ALLERGIES & EPI-PENS __________________ PRESENTED BY ZAIDA ENRIQUEZ

Severe Allergies &Epi-Pen AdministrationHealth Services Department

Presentation OverviewImpact of food allergies on childrenWhat is a food allergy?Triggers that worsen food allergiesMild signs & symptoms of allergiesMedical management of mild signs & symptomsAnaphylaxis (severe signs & symptoms of an emergency; interventions)Medical management of severe signs & symptomsPreventative measures

Script Notes:In this presentation we will be covering:- Impact of food allergies on childrenwhat a food allergy isWhat triggers food allergies to appearwhat signs and symptoms usually accompany someone exposed to a food allergen he or she is allergic toHow to manage mild food allergieswhat to look for in the event that anaphylaxis occurs, emergency signs and symptoms, and what to do within an emergency situationHow to manage food allergy emergencies through a prescribed epi-pen medicationAND What to do to prevent food allergy signs & symptoms

2Why You Have This TrainingIn accordance with Education Code (EC) Section 49414, legislation was enacted to develop minimum standards of training for school personnel in the administration of epinephrine auto-injectors. It is estimated that severe allergies affect nearly 40 million Americans in all age groups and put those individuals at risk of death from anaphylaxis.Impact of Food AllergiesFour out of every 100 children have a food allergy.

Food allergies are becoming more common AND hospitalizations related to food allergies are also increasing.

Children with food allergies are two to four times more likely to have other related conditions such as asthma and other allergies, compared with children without food allergiesAND are more likely to experience anaphylactic reactions to foods and be at higher risk of death.Script Notes: When it comes to food allergies, four out of every 100 children have a food allergy.

Food allergies are becoming more common AND hospitalizations related to food allergies are also increasing.

Children with food allergies are two to four times more likely to have other related conditions such as asthma and other allergies, compared with children without food allergiesAND are more likely to experience anaphylactic reactions to foods and be at higher risk of death.

The fear of an anaphylactic reaction and of food allergies can affect a childs well-being.Emotions associated with food allergies fear, sadness, anger, a sense of loneliness and feeling different. But the two primary feelings are anxiety and depression.

(Branum & Lukacs, 2008)

Children with food allergies, especially severe ones, may experience fear (fear of a severe reaction from what they eat), sadness and anger towards their condition, a sense of loneliness (from feeling like they cannot do or eat what other people and friends can) and may feel different (because they have to worry about what they eat while others do not have to). But the primary feelings they may feel are anxiety and depression. (Mondello, 2009)

In order to understand how to manage food allergies, identify how food allergies look, and combat the negative emotional and social effects food allergies may have on an individual it helps to first understand what food allergies are.

Photo from:Young kids with asthma may lag in reading skills. (2010, December 16). FOX News Network. Retrieved from http://www.foxnews.com/health/2010/12/16/young-kids-asthma-lag-reading-skills/4What are Food Allergies?A food allergy is an abnormal response to a food triggered by the bodys immune system. No food allergy symptoms occur on the first time a person is exposed to the foodFirst exposure can be:By eating or ingesting a food allergenTouching a food allergenUsing or eating other products with the food allergenNo cure

Script Notes:A food allergy is an abnormal response to a food triggered by the bodys immune system. No food allergy symptoms occur on the first time a person is exposed to the food. First exposure primes the body to respond the next time and an allergic response occurs upon following exposure. First exposure does not necessarily mean the first time an individual eats or tries a certain food. It can also occur by touching a food allergen directly, using or eating other products with the food allergen, or touching someone or being touched by someone who they themselves just directly touched the food allergen. ("Food allergy: An," 2010).

There is no cure for food allergies. The best method for managing food allergies is prevention by way of strict avoidance of any food that triggers a reaction ("Food allergies in," 2012)

Photo from Women's and Children's Health Network (. (2011, November 12). Food allergy - easy read. Retrieved from http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=302&id=2473

5Allergy TriggersThe eight major food allergens identified are: 1. Milk 2. Eggs 3. Fish (e.g., bass, flounder, cod) 4. Crustacean shellfish (e.g., crab, lobster, shrimp) 5. Tree nuts (e.g., almonds, walnuts, pecans) 6. Peanuts 7. Wheat 8. Soybeans

Script Notes: There are 8 major food allergens identified by the Food and Drug Administration that may trigger a food allergy response. The eight major food allergens identified are: 1. Milk 2. Eggs 3. Fish (e.g., bass, flounder, cod) 4. Crustacean shellfish (e.g., crab, lobster, shrimp) 5. Tree nuts (e.g., almonds, walnuts, pecans) 6. Peanuts 7. Wheat 8. Soybeans

These foods account for 90 percent of food allergic reactions ("Food allergies: What," 2010), BUT someone can be allergic to various other types of food, but the latter 8 are the most common.

