Administration of Epinephrine for Life-Threatening Allergic Reactions in School Settings

140

155

The European Academy of Allergy and Clinical Immunology (EAACI) Food Allergy and Anaphylaxis Guidelines, managing patients with food allergy (FA) in the community, intend to provide guidance to reduce the risk of accidental allergic reactions to foods in the community. This document is intended to meet the needs of early-childhood and school settings as well as providers of non-prepackaged food (e.g., restaurants, bakeries, takeaway, deli counters, and fast-food outlets) and targets the audience of individuals with FA, their families, patient organizations, the general public, policymakers, and allergists. Food allergy is the most common trigger of anaphylaxis in the community. Providing children and caregivers with comprehensive information on food allergen avoidance and prompt recognition and management of allergic reactions are of the utmost importance. Provision of adrenaline auto-injector devices and education on how and when to use these are essential components of a comprehensive management plan. Managing patients at risk of anaphylaxis raises many challenges, which are specific to the community. This includes the need to interact with third parties providing food (e.g., school teachers and restaurant staff) to avoid accidental exposure and to help individuals with FA to make safe and appropriate food choices. Education of individuals at risk and their families, their peers, school nurses and teachers as well as restaurant and other food retail staff can reduce the risk of severe/fatal reactions. Increased awareness among policymakers may improve decision-making on legislation at local and national level.

Section: Why the Community Is Importantmentioning

confidence: 99%

“…Reactions also occur in a wide variety of other community locations including restaurants, sports fields, beaches, and gymnasiums (14). Fatalities due to FA are equally likely to occur at home or in community locations such as a restaurant/takeaway (19), friend's home, school/nursery (20)(21)(22)(23)(24), camp, and work (25,26).…”

Section: Food Allergymentioning

confidence: 99%

EAACI Food Allergy and Anaphylaxis Guidelines: managing patients with food allergy in the community

Muraro¹,

Agache²,

Clark³

et al. 2014

140

155

“…Staff should be aware that allergies including food allergy reaction can present for the first time on school premises and those reactions may be severe (9). The most severe allergic reactions present as anaphylaxis (10) although severe asthma may also occur.…”

Section: How To Use the Recommendationsmentioning

confidence: 99%

The management of the allergic child at school: EAACI/GA²LEN Task Force on the allergic child at school

Muraro¹,

Clark

Beyer

et al. 2010

118

115

The management of the allergic child at school: EAACI/GA 2 LEN Task Force on the allergic child at school. Allergy 2010; 65: 681-689. AimThe aim of this Task Force document is to describe an ideal model of care centred on the allergic children at school (Box 1), which is appropriate for use by all stakeholders. Despite a substantial body of literature on allergy management, the evidence available on how to best care for such children at school is inadequate. Furthermore, legislation, education, facilities and health care practices vary between countries. We have presented the information in such a way that individuals will be able to adopt the advice within the context of their local or national facilities to improve care for all children with allergy at school. Where local facilities are not able to support such an approach, this document may be used as a reference to inform national policy. How to use the recommendationsOur key recommendations are presented as 'action points' for schools. Some of these are generic and apply to all allergic children at school (Box 2), and others are presented as disease-specific action points. To facilitate the implementation of these recommendations, specific responsibilities for each stakeholder have been identified (Box 3). A comprehensive protective package for children with allergy at school can therefore be provided within this framework. These recommendations are based upon the available evidence and expert opinion.Allergy at school manifests in multiple ways: eczema, bronchial asthma (hereafter asthma), rhinitis and/or conjunctivitis, food allergy and less commonly venom allergy and AbstractAllergy affects at least one-quarter of European schoolchildren, it reduces quality of life and may impair school performance; there is a risk of severe reactions and, in rare cases, death. Allergy is a multi-system disorder, and children often have several co-existing diseases, i.e. allergic rhinitis, asthma, eczema and food allergy. Severe food allergy reactions may occur for the first time at school, and overall 20% of food allergy reactions occur in schools. Up to two-thirds of schools have at least one child at risk of anaphylaxis but many are poorly prepared. A cooperative partnership between doctors, community and school nurses, school staff, parents and the child is necessary to ensure allergic children are protected. Schools and doctors should adopt a comprehensive approach to allergy training, ensuring that all staff can prevent, recognize and initiate treatment of allergic reactions. urticaria. Children may present with various symptoms such as wheezing and dyspnoea related to asthma, which may be triggered by allergen contact, airway infection or physical exercise. Children with allergic rhinitis (or rhinoconjunctivitis) might have a runny nose, sneeze frequently, mouthbreath persistently and have itchy eyes in spring and/or summer, or they may have all-year-round symptoms. Indoor pollutants can be particularly harmful for students already affected by allergies or asthma...

“…Auto-injectors Seven studies identified that many patients did not carry an auto-injector or did not have one available at the time of a reaction (29,34,50,53,57,67,68). One study suggested that hesitation in using or forgetting to carry the device may in part explain these behaviors (19).…”

Section: Theme 2: Anaphylaxis Managementmentioning

confidence: 99%

“…Lack of AMPs in schools was also identified as a problem in five studies (28,32,39,57,63). Furthermore, many AMPs did not provide epinephrine auto-injector administration instructions and were missing essential components such as critical emergency contact and health history information (64).…”

Section: Anaphylaxis Management Plansmentioning

confidence: 99%

Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature

Kastner

Harada

Waserman

2010

116

To cite this article: Kastner M, Harada L, Waserman S. Gaps in anaphylaxis management at the level of physicians, patients, and the community: a systematic review of the literature. Allergy 2010; 65: 435–444.AbstractDiagnosis and management of anaphylaxis can be a challenge because reactions are often unexpected and progress quickly. The focus of anaphylaxis management has mostly been on the acute episode, with little attention given to the long‐term management of patients at risk. This is compounded by conflicting information in current guidelines and a general lack of agreement among clinicians about which management strategies are the most appropriate. We systematically reviewed the literature to identify and summarize studies that investigated gaps in anaphylaxis management. Our search included MEDLINE, EMBASE, CINAHL, and Evidence‐Based Medicine Reviews. Studies were included if they addressed an outcome describing gaps in anaphylaxis knowledge, education, anaphylaxis management, and quality of life (QOL). Populations of interest were health care professionals involved in the care of patients at risk for anaphylaxis, and patients of any age, their parents, caregivers, and teachers in primary care, hospital or community settings. Of 5014 citations that were identified, the final 59 studies (selected from 75 full‐text articles) met the inclusion criteria. Two hundred and two gaps were identified and classified according to major themes: gaps in knowledge and anaphylaxis management (physicians and patients); gaps in follow‐up care (physicians); and QOL of patients and caregivers. Findings from this systematic review revealed gaps in anaphylaxis management at the level of physicians, patients, and the community. Findings will be used to provide a basis for developing interventional strategies to help address these deficiencies.