1. Mesquite ISD Allergy
Awareness Training
Beth A. Dittman, RN, MSN
Director, Health Services

2. Definitions
 Allergy: A potentially serious immune mediated
response to contact with a specific allergen such
as food, insect venom, medication, or latex.
 Food Allergy: A potentially serious immune
mediated response that develops after ingesting
or coming into contact with specific foods or
food additives.
 Anaphylaxis: A serious allergic reaction that is
rapid in onset and may cause death

3. Most Common Food Allergens
Eight foods account for more than 90
percent of allergic reactions in affected
individuals:
•Milk •Fish
•Eggs •Shellfish
•Peanuts •Soy
•Tree Nuts •Wheat

4. Signs and Symptoms
 Life threatening allergic reactions may be caused
by any of the following:
• Food, generally a specific protein in the food
• Insect venom such as bee, wasp, or ant stings
• Medications
• Latex
 Onset of symptoms may occur within seconds or
up to 2 hours after exposure
 In 1/3 of reported reactions, individuals
experience biphasic reactions where the early
phase of symptoms is followed by a delayed or
late phase of symptoms

5. Signs and Symptoms of Anaphylaxis
Mouth Tingling, itching, swelling of the
tongue, lips or mouth; blue-grey
color of the lips
Throat Tightening of throat; tickling feeling
in the back of throat; hoarseness or
change in voice
Nose/Eyes/Ears Runny, itchy nose; redness and/or
swelling of eyes; throbbing in ears

6. Signs and Symptoms of Anaphylaxis
Lung Shortness of breath; repetitive shallow
cough; wheezing
Stomach Nausea; vomiting; diarrhea; abdominal
cramps
Skin Itchy rash; Hives; swelling of face or
extremities; facial flushing
Heart Thin weak pulse; rapid pulse;
palpitations, fainting; blueness of lips,
face or nail beds; paleness

7. Beware of Potential Hazards
 Avoid using food for instructional purposes
– Trail Mix, M&M candies, Popcorn Mixes
 Read food labels to identify allergens in the
ingredients
 Communicate with parents to promote
awareness
– Field Trips
– Special Group Events

8. Food Allergy Management Plan
In accordance with state guidelines, a food allergy
management plan (FAMP) has been developed to:
 Identify students at-risk for anaphylaxis
 Implement emergency care plans, individualized care plans,
and 504 plans for students at risk for anaphylaxis
 Reduce the risk of exposure to identified allergens within the
school setting
 Educate staff on anaphylaxis and emergency response to
anaphylaxis reactions
 Review policies and procedures after an anaphylactic event
occurs
 Each campus should have a food allergy management team
(FAMT) to assist in implementation of the plan

9. PLANS: FAAP/EAP; IHP; 504
A food allergy action plan/emergency action plan
(FAAP/EAP) is developed by the student’s
primary care provider stating steps to take in
case of exposure or onset of symptoms.
An individualized health plan is developed by the
school nurse (RN) to assess the student, identify
potential problems and outcomes, establish
interventions, and evaluate outcomes.
A 504 is developed by the campus 504 committee
to protect the student from possible
discrimination related to the student’s allergy.

10. General Strategies
 Discourage labeling or discussing food-allergic students in
the presence of others
 Encourage at risk students to totally avoid food allergens
• Making wise choices and reading labels
 Be prepared in case a reaction occurs
• Know how to access epinephrine for the student
• Adhere to universal precautions to avoid accidental exposure
 Increase awareness through education of staff as well as
classmates and their families
 Avoid use of food products as displays in hallways and
other common areas
 Careful food preparation and clean up to avoid cross
contamination
 Discourage and report bullying

11. Risk Reduction Strategies
In the Classroom:
 Systematically alert substitutes to the presence of students
with allergy related plans (FAAP/EAP/IHP/504)
 Conduct non-identifying, age appropriate training on life
threatening allergies for the class
 Distribute letters to parents of students enrolled in class
citing the need to avoid certain foods in the classroom
without identifying the affected student
 Discourage sharing/trading of food items between
students
 Avoid use of food items for classroom projects/activities
and monitor items provided for classroom parties
 Notify parents of the affected student of classroom events,
activities and celebrations that involve food
 Encourage students to wash hands with soap and water
before and after eating-sanitizing gels do not remove food
allergens from the hands

