By Dana Ashe, RN, CCHC
Jackson County Health Department
Severe Allergic Reaction Training
Pre-Test
 Please fill in the blanks with F (false) and T (True)
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1. _____ Anaphylaxis is a mild reaction to a substance you are allergic to.
2. _____ The Epi-Pen and Epi-Pen Jr. can be used interchangeably.
3. _____If you have never had an allergic reaction, you will probably never have one.
4._____After administering the Epi-Pen, I should only call 911 if the parents want me to.
5._____An Epi-Pen must always be kept in a locked container.
6._____The Epi-Pen is a quick and painless way to administer epinephrine and save a
child’s life.
7. The body systems that are affected in an allergic reaction are: (Please Circle One)
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A. The Skin
B. The Respiratory System
C. The Gastrointestinal System
D. The Sympathetic Nervous System
E. A and B
F. All of the above
Objectives
 The trainee will:
 Learn what anaphylaxis is
 Causes of anaphylaxis
 Signs and symptoms
 Treatment (antihistamine vs. EpiPen)
 Learn how to use the EpiPen auto injector
 Storage
 When to implement an Individualized Emergency Care
Plan.
 When to call 911
Definition
 Anaphylaxis is a potentially life- threatening
allergic reaction caused by exposure to specific
allergen triggers.
 Rapid, severe, symptoms can be fatal within
minutes or can take two hours or more.
Anyone can have an Anaphylactic
reaction!
 After: ingestion
 Inhalation
 Skin Contact
 Or: injection of an allergen
 Allergens are substances that cause an overreaction of
the body’s defense mechanism.
What do I look for?
 Mild reactions are usually more localized.
 The child will be able to participate in normal
activities.
 But! Always keep in mind: It only takes 1-2 minutes for
a mild reaction to escalate to severe anaphylaxis!
Physical Changes
 Itching of the skin/eyes (tears)
 Raised rash (hives) – flushing
 Headache
 Nausea & Vomiting – Abdominal Cramps
 Hoarseness –Cough-Wheezing
 Shortness of Breath
Hives
Physical Changes
 Swelling of the tissues of the lips, throat, tongue,
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hands and feet.
Problem swallowing, Metallic taste
Anxiety
Sense of impending doom
Hypotension, dizziness or loss of consciousness
Swelling of the lips
Angioedema
 Angio – prefix that relates to blood vessels
 Edema – The presence of abnormally large amounts of
fluid in the intercellular tissue spaces (between the
cells).
 Severe allergic reactions cause angioedema deep in the
soft tissue of the throat and neck causing the throat to
swell shut, cutting off the person’s ability to breathe.
What Causes Anaphylaxis???
 Foods (leading cause outside hospital)
 Some insect venoms (bee stings are common cause)
 Medications
 Latex Allergy
 Exercise
 Idiopathic
Foods
 These 6 common foods account for 90% of reactions.
 Milk
 Eggs
 Peanuts
 Tree Nuts
 Soy
 Wheat
Other food triggers
may include:
 Legumes
 Cheese
 Fruits
 Unknown? (Idiopathic)
Insects
 Bees
 Wasp
 Yellow Jackets
 Hornets
 Fire Ants
Medications
 Antibiotics
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*Penicillin, Cephalosporins, etc.
Aspirin, NSAIDS
Chemotherapeutic Agents
Biological (Vaccines)
Radio Contrast Media
Latex Allergy
 Proteins in natural rubber latex
 Rubber bands
 Elastic (undergarments)
 Hospital and dental equipment
 !!!Latex dipped products are biggest culprits ---
Baloons, gloves, bandages, water bottles, etc.
Exercise
 Exercise induced anaphylaxis is a form of physical
allergy. Although the mechanism of action is
unknown, it may be related to ingestion of some
medications or foods before exercise.
 Rare
Idiopathic
 Idiopathic anaphylaxis is a life threatening allergic
reaction that occurs in the absence of any known
allergen. IN OTHER WORDS, Nobody really knows
what causes Idiopathic Anaphylaxis.
Remember
 Common symptoms or a reaction can range from mild
to severe. The severe or life threatening reactions are
called anaphylaxis. No predictable pattern.
 The time between exposurue to allergen and
symptoms can vary depending on the allergen,
exposure and sesnitivity.
Treatment
 Remove child from allergen contact.
 Refer to care plan and provide medications and
treatments as indicated.
 Mild s/s may indicate need for antihistamine or
decongestants.
 Severe s/s may indicate need for epipen.
Treatment
 Use epipen if required (per care plan instructions) –
used for emergency symptoms as indicated.
 After epipen ---Call 911!!! Don’t delay, the EpiPen
is only effective for 15-20 minutes.
 Call parents
Treatment
 Child should be lying on back with feet elevated. Keep
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child warm and loosed tight clothing.
Don’t give anything to drink.
Comfort child
Monitor signs and symptoms
Do not leave child unattended.
Demonstration
EpiPen
EpiPen Jr.
 Used for children – delivers one dose of 0.15mg.
Epiniphrine intramuscularly.
EpiPen
 Should be labeled with child’s name and stored
with a copy of the care plan.
 Store unlocked and out of reach of children.
 Store away from direct sunlight.
 Do not refrigerate.
 Check expiration date monthly.
 Check = replace if cloudy or discolored.
EpiPen
If EpiPen is expired, it is better to give it
in an emergency than to give nothing at
all!!
Anaphylactic Prevention
 Screen people at risk
 See MD for proper diagnosis and treatment.
 Wear Medic-alert* accidental exposures are never
planned/be prepared!
 Education on avoidance of allergens.
 As many as 35% of people who have an
anaphylactic reaction will experience a
recurrence in the hours following the
beginning of the reaction and will require
further treatment, including addition
epinephrine injections.
Management
 Identify children with allergies (review medical form
and talk to parents).
 Identify specific allergen.
 Remove as many allergens from environment as
possible.
 Post allergies (helpful = child’s picture)
Management
 Read labels – monitor ingredients
 Obtain written MD instructions
 Team approach to develop care plan
 Learn to recognize s/s of mild to severe allergic
reactions.
Management
 Learn to administer emergency medications safely and
appropriately. Know when and how to give meds
(specific individual instructions on care plan).
 Develop policies for safe storage and accessibility of
emergency meds.
 Call for help and stay calm!!
Post - Test
 Please fill in the blanks with F (false) and T (True)






1. ___F__ Anaphylaxis is a mild reaction to a substance you are allergic to.
2. ___F__ The Epi-Pen and Epi-Pen Jr. can be used interchangeably.
3. ___F__If you have never had an allergic reaction, you will probably never have one.
4.___F__After administering the Epi-Pen, I should only call 911 if the parents want me to.
5.___F__An Epi-Pen must always be kept in a locked container.
6.___T__The Epi-Pen is a quick and painless way to administer epinephrine and save a
child’s life.
7. The body systems that are affected in an allergic reaction are: (Please Circle One)






A. The Skin
B. The Respiratory System
C. The Gastrointestinal System
D. The Sympathetic Nervous System
E. A and B
F. All of the above
References
Refer to Caring For Our Children Standard
4.010
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Questions?