Anaphylaxis is a severe allergic reaction that can lead to rapid death if left untreated. Many Canadians suffer from extreme life-threatening allergies to certain foods, medications, insect stings or non-food materials, such as latex. For them, exposure to even a minute amount of the substance to which they are allergic can trigger an anaphylactic reaction. Although peanuts and peanut products are the most common foods to cause anaphylaxis, fish, eggs, sulphites, milk, sesame seeds or any other food can cause this dangerous condition.
Anaphylactic reactions occur when the body’s sensitized immune system overreacts in response to the presence of a particular allergen. Anaphylaxis affects multiple body systems, including skin, upper and lower respiratory, gastro-intestinal and cardiovascular.
The recommended emergency treatment for a student suffering an anaphylactic reaction is the administration of epinephrine (adrenaline) by an auto-injector (i.e. EpiPen or by an Anakit). The person affected must then be rushed to hospital to receive further medical attention, even if the symptoms decrease with the administration of the epinephrine.
The greatest risk of exposure is in new situations or when normal daily routines are interrupted, such as birthday parties or school trips.
The Toronto Waldorf School’s allergy plan has three components:
- Information and Awareness;
- Avoidance; and
- Emergency Response.
1. Information and Awareness
Ensuring the safety of anaphylactic students in a school setting depends on the co-operation of the entire school community. To minimize risk of exposure, and to ensure rapid response to an emergency, parents, students and school personnel should all understand and fulfill their responsibilities.
- The Board will be made aware of the legal responsibilities towards the children with life-threatening allergies and ensure there is a process for the annual review of the policy at the school.
- Reviews and updates the policy annually.
- Works closely with the parents of an anaphylactic student;
- Makes contact with parents of an anaphylactic student and lead each year to gather or update medical information related to the condition including: causal factors, severity of allergy, past incidents of anaphylactic reactions and other health considerations.
- Prepares and maintains a student file including consent forms, waiver, physician’s instructions and alert sheets with annual updated photograph for each anaphylactic student.
- Ensures the Alert sheets with updated photographs are posted in the child’s classroom, front office, After School Program areas and in the faculty room in a prominent location.
- Ensures parents provide two auto-injector kits to the receptionist by the first day of school. At least two auto-injectors are suggested, one located with the student and one located in the school office in a known accessible location.
- Notifies all appropriate school personnel (faculty and staff) of medical alert concern and of established policy.
- Reviews procedures with entire staff each year in September.
- Develops and maintains an emergency plan that is consistent with the school’s anaphylaxis policy.
- Arranges for staff training sessions for all school personnel on how to recognize and treat anaphylactic reaction, on school procedures to protect anaphylactic students from exposure, and on school protocol for responding to emergencies. This session should also include training in the emergency administration of the auto-injector. Training should take into consideration the age, maturity and responsibility-level of anaphylactic students.
- Works with the parent community to increase awareness of anaphylaxis, its avoidance and its treatment.
- Ensures that student teachers are fully aware of this policy and the emergency response procedure.
- Ensures that alert sheets are posted in the child’s classroom and in the faculty room in a prominent location.
- Discusses anaphylaxis in class, in age-appropriate terms.
- Conducts food safety discussions with all students at beginning of year and at regular intervals throughout the year while exercising sensitivity regarding the impact on the relevant students need for privacy.
- Encourages students not to share lunches or trade snacks.
- Establishes procedures to ensure that an anaphylactic student eats only what he/she brings from home or other foods determined to be safe.
- Reinforces with all students the importance of hand washing before and after eating.
- Facilitates communication with other parents.
- Leaves information in an organized, prominent and accessible format for substitute teachers.
- Ensures student teachers and others working with an anaphylaxis child is aware of the child’s needs, the policy.
Parents of an Anaphylactic Student
- Inform the school of their child’s allergies.
- Provide the school with two up-to-date auto-injection kits, clearly labelled with the child’s name and prescription details
- Provide their child with safe foods.
- Review the school prevention plan with school personnel and provides in-service support and information as requested.
The following are all ideal and we recognize the need to implement each in the context of what is age-appropriate for the child:
- Provide student with a body pouch or fanny pack for carrying at least one auto-injector at all times on their body.
- Provide a MedicAlert bracelet for their child.
- Teach their child:
(a) About their allergen and the substances that trigger it;
(b) To recognize the first symptoms of an anaphylactic reaction;
(c) To know where medication is kept, and who can inject it;
(d) To communicate clearly when he or she feels that a reaction is starting;
(e) To carry his/her own auto-injector in a body pouch or fanny pack;
(f) Not to share snacks, lunches or drinks and to politely explain why he/she is not sharing;
(g) To understand the importance of hand-washing;
(h) To cope with teasing and being left out; and
(i) To take as much responsibility as possible for his/her own safety.
[Recognizing the age-related limitations for our youngest students.]