12. Risk Reduction Strategies
In the Cafeteria:
 Be aware of students with food allergies
 If possible, share ingredient lists with students and parents
 Train food service personnel on food label reading and safe
handling of food as well as safe meal substitutions
 Educate cafeteria monitors about managing food allergies
including cross contamination
 Designate an allergen safe dining area for at risk students
 Single-use disposable wipes such as Clorox Wipes®
should be used to clean surfaces
 Discourage sharing/trading of food, drinks, straws, or
utensils
 Encourage hand washing before and after eating

13. Risk Reduction Strategies
For Bus Transportation:
 Be aware of students with food allergies at risk for
anaphylaxis
 Meet with the campus food allergy management team
 Consider seating students with food allergies at risk for
anaphylaxis near the front of the bus
 Discourage eating and sharing food on the bus
 Be aware of and report incidents of bullying
 Provide bus drivers and aides with training on symptoms
of and response to allergic reaction
 Reinforce emergency communications systems/plan for
bus drivers

14. Risk Reduction Strategies
For Field Trips/Other Events:
 Communicate FAAP/EAP to staff
 Collaborate with school nurse prior to the event to
facilitate review of emergency procedures and
communications as well as availability of emergency
medications during the event
 Select locations that are appropriate for students with
food allergies at risk for anaphylaxis, i.e. a trip to a local
peanut farm should not be scheduled for a class with a
peanut-allergic student
 Encourage parents of food allergic students to attend field
trips noting that parent attendance is not required for
student participation
 Notify parents if food will be served at the event or on the
field trip

15. When A Reaction Occurs
 Remain calm
 Contact the school nurse/campus office
 Follow the physician’s instructions on the
FAAP/EAP
 Do not hesitate to administer the student’s
Epipen® when available
 Call 911, even if the medication has been
administered and the student appears to be
improving
 Call the parent/guardian/emergency contact
 Dispose of the Epipen® in a sharps container
using universal precautions

16. Epinephrine Basics
 Epinephrine is the first-line treatment for anaphylaxis
 It is prescribed for emergency use as an auto-injector
device that is easy to use
 Epinephrine auto-injectors should be stored in an
unlocked area for ease of access that is secure from other
students
 When district guidelines are met, students may be
allowed to carry their epinephrine on their person
during the school day
 When epinephrine is administered, 911 should be called
in case the student experiences a biphasic reaction

17. Six Rights of Medication
Administration
 Right Student
 Right Medication
 Right Dosage
 Right Route
 Right Time
 Right Documentation (includes a description of
the reaction and the treatment given)
 Whenever Epinephrine is given, call 911

18. How to Use an EpiPen®
 DIRECTIONS FOR USE
 Remove auto-injector from carrier tube prior to use
 Never put thumb, fingers or hand over orange tip
 Never press or push orange tip with thumb, fingers or
hand
 The needle comes out of the orange tip
 Do not remove blue safety release until ready to use
 Do not use if solution is discolored
 Do not place patient insert or any other foreign objects
in carrier with auto-injector as this may prevent you
from removing the auto-injector for use

19. Removing Auto Injector from the
Carrier Tube
 Flip open the yellow cap of the EpiPen® or the
green cap of the EpiPen Jr ® carrier tube
 Tip the tube and slide the EpiPen ® out

20. To Administer the Auto-Injector
 Grasp the unit with the orange tip
pointing downward
 Form a fist around the unit
 Hold orange tip near outer thigh
DO NOT INJECT INTO
BUTTOCKS

21. Administration of Auto-Injector
 Swing and firmly press at a 90° angle against
outer thigh until the unit clicks
* The auto-injector is designed to go through clothing*
Hold firmly against thigh for about 10 seconds
to complete drug delivery

22. Completing the Process
 Remove the unit from the thigh noting that the
orange needle cover extends to cover the needle
 Massage the injection site for 10 seconds
 Call 911 or activate Emergency Medical Services
(EMS) immediately
 Give the used auto-injector to EMS when they
arrive
 Note that the correct dose is given when the orange
needle tip is extended and the window is obscured

23. More information is available at:
http://www.foodallergy.org/section/for-school-pr
The school nurse will contact you with
further information and training if you
work with a student at risk for anaphylaxis