this important update can be read by clicking here and here.
- following epinephrine use, all individuals must immediately be taken to hospital for observation, as further treatment may be required
- during transport to the hospital, additional epinephrine must be available and MAY BE ADMINISTERED EVERY 15 to 20 MINUTES where the allergic response is not under adequate control (for example if breathing becomes more labored or consciousness decreases)
- education of ALL teachers, staff, AND students regarding food allergies should be incorporated into first aid courses
I also appreciate the consensus recommendations regarding peanut allergen in schools, in particular that:
- minute amounts of certain foods like peanut when ingested can be life threatening
- skin rashes and stomach upset can occur from simply contacting residual peanut butter on tables wiped clean of visible material
- peanut allergies require more stringent management plans as they are the leading cause of food induced anaphylaxis and reactions are often more severe
- because peanuts are ubiquitous in the food supply, in one study 50% of peanut allergic children had accidental peanut ingestion within one year
- to control peanut exposure in school, it is recommended that in nursery, day care, and early public school grades NO peanuts, peanut butter, or peanut containing foods should be allowed because it is extremely difficult to avoid accidental ingestion
- in higher public school grades and high school, NO peanut foods should be allowed in common eating areas, and allergen free classrooms may need to be instituted when appropriate
- foods served by the school, nursery, or day care should omit peanuts AND OTHER NUTS
- for children with a life threatening allergy to a different allergen, the approach is similar to that outlined for peanut, and care should be individualized based on discussions between the parent, the allergy specialist and the school
To read the full consensus statement drafted together with FARE (it was called Food Allergy Network then) and AAIA titled “Anaphylaxis In Schools and Other Child Care Settings”, click here.
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