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Peanut Allergy Resolved... now what?

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by k1p1ssk k1p1ssk, BSN, RN (Member)

k1p1ssk has 7 years experience as a BSN, RN and works as a school nurse.

3,894 Visitors; 173 Posts

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I have a student who is presently going through desensitization and will be eating his first peanut on Thursday (at his allergist's). Now, assuming he passes the tests and is deemed to be free of a peanut allergy, and I receive documentation of this/documentation to d/c the med order and allergy action plan, what should I do with his epi-pen? Would it be rude of me to ask the family if I can add it to my stock epi supply? None of their other children have allergies that I'm aware of...  

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1,179 Visitors; 215 Posts

Epinephrine and allergy action plan need to be kept! He isn't cured, he's desensitized and still at risk for reaction.

Edited by jess11RN
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3,554 Visitors; 421 Posts

DItto Jess above! Keep it for him "just in case"

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k1p1ssk has 7 years experience as a BSN, RN and works as a school nurse.

3,894 Visitors; 173 Posts

But can I even use them if they have been discontinued by a doctor? And I shouldn't have used the word desensitized... He was presumed to have a peanut allergy based on family history. His bloodwork has been negative and so was his skin test. His ingestion test is the only thing left. 

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BiscuitRN has 4 years experience as a BSN, RN and works as a School Nurse.

1,712 Visitors; 372 Posts

I've had two students with orders to d/c allergy action plan/epi/etc.  I've notified staff, updated the profile on our school-wide program (where teachers can see) to say "former allergy to ___", and I keep the epi until it expires because who knows what could happen.  Also, I've had a few instances where students leave our school and don't collect their epi.  I keep it.  I don't put it in my stock supply but if there's some wild emergency I at least know I've got some extra epi there.

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ruby_jane has 10 years experience as a BSN, RN.

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Even if I'd gotten the D/C order...I might not mention that to the family and keep the pen until it expired.

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Blue_Moon has 18 years experience as a BSN, RN and works as a Registered Nurse.

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We have a student going through this process BUT his allergist has said it's to keep him from dying when exposed to peanuts, not free reign to eat as much as he wants. I guess it depends on how severe the allergy is to begin with. In this case you better believe I'd have a backup! 

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k1p1ssk has 7 years experience as a BSN, RN and works as a school nurse.

3,894 Visitors; 173 Posts

Ok, cool. Thanks everyone!

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1,179 Visitors; 215 Posts

1 hour ago, k1p1ssk said:

But can I even use them if they have been discontinued by a doctor? And I shouldn't have used the word desensitized... He was presumed to have a peanut allergy based on family history. His bloodwork has been negative and so was his skin test. His ingestion test is the only thing left. 

Got it. So, there are 2 different senerios....

1. Kid has peanut allergy, goes through OIT desensitization, still has peanut allergy, stays on maintenance dose of peanuts daily to prevent reaction, but is considered desensitized, so if there is accidental exposure, chances are, kid won't react.

2. Kid has peanut allergy (or presumed), outgrows or never had it in the first place, goes through oral challenge at allergist office, if kid can tolerate 2 TBSP of peanut butter (ie, 1 full serving of peanuts), then he is deemed not allergic. 

It seems that your student is the second senerio, so yes, you would just need to get a documentation from the doctor stating "LD no longer is allergic to peanuts, discontinue allergy action plan and emergency medications"

But, as far as adding the student's designated epi to your undesignated stock epinephrine (sorry, didn't answer that one), no, you just have to give it back to parents and they can do whatever they choose to do with it. 

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Flare is a ASN, BSN and works as a School nurse firefighter.

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so since it's mid year, I see no harm in keeping the allergy action plan in place and the epipen on hand for the rest of the year and simply not renewing for next year with the documentation you have with the resolution of the allergy being the reason.  I've had kids over the years that were "highly allergic" in kinder and then over the years the epipen stopped coming in and then the allergy action plan stopped coming in and despite repeated phone calls and requests for updates, there is no documentation to explain.  Then If i'm lucky, I get a note from the parent saying they don't need it or an updated physical with a note *now saying* no allergies.  Sigh... i ask so little.  

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KidsRNstill has 40 years experience and works as a School Nurse.

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17 hours ago, Blue_Moon said:

We have a student going through this process BUT his allergist has said it's to keep him from dying when exposed to peanuts, not free reign to eat as much as he wants. I guess it depends on how severe the allergy is to begin with. In this case you better believe I'd have a backup! 

^^This.  I have a child, no history of anaphylaxis but allergy to peanuts from blood test.  She completed desensitization over a period of 8-9 months with no reaction, continues to eat peanuts/peanut butter daily at home (small amounts).  I feel better about accidental exposure--the kid HATES peanuts so she won't be deliberately ingesting at school.  The allergist states she doesn't need an Epi-Pen at school

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