For adolescents at risk of anaphylaxis and their parents, the shift from elementary school to a much larger middle or high school can be unsettling. Parents and teens at risk need to rethink the teen’s anaphylaxis management strategies to address both a new environment and the developmental changes that take place during puberty. There are many changes during this time, but three stand out: the loss of control over the school environment, the social changes that teens face, and the way the teen’s brain will be evolving during this time.
Management of Anaphylaxis in the High School Setting- It is important for individuals at risk of anaphylaxis to be under the care of a physician. Teens with asthma that are also at risk of anaphylaxis need to be followed by an allergist on a regular basis. Studies show that victims of fatal anaphylaxis were often older children, teens and young adults, many of whom had a history of anaphylaxis and asthma.
- Teens with asthma who are at risk of anaphylaxis should be taught to err on the side of caution and use their epinephrine auto-injector if they are not sure if they are having an asthma attack or an allergic reaction. Epinephrine can be used to treat a life-threatening asthma attack or an allergic reaction. They must carry an epinephrine auto-injector at all times and know how to use it. If they have asthma, they should also carry their asthma inhalers with their auto injector. Some high school staff and school nurses do ‘spot checks’ to ensure that students at risk have their auto-injectors and asthma inhalers (if appropriate) with them.
- Food-allergic students should always be cautious about eating food from the school cafeteria and ask about ingredients each time food is purchased. (Parents should role play with their children to teach them how to inquire about food safety when they are away from home, out of their care. Ideally, older children should be familiar with safety procedures when dining out before they enter high school where there is typically a cafeteria).
- Teens at risk should eat off a napkin to avoid contact with potentially contaminated surfaces. If they do not have their auto-injector with them, they should not eat.
- Teens should eat lunch with friends who are informed about their allergy and are able to help them if they have a reaction. These friends would know where their auto-injector is kept and when and how to use it. Some schools have incorporated a special lesson in the health curriculum to teach peers about anaphylaxis.
- Students at risk need to know they have the support of school staff, and all complaints should be taken seriously. Parents are encouraged to meet with their child’s teachers and coaches individually to review their child’s situation. Some parents ask if the student can eat during the first lunch period and to have a designated table which a custodian and the student wipe down. Parents and students should make sure that eating arrangements at school and on field trips are in place. This process may need to be repeated when the semester changes.
- At the beginning of the school year, all high school staff should be informed about allergic students and, ideally, all staff should be trained.
- Foodservice staff should be included in anaphylaxis training for staff. An Anaphylaxis Emergency Plan for each food-allergic student should be kept in foodservice preparation areas where staff can review information discreetly while respecting the privacy of food-allergic students.
- High schools should consider keeping a spare epinephrine auto-injector in the cafeteria and office in case of emergency. The accessibility of back-up devices needs to be considered; they should not be locked up. (High school offices are often locked at the end of the school day, however, students may be at school until evening for extracurricular events.)
- High school populations are comprised of students from many different “feeder” schools in a region. It is important that school computer systems are set up to track critical information as students register. This includes the student’s health information, including information about anaphylaxis. All staff need to know which students are at risk for all medical conditions.
