Anaphylaxis in Schools 3rd Edition

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Consensus Statement Understanding Anaphylaxis What is anaphylaxis? Anaphylaxis (pronounced anna-fill-axis) is a serious allergic reaction that is rapid in onset and may cause death. 1 An allergen is a substance capable of causing an allergic reaction. Upon first exposure in individuals who are predisposed to allergy, the immune system treats the allergen as something to be rejected rather than tolerated. This process is called sensitization. Re-exposure to the same allergen in the now-sensitized individual may result in an allergic reaction which, in its most severe form, is called anaphylaxis. How common is it? While the exact prevalence is unknown, it has been estimated that up to 2% of Canadians are at risk of anaphylaxis from food and insect allergy. 2 This currently represents about 700,000 Canadians. What are the signs and symptoms? Signs and symptoms of a severe allergic reaction can occur within minutes of exposure to an allergen. In rarer cases, the time frame can vary up to several hours after exposure. The ways these symptoms occur can vary from person to person and even from episode to episode in the same person. Symptoms of anaphylaxis generally include two or more of the following body systems: skin, respiratory, gastrointestinal and/or cardiovascular. However, low blood pressure alone (i.e. cardiovascular system), in the absence of other symptoms, can also represent anaphylaxis. 1,3 • Skin: hives, swelling (face, lips, tongue), itching, warmth, redness • Respiratory (breathing): coughing, wheezing, shortness of breath, chest pain or tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny, itchy nose and watery eyes, sneezing), trouble swallowing • Gastrointestinal (stomach): nausea, pain or cramps, vomiting, diarrhea • Cardiovascular (heart): paler than normal skin colour/blue colour, weak pulse, passing out, dizziness or lightheadedness, shock • Other: anxiety, sense of doom (the feeling that something bad is about to happen), headache, uterine cramps, metallic taste Because of the unpredictability of reactions, early symptoms should never be ignored, especially if the person has suffered an anaphylactic reaction in the past. It is important to note that anaphylaxis can occur without hives. 6 Anaphylaxis in Schools & Other Settings Copyright © 2005-2014 Canadian Society of Allergy and Clinical Immunology
If an allergic person expresses any concern that a reaction might be starting, the person should always be taken seriously. When a reaction begins, it is important to respond immediately, following instructions in the person’s Anaphylaxis Emergency Plan. (See Appendix D.) The cause of the reaction can be investigated later. The most dangerous symptoms of an allergic reaction involve breathing difficulties caused by swelling of the airways (including a severe asthma attack in those who have asthma) or a drop in blood pressure indicated by dizziness, lightheadedness, feeling faint or weak, or passing out. Both can lead to death if untreated. Consensus Statement What triggers anaphylaxis? Although many substances have the potential to cause anaphylaxis, the most common triggers are foods and insect stings (e.g. yellow jackets, hornets, wasps, honey bees). In Canada, the most common food allergens that cause anaphylaxis are: • Peanut • Tree nuts (almonds, Brazil nuts, cashews, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios, walnuts) • Milk • Egg • Sesame • Soy • Wheat • Seafood Fish, e.g. trout, salmon Shellfish -- Crustaceans, e.g. lobster, shrimp, crab -- Molluscs, e.g. scallops, clams, oysters, mussels • Mustard Health Canada requires these ‘priority allergens’ to always be identified on food labels by their common names. Medications and exposure to natural rubber latex can also cause potentially life-threatening allergic reactions. A less common cause of anaphylaxis is exercise, which in some individuals can be triggered by the prior ingestion of a specific food which is not normally a problem. In some cases of anaphylaxis, the cause is unknown (‘idiopathic’). Note: For regulatory purposes, Health Canada uses the following terms to describe seafood: fish (e.g. trout, salmon), shellfish (e.g. scallops, clams) and crustaceans (e.g. lobster, shrimp). Health Canada also includes sulphites (a food additive) as a priority allergen. How is a person identified as being at risk for anaphylaxis? Family doctors and emergency physicians are most often the first healthcare professionals to identify a person who has experienced an allergic reaction. They play an important role in discussing anaphylaxis management with individuals (e.g. allergen avoidance strategies), prescribing an epinephrine autoinjector, and referring them to an allergist for evaluation. People thought to be at risk of life-threatening allergic reactions should be evaluated by an allergist. Anaphylaxis in Schools & Other Settings Copyright © 2005-2014 Canadian Society of Allergy and Clinical Immunology 7
Page 1 and 2: Anaphylaxis in Schools & Other Sett
Page 3 and 4: Copyright © 2005-2014 Canadian Soc
Page 5 and 6: Table of Contents Table of Contents
Page 7 and 8: Executive Summary Executive Summary
Page 9: Consensus Statement Consensus State
Page 13 and 14: Other Factors to Consider • Prev
Page 15 and 16: 3. All individuals receiving epinep
Page 17 and 18: Avoidance Strategies Consensus Stat
Page 19 and 20: -- Stay away from areas where sting
Page 21 and 22: child/school with an epinephrine au
Page 23 and 24: Training & Communication Consensus
Page 25 and 26: References Consensus Statement 1. S
Page 27 and 28: Appendices Consensus Appendices Sta
Page 29 and 30: of position may lower their blood p
Page 31 and 32: School Anaphylaxis Plan Appendix C
Page 33 and 34: • Have the child wear medical id
Page 35 and 36: Given that anaphylaxis can be trigg
Page 37 and 38: Anaphylaxis Emergency Plan: (name)
Page 39 and 40: HOW TO USE ALLERJECT TM Practice Wi
Page 41 and 42: Think F.A.S.T. Appendix E Anaphylax
Page 43 and 44: Sample Letter from Teacher (element
Page 45 and 46: Avoidance Strategies for Specific F
Page 47 and 48: Avoidance of Peanut and Tree Nuts A
Page 49 and 50: look for ‘may contain’ warnings
Page 51 and 52: effective. 9 In the same study, res
Page 53 and 54: Teens must be able to resist peer p
Page 55 and 56: Anaphylaxis in the Workplace Append
Page 57 and 58: Manitoba Since 1995, Manitoba has b
Page 59 and 60: On January 1, 2012 the Ontario Mini
Page 61 and 62:
• A requirement that every schoo
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Idiopathic reaction: a reaction tha
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Anaphylaxis Canada Anaphylaxis Cana
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OTHER ORGANIZATIONS Appendix L Alle
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Health Canada (Food Directorate) Th
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Association of Allergists and Immun
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Anaphylaxis in Schools 3rd Edition

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