- Has an age appropriate understanding of his/her allergy and its triggers.
- Takes as much responsibility as possible for avoiding allergens.
- Takes responsibility for checking food labels and monitoring food intake.
- Washes hands before and after eating.
- Learns to recognize symptoms of an anaphylactic reaction.
- Promptly informs an adult, as soon as accidental exposure occurs or symptoms appear.
- Keeps an auto-injector on his/her person at all times.
- Will respond co-operatively to requests from the school to eliminate allergens from packed lunches and snacks, and any other foods sent to the classroom.
- Inform themselves and participate in parent information sessions as appropriate.
- Encourages their own students to respect an anaphylactic student and follow school prevention plans.
[Recognizing the age-related limitations for our youngest students.]
- Learn to recognize symptoms of anaphylactic reactions.
- Avoid sharing food, especially with anaphylactic students.
- Follow school rules about keeping allergens out of a classroom and washing hands.
- Refrain from bullying or teasing a student with a food allergy.
- The school will adopt a policy whereby the class environment will be adapted to accommodate anaphylactic students. The school cannot assume responsibility for providing a completely allergen-free environment.
- Anaphylactic students must learn to avoid specific triggers. While the key responsibility lies with anaphylactic individuals and their family, in the case of an anaphylactic student, the school community must also be aware. The approach is to regularly educate the parent community, solicit the co-operation of families, and to set in place procedures that are designed to safeguard the anaphylactic student.
- The school will provide allergen-free areas (most commonly the home classroom of the student with the allergy), using a co-operative approach with students and parents.
- Safe eating area procedures will be established, including cleaning and hand-washing procedures.
- Anaphylactic students will be required to eat only food prepared at home or approved for consumption.
- An anaphylactic child will be encouraged to take precautions, such as placing food on a placemat, or napkin rather than in direct contact with a table or desk, taking one item at a time out of the lunch bag to prevent other children from touching the food and packing up and leaving the lunch with the teacher, if the child needs to leave the room during lunchtime.
- Education about the allergies hidden in non-food materials will be provided (i.e. play materials, play dough, soap, counting aids, science projects, special seasonal activities, such as gardening).
- An anaphylactic child will be encouraged not to share food, utensils, containers or towels; not to leave food unattended; and not to share musical instruments that go in the mouth.
- School festivals involving food should avoid products containing allergens wherever possible.
- Anaphylactic children should not be involved in garbage disposal, yard clean-ups or other activities that could bring them into contact with food wrappers, containers or debris.
- Food is often stored in lockers and desks. Allowing the anaphylactic child to keep the same desk all year may help prevent accidental contamination.
3. Emergency Response Plan
An anaphylactic reaction can begin within seconds of exposure or after several hours. Any combination of the following symptoms may signal the onset of a reaction.
|| Throat tightness or closing
| Itching (on any part of the body)
|| Difficulty breathing
| Swelling (of any body part, especially eyes, lips, face, tongue)
|| Difficulty swallowing
| Red watery eyes
|| Sense of doom
| Runny nose
| Fainting or loss of consciousness
|| Change of colour
| Stomach cramps
|| Change of voice
*Hives may be entirely absent, especially in severe or near fatal cases of anaphylaxis.
Symptoms do not always occur in the same order, even in the same individuals. The time from onset of first symptoms to death can be as little as a few minutes if reaction is not treated.
Anaphylactic children usually know when a reaction is taking place. School personnel should be encouraged to listen to the child. If he or she complains of any symptoms that could signal the onset of a reaction, staff should not hesitate to implement the emergency response steps.
THERE IS NO DANGER OF REACTING TOO QUICKLY AND POTENTIAL DANGER IN REACTING TOO SLOWLY.
Emergency Response Steps
- Keep the child calm.
- Administer EpiPen immediately if the child displays any of the symptoms. The EpiPen gives you 15 minutes to seek medical attention. If you are with someone else, have them call 911. If not, administer the EpiPen first and then call 911.
- Pull off grey safety cap.
- Grip with a tight fist and firmly jab/press black tip into outer thigh. Keep pressed against thigh and hold for count of 10. Do not place thumb at end of Epi-Pen. Listen for “click” and check to see if the needle is exposed when it is pulled out of the thigh. If so, it has worked. If there is no exposed needle, administer the 2nd pen right away.
- Call 911. Advise dispatcher that the child is having an anaphylactic reaction.
- Treat with second dose of epinephrine (Epi-Pen) if necessary in 10 to 15 minutes if an ambulance has not arrived and the symptoms have reappeared.
- Advise the Front Office of the situation, including the need to call the parents ASAP.
- Follow through in transporting the child to hospital immediately even if symptoms subside.
- Remain in the emergency room for four to six hours for observation.
*Note: Used Epi-Pen needs to be discarded in a needle-proof container to minimize any chance of injury.