Anaphylaxis in Schools 3rd Edition
Anaphylaxis in Schools 3rd Edition
Anaphylaxis in Schools 3rd Edition
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Consensus Statement<br />
An <strong>in</strong>dividual is diagnosed as be<strong>in</strong>g at risk by obta<strong>in</strong><strong>in</strong>g a detailed personal history and confirmation of<br />
an allergy through appropriate <strong>in</strong>vestigations such as sk<strong>in</strong> and/or blood tests. Once a diagnosis is made,<br />
a person should do the follow<strong>in</strong>g: 4,5<br />
• Avoid the allergenic substance;<br />
• Carry an ep<strong>in</strong>ephr<strong>in</strong>e auto-<strong>in</strong>jector at all times;<br />
• Wear medical identification such as MedicAlert ® (available as bracelets, bands and necklaces);<br />
• Have a written <strong>Anaphylaxis</strong> Emergency Plan which describes the signs and symptoms of<br />
anaphylaxis and what to do <strong>in</strong> case of a reaction (See Appendix D.);<br />
• Receive <strong>in</strong>struction on a regular basis from their healthcare professional on when and how to use<br />
ep<strong>in</strong>ephr<strong>in</strong>e auto-<strong>in</strong>jectors. Local pharmacists can also provide <strong>in</strong>formation on anaphylaxis and the<br />
use of ep<strong>in</strong>ephr<strong>in</strong>e auto-<strong>in</strong>jectors.<br />
Factors that may <strong>in</strong>crease the risk of a severe anaphylactic reaction<br />
1. <strong>Anaphylaxis</strong> and asthma<br />
People with asthma who are also diagnosed with life-threaten<strong>in</strong>g allergies are more susceptible to<br />
severe breath<strong>in</strong>g problems when experienc<strong>in</strong>g an anaphylactic reaction. It is extremely important for<br />
asthmatic <strong>in</strong>dividuals to keep their asthma well controlled. In cases where an anaphylactic reaction<br />
is suspected but there is uncerta<strong>in</strong>ty whether or not the person is experienc<strong>in</strong>g an asthma attack,<br />
ep<strong>in</strong>ephr<strong>in</strong>e should be used first. Ep<strong>in</strong>ephr<strong>in</strong>e can be used to treat life-threaten<strong>in</strong>g asthma attacks as<br />
well as anaphylactic reactions. People with asthma who are at risk of anaphylaxis should carry their<br />
asthma medications (e.g. puffers/<strong>in</strong>halers) with their ep<strong>in</strong>ephr<strong>in</strong>e auto-<strong>in</strong>jector. Both anaphylaxis and<br />
asthma should be listed on their medical identification (e.g. MedicAlert ® bracelet).<br />
2. Under-utilization and delay <strong>in</strong> the use of ep<strong>in</strong>ephr<strong>in</strong>e<br />
Ep<strong>in</strong>ephr<strong>in</strong>e is the drug of choice to treat an anaphylactic reaction and needs to be given early <strong>in</strong><br />
the course of a reaction. It is extremely important that all <strong>in</strong>dividuals at risk of anaphylaxis, parents/<br />
guardians of children at risk, teachers, and caregivers know the signs and symptoms of anaphylaxis<br />
and the correct use of emergency medication (i.e. ep<strong>in</strong>ephr<strong>in</strong>e auto-<strong>in</strong>jector). In studies of <strong>in</strong>dividuals<br />
who have died as a result of anaphylaxis, ep<strong>in</strong>ephr<strong>in</strong>e was underused, not used at all, or adm<strong>in</strong>istration<br />
was delayed. 6-9<br />
There are no contra<strong>in</strong>dications to us<strong>in</strong>g ep<strong>in</strong>ephr<strong>in</strong>e for a life-threaten<strong>in</strong>g allergic reaction. This means<br />
that <strong>in</strong> normally healthy <strong>in</strong>dividuals, ep<strong>in</strong>ephr<strong>in</strong>e will not cause harm if given unnecessarily. Possible<br />
side effects from ep<strong>in</strong>ephr<strong>in</strong>e can <strong>in</strong>clude: rapid heart rate, pallor (paleness), dizz<strong>in</strong>ess, weakness,<br />
tremors and headache. These side effects are generally mild and subside with<strong>in</strong> a few m<strong>in</strong>utes.<br />
3. Underly<strong>in</strong>g cardiac diseases<br />
People with heart disease or high blood pressure should speak to their physician about their cardiac<br />
medications and their need for ep<strong>in</strong>ephr<strong>in</strong>e. Some medications (e.g. beta-blockers, ACE <strong>in</strong>hibitors) may<br />
<strong>in</strong>terfere with the action of ep<strong>in</strong>ephr<strong>in</strong>e and worsen the allergic reaction. (See Appendix K.)<br />
8<br />
<strong>Anaphylaxis</strong> <strong>in</strong> <strong>Schools</strong> & Other Sett<strong>in</strong>gs<br />
Copyright © 2005-2014 Canadian Society of Allergy and Cl<strong>in</strong>ical Immunology