Photo from Stier, R. (2008, Oct/Nov). Processcontrol: Building a world-class allergen control program, part 1 . Retrieved from http://www.foodsafetymagazine.com/article.asp?id=2645&sub=sub1

6Other Severe Allergy TriggersCommon causes:FoodInsect stings (bees, hornets, yellow jackets)Medication (e.g. antibiotics, aspirin, and non-steroidal anti-inflammatory drugs)LatexUncommon causes:Food dependent exercise induced anaphylaxis (rare)Idiopathic anaphylaxisFood-dependent exercise induced anaphylaxis- occurs when an individual eats a specific food and exercises within three to four hours after eating

Idiopathic unknown cause

Severe allergic reactions may at times be unavoidable because foods may contain unknown or unreported allergy producing ingredients, insects range widely, latex can be found almost anywhere, and some individuals do not know that they are severely allergic to one or more allergens7Food Allergies vs. Food IntoleranceFood allergies are different from a food intoleranceA food intolerance is the bodys abnormal reaction to a food but DOES NOT involve the immune systemA doctor can confirm the presence or absence of a food allergy and/or food intolerance

Types of Food Intolerance:- Lactose IntoleranceFood additivesGluten IntoleranceFood poisoningHistamine toxicity

Signs & Symptoms:BloatingAbdominal pain or crampingDiarrheaNausea & vomiting

SCRIPT NOTES:A food allergy is different from a food intolerance. Milk is one that is often misinterpreted by some as a food allergy when in actuality may just be a food intolerance. A food intolerance is the bodys abnormal reaction to a food but in a way that does not involve the immune system. A food allergy is triggered by an immune responseand poses a much greater health risk (U.S. Food and Drug Administration).

A doctor can confirm the presence or absence of a food allergy and/or food intolerance. Some ways they may diagnoses is through a skin prick test that exposes a person to a tiny amount of suspected food allergens on the skin and observing what cause a reaction. They may also have an individual keep a diet diary to record foods eaten and his or her reaction to them and then eliminate suspected foods from the diet and observe results there after.

Types of food intolerance that may occur are:Lactose intolerance in which the body lacks an enzyme called lactase that helps to breakdown the sugar called lactose that is found in milk and milk products. The inability to breakdown lactose causes bloating, abdominal pain, and sometimes diarrhea.An intolerance to products that enhance taste, add color, or protect against the growth of microbes such as MSG (monosodium glutamate) for flavor enhancing and sulfites to prevent mold growth can cause flushing, sensations of warmth, headache, or chest discomfort in some.A gluten intolerance occurs in people who cannot tolerate the product gluten in wheat, barley, and rye.Food poisoning occurs when microbes contaminate food and cause abdominal discomfort.And histamine toxicity occurs when seafood, such as fish, become contaminated by bacteria that contain high levels of histamine which cause symptoms similar to food allergies.

The usual signs & symptoms of food intolerance are gastrointestinal related and can be bloating, abdominal pain or cramping, diarrhea or nausea & vomiting. ("Food allergy: An," 2010).

Photos from National Institutes of Health, National Institute of Allergy and Infectious Diseases. (2010). Food allergy: An overview. Retrieved from NIH Publication website: http://www.niaid.nih.gov/topics/foodAllergy/Documents/foodallergy.pdf

8Mild Signs & SymptomsSymptoms of food allergies typically appear from within a few minutes to two hours after a person has eaten the food to which he or she is allergic. Allergic reactions can include: Hives Flushed skin or rash Tingling or itchy sensation in the mouth Itching (of any part of the body)Face, tongue, or lip swelling (or any body part)Vomiting and/or diarrhea Abdominal cramps Coughing or wheezing Dizziness and/or lightheadedness Swelling of the throat and vocal cords Difficulty breathing Loss of consciousness

Script Notes: When a real food allergy is triggered when one is exposed to such foods they are allergic to symptoms of food allergies typically appear from within a few minutes to two hours after a person has eaten the food to which he or she is allergic. Allergic reactions can include:

Hives Flushed skin or rash Tingling or itchy sensation in the mouth Face, tongue, or lip swelling Vomiting and/or diarrhea Abdominal cramps Coughing or wheezing Dizziness and/or lightheadedness Swelling of the throat and vocal cords Difficulty breathing Loss of consciousness

("Food allergies: What," 2010).

