PROCEDURE #7109
MINNESOTA STATE ACADEMIES
FARIBAULT, MINNESOTA
SPECIALIZED SERVICES
HEALTH
Nut Allergy - Nut Aware Procedure
1. Purpose:
The Minnesota State Academies have established and maintains a NUT-AWARE
environment, for the safety of children who are anaphylactic to nuts and for those children who
have yet to be identified allergic to these products.
2. Philosophy:
Minnesota State Academies is “NUT AWARE”. We recognize that with so much traffic in and
out of the campus, as well as, the difficulty of always determining when a product contains
nuts, that it is impossible to be completely “Nut-Free”. Members of the school community must
understand that the school cannot take primary responsibility for managing a student’s food
allergy. These policies are designed and intended to assist students in following the practices
they and their parents feel appropriate. The school will try in good faith to implement these
policies but cannot, of course, guarantee they will be followed in every circumstance. The
school’s policy cannot substitute for the need for students and parents to establish and follow
these practices. In addition, the school cannot be responsible for serving food containing nuts
when it is not reasonably evident that nuts are in the food.
Events outside the school day and rental events in the school buildings cannot be monitored
by the school and therefore are not subject to this procedure.
3. Definition of Anaphylaxis:
This term refers to a number of reactions within the body, including hives, itching, swelling,
watery eyes, runny nose, vomiting, diarrhea, stomach cramps, coughing, wheezing, throat
tightness/closing, difficulty swallowing, difficulty breathing, dizziness, fainting, cardiovascular
collapse. The most dangerous life threatening symptoms are breathing difficulties or a drop in
blood pressure, which can be potentially fatal.
4. Procedure for Children with Known Allergy to nuts:
If the school is advised that a child has been medically diagnosed as anaphylactic to nuts, or
other anaphylaxis allergen risk, he/she will be identified to staff and a medical emergency plan
will be developed. The medical emergency plan will include the child’s name, emergency
contact details, specific allergy, warning signs of reaction and emergency treatment required
including emergency medication prescribed and signed by parent.
The parents/guardians should provide adrenalin (in the form of a self-administering EpiPen) for
storage in the Health Office and other areas as determined in the emergency plan. The
responsibility of providing an EpiPen is that of the parents/guardians of the child concerned. It
is also their responsibility to ensure the medication is within the prescribed use-by period,
expired medication is replaced, and medical information is up to date. Medication not picked
up at the end of the school term will be disposed of without notice to the parents/guardians of
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PROCEDURE #7109
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FARIBAULT, MINNESOTA
the child concerned. Medical emergency plans are for the current school term and must be
renewed yearly.
In addition to providing an EpiPen for the Health office and other areas as determined on the
emergency plan, all middle and upper school students with medical direction for EpiPen are
required to carry an EpiPen on their person at all times and to all off campus events and
activities, field trips, after school activities and sports. Students who do not have an EpiPen
available to take with them will not be permitted to participate in the activity. Exceptions to this
would be students who are cognitively unable manage their own care for EpiPen
administration.
In the early childhood and elementary classrooms, the teacher is responsible to keep the
EpiPen in a safe and secure place and to provide information about student’s with allergies to
substitute teachers. The teacher must take the EpiPen with the class on all emergency drills,
trips and off campus activities. Again, in all cases, it is the responsibility of the parent/guardian
of the concerned student that the EpiPen medication is within its prescribed use-by date and
replaced when expired.
5. Procedure for Children with Un-Known Allergy to nuts:
MSA will keep one dose of stock EpiPen (pediatric and adult dose) at health clinic office at
each school. For students who have an unknown allergy which results in anaphylaxis – the
school nurse will administer the EpiPen per standing physician orders (copy attached to this
document). If the allergic reaction occurs when the health clinic is not open – staff should call
911.
6. Management of Anaphylaxis:
Should accidental exposure to an allergen occur, the emergency action plan will be put into
effect. It is important to remember that a reaction may be instant or it may take several hours
to develop. If symptoms occur, the child should be treated as per the emergency action plan (if
known allergy) or per standing orders (for unknown allergy). It may be necessary to administer
an EpiPen for the child (injecting it into the upper thigh muscle), as it is possible they will be
unable to self-administer. The Health Clinic staff should be notified immediately should a
child be suspected of having been exposed to an allergen, even in the absence of
symptoms and any time an EpiPen is administered.
The school’s understanding is that adrenalin within an EpiPen will not cause permanent
damaging side effects if administered unnecessarily. Known side effects are increased heart
rate, increased blood pressure, nausea or headache. The risk of not giving adrenalin is greater
than any potential risk of giving it unnecessarily. Staff is covered by the Good Samaritan Act
when administering EpiPen and other emergency care to a child with allergies and a risk of
anaphylaxis when trained by the school nurse.
911 emergency system must be initiated any time an EpiPen is administered (unless otherwise
indicated in the student’s emergency medical plan). If the parent/guardian is not available at
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PROCEDURE #7109
MINNESOTA STATE ACADEMIES
FARIBAULT, MINNESOTA
the time EMS transports to the hospital, an adult staff member will accompany the child and
remain with him/her until the parent/guardian relieves them.
