Food Allergies on the Rise

[tnbutterfly - Mary, BSN]

[h=1]Food Allergies are on the Rise: School Nurses Take Action[/h]

Food allergies, a common cause of anaphylaxis, are on the rise in the U.S., affecting an estimated one in 13 children. Up to 25% of anaphylaxis cases in schools occur in children without a previous allergy diagnosis. For this reason, ensuring access to undesignated epinephrine auto-injectors – epinephrine auto-injectors that aren't prescribed to a particular student or staff member – is a key priority for facilitators and nurses alike.

Recent legislation has improved epinephrine access in the school setting by allowing or requiring schools in many states to stock epinephrine auto-injectors. To date, 47 states have enacted laws or policies allowing or requiring schools to stock undesignated epinephrine auto-injectors.

What policies do you have at your school re. training for handling food allergies?

[RatherBHiking, BSN, RN]

We educate staff on anaphylactic reactions and symptoms and how/when to use epi pens. We notify teachers which students they are working with have an allergy. We ask classrooms to not have that allergen in their room. We are not an allergen free school so we have those with allergies sit at a separate lunch table free of any students eating cold lunch which is wiped clean between lunch periods. Our cooks at this time don't serve foods with nuts so that helps. If a non allergic students eats something with nuts in it from home we ask them to wash their hands afterwards to prevent cross contamination if there is a severe allergy in their class.

[ERRNDeans]

Our school has fruit and veggie only for snacks/classroom foods. I really like this, keeps the kids from eating junk, teaches them what a snack SHOULD be and decreases the chances of an allergic reaction.

Teachers are trained on how to use Epi Pens also.

[JenTheSchoolRN, BSN, RN]

Our school has fruit and veggie only for snacks/classroom foods. I really like this, keeps the kids from eating junk, teaches them what a snack SHOULD be and decreases the chances of an allergic reaction.

Teachers are trained on how to use Epi Pens also.

Except for the growing number of kids I'm seeing with fruit allergies...

I do Epi-pen training and we are a nut and peanut-free school. I, at this time sadly, do not have stock Epi-pens .

[SnowyJ, RN]

I am not saying food allergies aren't on the rise, but we have an allergy group here that LOVES to order epi pens without any testing to confirm the allergy. While I go by the "better safe than sorry" thought on this, or district supposedly requires "proof" of a food allergy to have an epi pen at school. I have actual test results from maybe 1/4 of my allergic children.

Left wondering why....

[Spidey's mom, ADN, BSN, RN]

Timely question - had two anaphylactic reactions in kids who have no diagnosis of allergies yesterday.

California passed a law last September that all school districts must have stock epi-pens. The law of course did not make physicians happy and the law did not spell out how we were supposed to get those epi-pens. You need an Rx.

It took our county and many other counties almost a year to get this into effect. I just finished training all 11 campuses but had to do the office staff and principals/vice principals because the law stipulates the Superintendents have to ASK for volunteers to be trained and no one wanted to do so.

The feeling among teachers and other school staff is the state is making the schools into mini-medical clinics and training lay people to do medical things. There are very few full-time nurses in California and very few districts with a nurse on every campus.

Yesterday a new elementary school student with NO medical history on file came into the office c/o breathing difficulties. The staff did a great job, followed the protocol, administered Jr. Epi, called 911 and called me. I was 20 miles away. I met them at the ER.

The physician got very angry that a lay person gave epi without a diagnosis and was shocked that we had stock epi at school. He ranted and raved about how dangerous that is, that a man died of a heart attack after getting epi, etc. The poor staff person who gave them epi was in tears and questioned whether she did the right thing.

I advised her that she did do the right thing. I went later to debrief at that campus and everyone was talking about how the physician behaved and people were really hesitant about giving epi now.

I truly think making anyone besides a medical person responsible for giving epi, insulin, diazepam, glucagon, is not being fair to the staff who were hired to teach or do office work.

I'm going to follow up today with that campus but I'm heartsick over this incident.

The student is fine - has a follow-up appointment now to be tested for allergies.

The other student was 90 miles away on a field trip - no Rx for epi and we can't send the stock epi on field trips. I said call 911. That student is ok too.

[SnowyJ, RN]

"If you are in doubt, always give the shot"

I agree with this statement. Tell your staff member she absolutely did the right thing!!! More people have died from NOT getting epi when needed than from ever being given an epi pen. Ridiculous for that MD to state otherwise.

Feel free to share this with your staff member. The MD starts to give info at the 50 second mark. at about the 2 minute mark, he stresses "if you are in doubt, always give the shot."