WebMD Health - Allergies

May 3, 2011 3:41 PM

Coping With Serious Allergic Reactions

When you send your kids to school, it's normal to be apprehensive. Will they pay attention in class? Will they get good grades?

For some parents, the concern is much more serious. Will a peanut butter sandwich or buzzing bee trigger a life-threatening allergic reaction? A severe allergic reaction is also known as anaphylaxis. Although anaphylaxis is somewhat rare, it can be very dangerous.

Anaphylaxis is due to an overreaction of the immune system. The body releases a flood of chemicals such as histamine when exposed to an allergen like peanuts (or another food), insect venom, or medicine. These chemicals lead to severe symptoms like difficulty breathing, low blood pressure, and shock. An anaphylactic reaction starts quickly and can turn deadly within minutes.

It is possible to keep allergic kids safe at school, but you need to take a few precautions. Put an allergy plan in place well before the school year starts. Follow that plan year-round and keep in close contact with teachers and school administrators regularly.

Prepping Your Child for School

The first thing to do is visit your allergy specialist for a back-to-school checkup. A thorough checkup helps set the stage for a healthy school year.

"The advantage of seeing an allergist is that we are able to identify the triggers, whether it be food allergies or respiratory allergies," says James Sublett, MD, clinical professor and section chief of pediatric allergy at the University of Louisville School of Medicine, and managing partner of Family Allergy & Asthma in Louisville, Ky. The doctor can confirm that your child has a severe allergy by taking a medical history and doing blood and skin reaction tests.

Once you know the allergy trigger, there is a way to prevent your child from having a severe allergic reaction. This method is called desensitization, or immunotherapy. Tiny amounts of the allergen (such as bee venom) are injected under the skin or placed under the tongue. The amount is slowly increased over a period of months until your child can tolerate it.

This technique works about 95% of the time, especially for bee, hornet, wasp, and other insect stings. However, it's not recommended for peanut allergies. Although at least one study has shown that peanut desensitization can work, it can be risky for children who are highly allergic.

"At this point, it would be considered experimental and dangerous," says J. Allen Meadows, MD, public education committee chairman of the American College of Allergy, Asthma & Immunology and an allergist in Montgomery, Ala. Kids who can't be desensitized must be prepared in case they encounter allergy triggers at school.

Have a Plan

Knowing your child's allergy triggers is just the first step. The next step is to ensure that your child avoids those triggers.

Tell teachers and other school staff about your child's allergies. "Early on, establish good lines of communication with the school," advises Sublett. "School nurses are a great starting point."

Work closely with the school and your allergist to create a detailed allergy plan. "Because stinging insect allergies and food allergies are so common, most of the schools already have protocols set up," says Meadows. You just need to fill out the forms and have your doctor sign them.

A typical allergy plan includes:

  • A description of your child's allergy (such as peanuts or insect stings)
  • Symptoms
  • The name of the medication to give for each symptom, and the correct dosage
  • Who to call in case of an emergency

The plan should cover not just school, but also after-school activities, field trips, and the school bus.

Avoid Triggers

Here are a few other tips to help avoid accidental run-ins with your child's allergy trigger:

  • Pack a lunch for your child every day. Kids with food allergies shouldn't share food or eat anything they didn't bring to school unless a teacher or other adult confirms that it is allergen-free.
  • Kids who are allergic to insect stings should avoid wearing brightly colored clothing that may attract bees and should apply bug repellent when they're outside.
  • Teach your child how to recognize the symptoms of anaphylaxis and what to do in case of an allergic reaction.
  • If the allergy is to nuts, ask the school to make the lunchroom or your child's classroom a nut-free zone. Post signs to alert other students and teachers.
  • Have your child wear a medical alert bracelet or necklace labeled with the allergy trigger.

In Case of Emergency

No matter how carefully you prepare, your child might accidentally be exposed to the allergen. Everyone at school who spends time with your child, from the nurse to the teachers, should be trained to recognize symptoms of an anaphylactic reaction and know what to do in an emergency. "It's important for all teachers and school personnel to have knowledge of this. It's like CPR - it can save someone's life," says Sublett.

Almost every state now allows students to carry an epinephrine auto-injection pen such as EpiPen or Twinject with them. Kids can inject the epinephrine themselves into a leg or arm. However, your child's doctor must first demonstrate how to use the epinephrine injection device correctly. Otherwise, kids might accidentally turn the injector upside down and stick the needle into their thumb. "It sounds simple, but in situations where people are already anxious they can make mistakes," says Sublett.

It's a good idea for children to carry two epinephrine injections. If they still have symptoms after five or 10 minutes or the symptoms are getting worse, they can take a second dose.

Remember that injected epinephrine won't stop an anaphylactic reaction. It will only control the severe symptoms for a few minutes. The school should always call 911 and get your child to an emergency room right away. Remember to check expiration dates; as with any drug, epinephrine does expire. Look on the barrel of the auto-injector for the product's expiration date.