CPR training will be provided to school staff, along with EpiPen training. Any field trip with a
student with medical direction for EpiPen will have at least one chaperone trained to recognize
and treat anaphylaxis, including administration of EpiPen.
7. Decreasing exposure to nut allergen:
• Food or product containing nuts or nut products, including a package warning of
“trace nuts”, “processed in a factory with nuts” or “may contain nuts” may not be
brought into school or to any school activity or trip which involves students.
• Check all food before bringing into school. READ THE LABEL.
• All snacks for the Early Childhood Program and Elementary Program will be provided by
MSA nutrition services. Parents may send alternatives to food such as stickers, pencils,
erasers, bracelets, rings, CD’s or DVD’s etc., for special events such as birthday
celebrations.
• Should a child or adult bring food containing nuts to school, the food should be placed in a
sealable plastic bag and disposed of.
• Key staff will be trained in the use of an Epi-pen and of the importance in recognizing a
potential anaphylactic reaction.
• Children will be educated on the danger of allergies and anaphylaxis, both in general
interaction and more formal education such as classroom discussion.
• The school food service routinely reviews the contents of the items used in food
preparation, to ensure that no nut products are contained within items they provide during
the lunch meal. Particular attention will be given to the wording on ingredients of “trace
nuts”, “processed in a factory with nuts” or “hydrolyzed vegetable protein”, as these may
contain peanut products. Ingredients labeled “may contain nuts” are not to be used in any
of the menu items.
• Parents will be advised of the school’s nut procedure in the parent/student handbook and
school web site.
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PROCEDURE #7109
MINNESOTA STATE ACADEMIES
FARIBAULT, MINNESOTA
Minnesota State Academies Standing Order: Evaluation and Treatment of Anaphylaxis
Standing Order: All Licensed nurses employed or contracted by the agency who have
completed orientation and have been appropriately trained in agency emergency protocols
may evaluate for symptoms of anaphylaxis and administer treatment as outlined in the
following guidelines.
Assessment:
1. Subjective: The patient reports a reaction and complains of 1 or more of the following
generalized symptoms usually within 20 minutes of exposure to an antigen or potential
allergen e.g., vaccine, medication, latex or insect sting.
 Generalized itching
 Tingling sensation around the mouth and face
 Chest tightness
 Difficulty breathing
 Swelling in the throat
 Abdominal Cramping
2. Objective: Onset of 1 or more of the following generalized symptoms usually within 20
minutes of exposure to an antigen or potential allergen, e.g., medication, nuts, seafood, latex
or insect sting.
 Presence of generalized hives, redness or rash
 Swelling of the face or lips
 Respiratory stridor or wheezing
 Clamminess or sweating of the skin
 Low blood pressure with rapid weak pulse
 Loss of consciousness
Plan of Care:
1. Implementation:
 If symptoms are confined to the injection, contact, or sting site apply a cold compress to
the site and observe the patient closely for 20 minutes for the development of
generalized symptoms
 Stay with the patient and assess airway, breathing and circulation, call for assistance if
needed and obtain emergency supplies
 If symptoms are generalized - Call 911 to activate the Emergency Medical System
(EMS)
 Administer Epinephrine via EpiPen
EpiPen: 0.3mL for persons > 65 lbs
Or
EpiPen Jr.: 0.15mL for persons age 4 years or greater and 33 to 65 lbs
 In addition, if patient is alert and able to swallow easily - give Diphenhydramine
(Benadryl) orally
Weight
Age
Dose: Orally: 25-50 mg capsules/tablets
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PROCEDURE #7109
MINNESOTA STATE ACADEMIES
FARIBAULT, MINNESOTA
33-99 lbs
25 mg
99+ lbs
13 years
50mg
 Monitor the patient continuously obtaining BP, pulse, O2 Saturations, and respirations
every 5 minutes
 Keep the patient supine. The head may be elevated, if the patient is having respiratory
difficulty, and BP is not low
 Epinephrine dose may be repeated (x1) after15 minutes if symptoms persist, until EMS
arrives
 Initiate Basic Emergency Life Support (CPR) steps if patient becomes unconscious as
necessary and continue until relieved by another trained person or EMS arrives
2. Nursing Actions:
 Document actions taken including vital signs, medications and treatments including the
time, name of personnel administering and the patient response.
 Keep the patient informed as to what is happening during the process or once they
recover
 Report the events and actions taken to EMS when they arrive
3. Criteria for Calling the Physician:
 Notify, or advise the patient to notify, their physician of the reaction and treatment
provided
4. Follow Up Requirements:
 For local reactions recommend continuing cold compresses for 8-12 hours as needed
and to seek medical care immediately if symptoms worsen or signs of systemic reaction
occur.
 Flag the patient’s record to indicate the allergy and record the reaction
 Complete an Incident Report form per agency protocol
 If indicated follow up with the patient/parent to assure notification of their physician and
school/daycare/caregiver of the reaction and to counsel against further exposure to the
sensitizing agent.
Linda Mitchell, Superintendent
Minnesota State Academies
Reviewer:
Date Originated:
Date Revised:
Director of Health Services
02/13/2012
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