Photos from Women's and Children's Health Network. (2011, November 12). Food allergy - easy read. Retrieved from http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=302&id=2473

9Medication ManagementDiphenhydramine (Benadryl)An antihistamineRelieves mild signs & symptoms like:Hives Flushed skin or rash Tingling or itchy sensation in the mouth Face, tongue, or lip swelling Minor throat or airway irritationFollow the directions labeled on the package or bottle prior to giving the medicine.Can have side effects:DrowsinessDry mouth, nose & throatExcitement (especially in children)

Script Notes:Mild signs & symptoms caused by food allergies may be alleviated through over the counter allergy medicines such as the brand name medicine, benadryl, which also goes by the generic name diphenhydramine.

Benadryl is an antihistamine that works to target the immune system response that leads to allergy symptoms. It can relieve mild signs & symptoms like hives, flushed skin or rash, tingling or itchy sensation in the mouth, face, tongue, or lip swelling, and minor throat or airway irritation. Follow the directions labeled on the package or bottle prior to giving the medicine; and be aware of possible side effects such as drowsiness, dry mouth, nose & throat, and excitement (especially in children)

("Diphenhydramine," 2011)

10Severe Signs and SymptomsA severe, life-threatening allergic reaction is called anaphylaxis. This can lead to: Constricted airways in the lungsSevere lowering of blood pressure and shock (anaphylactic shock)Suffocation by swelling of the throat

Script Notes:A severe allergic reaction can lead to far more life-threatening signs & symptoms. A severe, life-threatening allergic reaction is called anaphylaxis and can often lead to constricted airways in the lungs, severe lowering of blood pressure and shock (anaphylactic shock), and suffocation by swelling of the throat ("Food allergies: What," 2010).

An epi-pen is used to treat someone with a severe, life-threatening allergic reaction.

Photo from Drugs.com. (2010, June). Epipen. Retrieved from http://www.drugs.com/pro/epipen.html

Epi-pens should be stored at room temperature until the marked expiration date. Do not refrigerate or expose to extreme heat or sunlight.11Medication Management

Script Notes:Keep in mind, even mild signs & symptoms of a reaction to a food allergy can lead to a severe allergic reaction. Those with known severe allergic reactions to food allergies should have prescribed medication on-hand ready to be used at any time he or she suspects the onset of an allergic reaction. That medication is usually referred to as an epi-pen.

12What To Do in An EmergencyNotice the signs & symptomsTake all reactions seriouslyTry to keep calmInitiate EPI-PEN medication treatment as prescribed by the doctor immediatelyCALL FOR AN AMBULANCE THEN CALL THE PARENT(S) 1 in 4 will have a latent reaction

Script Note:Persons with a known food allergy who begin experiencing symptoms while, or after, eating a food should have EPI-PEN medication treatment initiated immediatelyIf not treated promptly, these symptoms can become more serious in a very short amount of time, and could lead to anaphylaxis ("Food allergies: What," 2010).

Discuss biphasic reaction: The signs and symptoms of anaphylaxis usually appear rapidly, within seconds or minutes, after an exposure to an allergen. However, in some cases, the reaction can be delayed for up to one to three hours depending on the substance causing the reaction.

Some individuals have an anaphylactic reaction, and the symptoms go away only to return a few hours later. This is a bi-phasic reaction. This may take the individual by surprise. After a serious reaction, observation in a hospital setting is necessary for at least four hours after initial symptoms subside because delayed and prolonged reactions may occur even after proper initial treatment. (AAAI recommendation).

So in the event of an emergency notice the signs and symptoms early, take all reactions seriously (because even mild signs and symptoms can progress into a serious reaction), try to keep calm, initiate EPI-PEN medication treatment as prescribed by the doctor immediately and CALL FOR AN AMBULANCE THEN CALL THE PARENT(S)

In order to help prevent emergency situations, and help maintain a childs well-being and positive outlook on life taking proper preventative measures to aid in the prevention of an allergic reaction may help ease a parent or childs worries and improve quality of life.

Photo from Women's and Children's Health Network. (2011, November 12). Food allergy - easy read. Retrieved from http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=302&id=2473

It is better to give an epi pen than withold it. Epinephrine will not harm the child. However, if a conscious, alert, and oriented student refuses to be administered an epi pen, make sure you have called 911.

