Written by Michael Pistiner, MD, MMSc
The pillars must be implemented at all times
PREVENTION: A.C.T. to Prevent Allergic Reactions
Avoid Allergen: Oral ingestion is the most serious and common way to have an allergic reaction to food. Before eating, read labels to avoid any allergen. Ingredients change without notice so all labels should be read every time a new package is opened. People need to learn labeling laws and how they relate to the child’s allergens. Advisory statements like produced in a factory, etc., should be avoided for the specific food allergens unless otherwise noted by the healthcare provider. Labels of skin products, supplements and pet food should also be read.
Healthy skin does a good job keeping allergens out of our body. Getting allergens on skin can cause local rash and hives. Keep in mind that children and even grown-ups frequently put their hands in their mouths, eyes, and nose so more severe reactions can easily occur.
The smell of a food alone does not cause an allergic reaction. Inhaling cooking vapors, dusts, crushed or powdered forms of allergen has been reported by some to cause a reaction. These reactions are usually mild, but there are people that have reported having severe reactions.
Cross-contact occurs when a food allergen comes in contact with food or an item not meant to contain the allergen. Exposure to an allergen by cross contact is a common cause of allergic reactions. It can occur from contact with surfaces, other foods, and with transfer of saliva. Allergens can withstand heating and drying and oral exposure to small amounts of allergen is enough to result in anaphylaxis. Saliva from a person or a pet can contain allergens and therefore can be a source of cross contact. Sharing of anything that goes in the mouth can be a source. Preventing cross contact with cleaning is important. Soap and water, as well as hand wipes work to clean hands of allergens while hand sanitizing gels do not work. Commercial cleaners, commercial wipes and soap and water work to clean tabletops.
Communicate: The child and all caregivers need to know about the allergy and know which allergens need to be avoided. Consider the use of medical alert jewelry. Always have a way to reach emergency services, 911.
Teach: Educate any caregivers that are responsible for the child in avoidance strategies and emergency preparedness. Include kids in developmentally appropriate self-management skills. Anyone responsible for serving or preparing their food must know how to read a label and how to prevent cross-contact.
EMERGENCY PREPAREDNESS: Be Prepared to R.E.Act.
(School staff see “Anaphylaxis: What School Staff Need to Know” for school specific R.E.Act.)
Recognize anaphylaxis: Anaphylaxis is a severe and life threatening allergic reaction. It can start with mild symptoms and progress quickly. The longer this reaction goes without treatment the more dangerous it becomes. Those responsible for the care of the child will need to know which symptoms suggest a severe allergic reaction and when to use an epinephrine auto-injector. An anaphylaxis emergency care plans should be available to help serve as a guide. These emergency care plans are filled out for the specific child by their healthcare provider.
Give Epinephrine: Epinephrine is the treatment of choice for anaphylaxis. This medication, a form of adrenaline, works fast and is safe. Doctors prescribe epinephrine auto-injectors to people with allergies that can be severe. This life saving medicine should be close by at all times and someone must know when and how to use it. If available follow the anaphylaxis emergency care plan. Two doses should be available as some children need a second dose and sometimes the first dose misfires. Use a training device to learn how to give the specific auto-injector prescribed to the child.
Activate emergency response: If someone has a severe allergic reaction they need to go to the emergency department in an ambulance immediately. Someone needs to call 911 or local emergency services and tell them that a child is experiencing an allergic emergency and might need more epinephrine.
The above is intended to serve as a guide to assist in, not replace, training provided by the school nurse or designee, parents, or healthcare provider.
REFERENCES:
BASICS:
Pistiner, M., LeBovidge J., Bantock, L., James, L., and Harada,L. Anaphylaxis Canada. Living Confidently With Food Allergy Handbook. Anaphylaxis Canada (2013).
National Institute of Allergy and Infectious Disease (NIAID)-Sponsored Expert Panel. “Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel.”The Journal of Allergy and Clinical Immunology 126.6 (2010): S1-S58.
PREVENTION:
Kim, J.S. and Sicherer, S.H. “Living with Food Allergy: Allergen Avoidance.” Pediatric Clinics of North America 58.2 (2011): 459-470.
Hefle, S.L. et al. “Consumer attitudes and risks associated with packaged foods having advisory labeling regarding the presence of peanuts.” The Journal of Allergy and Clinical Immunology 120.1 (2007): 171-176.
Wainstein, B.K. et al. “Combining skin prick, immediate skin application and specific-IgE testing in the diagnosis of peanut allergy in children.” Pediatric Allergy and Immunology 18 (2007): 231–239.
Simonte, S.J. et al. “Relevance of casual contact with peanut butter in children with peanut allergy.” The Journal of Allergy and Clinical Immunology 112.1 (2003): 180-182.
Tulve, N. et al.“Frequency of mouthing behavior in young children.” Journal of Exposure Analysis and Environmental Epidemiology 12 (2002): 259–264.
Nicas, M., and Best, D.J. “A study quantifying the hand-to-face contact rate and its potential application to predicting respiratory tract infection.” Journal of Occupational Environmental Hygiene 5.6 (2008): 347-52.
Roberts, G., Golder, N. and Lack, G. “Bronchial challenges with aerosolized food in asthmatic, food-allergic children.” Allergy 57.8 (2002): 713-7.
Maloney, J.M., Chapman, M.D., and Sicherer, S.H. “Peanut allergen exposure through saliva: Assessment and interventions to reduce exposure.” The Journal of Allergy and Clinical Immunology 118.3 (2006): 719-724.
Perry, T.T. et al. “Distribution of peanut allergen in the environment.” Journal of Allergy and Clinical Immunology 113.5 (2004): 973-6.
EMERGENCY PREPAREDNESS:
National Institute of Allergy and Infectious Disease (NIAID)-Sponsored Expert Panel. “Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel.”The Journal of Allergy and Clinical Immunology 126.6 (2010): S1-S58.
Sampson, H.A. et. al. “Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium.” The Journal of Allergy and Clinical Immunology 117.2 (2006): 391-397.
