Managing Severe Allergies in School
Managing severe allergies in schools involves creating a safe and supportive environment for students with allergies. While some parents/guardians or school staff would like to make schools completely “allergen free”, that is not a reasonable expectation because it is difficult to manage everything that comes into the school building. Rather, it is more reasonable to create “allergy aware” school buildings providing education about common allergens, employing prevention strategies to mitigate allergic reactions, and be trained and prepared to manage an allergic reaction and anaphylaxis.
What is a Severe Allergic Reaction/Anaphylaxis?
Food allergies impact an estimated 8% of US children. This equates to about 1 in 13 school-age children. Food allergies (or other allergies) occur when the body has an immune response to the allergen. Typically, the body’s immune system protects the body from germs that cause illness and disease; however, in people with allergies, the immune system mistakes the allergen as harmful and deploys its attack mechanisms. The body’s immune response can be severe and life threatening (i.e., an anaphylactic reaction). CDC Healthy Schools: Food Allergies
Anaphylaxis is a severe, potentially life-threatening allergic reaction that affects multiple organs of the body. It can be triggered by a variety of allergens, including food, medications, insect stings, and latex. The reaction usually starts within minutes up to two hours after exposure to the allergen. Anaphylaxis can affect the skin, respiratory, cardiovascular, gastrointestinal, and neurological systems of the body. Anaphylaxis occurs because a flood of chemicals released by the immune system, including histamines and leukotrienes, which can cause a sudden drop in blood pressure and narrowing of the airways. Asthma & Allergy Network: What is Anaphylaxis
Statutory Requirements
Minnesota Statute 121A.2205 requires public schools and encourages non-public schools to develop and implement an individualized written health plan for a student who is prescribed epinephrine auto-injectors. The written plan must:
- Enable the student to possess an epinephrine auto-injector; or
- If parent and prescribing medical professional determines the student is unable to possess the epinephrine auto-injector, have immediate access to auto-injector in close proximity during the instructional day.
- Designate the school staff responsible for implementing the student’s health plan, including recognizing anaphylaxis and administering epinephrine via auto-injector.
- The school board of the school district must define instructional day for the purpose of this law.
What is an Allergy Emergency Action Plan?
An allergy emergency action plan is a detailed document that outlines the steps to be taken in case a person experiences an allergic reaction. For many students who are prescribed an epinephrine auto injector for emergency use, their health care provider will create this plan.
Key components of an allergy action plan include:
- Medical information such as a list of the specific allergens that trigger reactions (e.g., peanuts, tree nuts, milk, eggs, insect stings).
- Symptoms of an allergic reaction (e.g., hives, swelling, difficulty breathing, swelling of the face or throat).
- Note: Past reactions do not predict future reactions; therefore, the action plan should include what type of reactions are possible, not only what reactions the individual has had in the past.
- Medication information (i.e., name and dosage of medications prescribed to treat an allergic reaction).
- Clear step by step instructions on how and when to respond to an allergic reaction, including mild, moderate, or severe reactions.
- Instructions to follow after administering epinephrine, including calling 911, contacting parents, and monitoring the student until emergency services personnel arrive.
- Emergency contact information.
- Health care provider information in case there are any questions the school nurse needs to clarify.
Nurse Care Planning in Schools provides additional information about emergency care plans/emergency action plans.
Self-Carry versus Self-Management
Self-carry and self-management are two important concepts in the context of managing allergies, particularly in the school setting. While they are related, they refer to different levels of responsibility and independence in handling allergy management.
Self-carry refers to allowing the student to carry their own allergy medication (i.e., epinephrine auto-injector) on their person at all times. This practice ensures the student has immediate access to their emergency medication in case of an allergic reaction.
MN Statute 121A.2205 authorizes students to possess (i.e., self-carry) their epinephrine auto-injector if the parent and prescribing medical professional determine the student is able to possess it.
Self-management refers to the broader concept where a student takes full responsibility for managing their allergies, including understanding their allergy triggers, avoiding allergens, recognizing symptoms of an allergic reaction, and taking appropriate action to an allergic reaction without needing assistance (i.e., administering their own medication).
Students must be confident and competent in managing their allergies independently. Assessments by the parents/guardians, healthcare provider, and school nurse are needed to ensure the student is ready for the level of responsibility that self-management involves. Medication Procedures provides additional guidance related to self-carry and self-administration of emergency medications.
If a student self-manages their allergies, it is still important to create a support system for the student. This might mean that the student takes primary responsibility, but the school provides a supportive environment in the school nurse, health services staff, and informed teachers and staff can provide backup if needed.
Special Diet Statements
Some students with food allergies may need a dietary accommodation to participate in school lunch or breakfast. The Minnesota Department of Education, Food and Nutrition program operates this program statewide which is guided by the U.S. Department of Agriculture (USDA). School nurses and food and nutrition staff work closely to meet the student need while staying in compliance with federal regulations. The Special Diet Statement must be completed by a license physician, physician assistant or certified nurse practitioner. It only needs to be completed once unless there are new dietary restrictions or changes. Those students who only require lactose-reduced milk ONLY will only need parent/guardian authorization. Questions can be directed to mde.fns@state.mn.us.
Resources
Severe Allergy Resources for School Nurses: Emergency Care Plans, Training Tools & Resources document is not an exhaustive list; however, represents reputable resources for a School Nurse to utilize in his/her/their practice. These resources may be used in care planning for students, to strengthen competency for a nurse, or may be used to train other people performing these cares.
CDC Food Allergies in Schools Toolkit
Stock supply of epinephrine auto-injectors for life threatening allergies in schools is covered in Types of Medications.