There is an iphone app for Epi pen? ( I cannot find it).

13Epi-Pen Video

Discuss how relatively harmless epi pens are.14How to Prevent a ReactionStrict avoidance of food allergensKnow mild & severe signs & symptoms of allergic reactions Read food labels prior to consumptionIf an individual is known to have severe reactions to food allergens then have an Epi-Pen prescribed by a doctor on handKnow how and when to administer an Epi-PenHave an action plan

Script Notes: In order to prevent severe allergic reactions individuals should do the following:Strictly avoid known food allergensBe able to recognize and manage allergic reactions to food early.Read food labels prior to consumption. Food labels help allergic consumers to identify offending foods or ingredients so they can more easily avoid them.Promptly administer epinephrine by autoinjector (e.g., Epi-pen) during early symptoms of anaphylaxis ("Food allergies: What," 2010).AND have an action plan to help guide food allergy management.

Photo #1 from Celiac Central. (2012, May 23). 5 tips to empower gluten-free kids. Retrieved from http://celiaccentral.wordpress.com/2012/05/23/5-tips-to-empower-gluten-free-kids/

Photo #2 from Action for Media Education (AME). (n.d.). How to read labels. Retrieved from http://www.nutritionandmedia.org/page16/page57/page57.html

15What You Need at SchoolAn Emergency Care PlanA Dietary Prescription completed by physician (for food allergies only)A Medication Administration Authorization formAn Epi-penCPR trainingVideo from U.S. Food and Drug Administration. (n.d.). Food allergies: Reducing the risks (video) [Web]. Retrieved from http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm182842.htm

Include district dietary prescription form, medication authorization form in packet

According to Ed Code, any school personnel volunteering to be trained to administer epinephrine are required to receive instruction and maintain current certification in CPR from a recognized provider (AHA, ARC)16Sample Emergency Care Plan

Sample Dietary Prescription

Medication Authorization Form

ResourcesCenter for Disease Control and Prevention1600 Clifton Rd. Atlanta, GA 30333, USA800-CDC-INFO (800-232-4636)TTY: (888) 232-6348E: cdcinfo@cdc.govhttp://www.cdc.gov/asthma/(800) 822-2762Food Allergy and Anaphylaxis Network 11781 Lee Jackson Highway, Suite 160 Fairfax, VA 220333309 8009294040 www.foodallergy.org Food Allergy Initiative 1414 Avenue of the Americas, Suite 1804 New York, NY 100192514 2122071974 www.faiusa.org National Institute of Allergy & Infectious Diseases6610 Rockledge Drive, MSC 6612Bethesda, MD 20892-6612United States of AmericaPhone: 301-402-1663Email: niaidnews@niaid.nih.govFax: 301-402-0120www.niaid.nih.govU.S. Food and Drug Administration10903 New Hampshire Avenue Silver Spring, MD 20993 Ph. 1-888-INFO-FDA (1-888-463-6332)http://www.fda.gov/

ReferencesBranum, A. M., & Lukacs, S. L. U.S. DEPARTMENT OF, National Center for Health Statistics. (2008). Food allergy among U.S. children: Trends in prevalence and hospitalizations. Retrieved from Centers for Disease Control and Prevention website: http://www.cdc.gov/nchs/data/databriefs/db10.htmCenters for Disease Control and Prevention , (2012). Food allergies in schools. Retrieved from website: http://www.cdc.gov/healthyyouth/foodallergies/Mondello, W. (2009, Oct/Nov). Food-allergic children and their emotional wellbeing. Living Without, Retrieved from http://www.livingwithout.com/issues/3_6/Emotional-State-Food-Allergic-Children-1022-1.htmlNational Center for Biotechnology Information, U.S. National Library of Medicine (2011). Diphenhydramine. Retrieved from PubMed Health website: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000704/National Institutes of Health, National Institute of Allergy and Infectious Diseases. (2010). Food allergy: An overview. Retrieved from NIH Publication website: http://www.niaid.nih.gov/topics/foodAllergy/Documents/foodallergy.pdfU.S. Food and Drug Administration, Silver Spring, MD. (2010). Food allergies: What you need to know. Retrieved from website: http://www.fda.gov/downloads/Food/ResourcesForYou/Consumers/UCM220117.pdfU.S. Food and Drug Administration. (n.d.). Food allergies: Reducing the risks (video) [Web]. Retrieved from http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm182842.htmPost Test