File: JLCE-R3

GARDNER SCHOOL HEALTH SERVICES

Evaluation and Treatment of Children Following Exposure to Allergens or

Insect Stings

Purpose: To provide guidelines and standing orders for the licensed nursing staff to treat children following exposure to known allergens, or to insect stings.

Information:

1. Exposure to allergens may cause discomfort, watery eyes, itching, sneezing, hives, or localized reactions that are not severe, but may require treatment to prevent further discomfort, or prolonged reactions. These symptoms may be alleviated by the use of Diphenhydramine (Benadryl), following judicious assessment by the school nurse.

2. The most common types of insect stings that require medical attention are from insects that are members of the hymenoptera family, including bees, wasps, and yellow jackets.

3. The most common response is a local reaction, which requires minimal nursing intervention.

4. In allergic children, a generalized reaction may occur which requires prompt nursing intervention and treatment.

Definitions:

Local Reaction: Redness and swelling around the site of the insect sting, or around an area exposed to an allergen. There may also be swelling of the same extremity in which the exposure/sting occurred.

Generalized (anaphylactic) Reaction: Reaction of the body in a part removed from the direct exposure or sting. This may include a generalized itchy, red rash, difficulty in breathing, swelling or redness in another extremity in which the sting did not occur, faintness, drop in blood pressure, abdominal cramping, and/or anaphylaxis.

Procedures:

1. Following a suspected or observed exposure to an allergen or an insect sting, the child should be evaluated for evidence of reaction, or of the sting (swelling, redness, stinger). Signs of anaphylaxis related to an exposure or sting must be assessed.

2. Any suspicion or evidence of anaphylaxis MUST be treated with an

Epi-pen immediately.

3. If the child has had a known anaphylactic reaction or demonstrates any immediate signs of anaphylaxis, follow protocol for administering an appropriate size Epi-pen. CPR should be administered if the child stops breathing or loses a pulse. An ambulance should be called immediately and the child should be taken to the emergency room. Notification of the child’s parents must occur simultaneously.

4. If the child does not demonstrate any immediate signs of anaphylaxis, the insect stinger may be carefully removed with fine point tweezers or another clean utensil to prevent more venom from being released into the wound. Ice and/or pressure may be applied to any local area reaction.

5. For any local reaction to exposure to an allergen or insect sting (i.e. local redness, swelling, itching), a dose of Benadryl (Diphenhydramine, 12.5mg/teaspoon) may be administered orally. (Check for allergy to Benadryl.) If the student is under 6 years old, the Primary Care Physician must be notified to clarify dose. For students over 6 years old, follow directions on Benadryl bottle for dosing.

6. The child should remain in the nurse’s office for 30 minutes after the exposure or sting. The child should be periodically evaluated for any evidence of anaphylactic reaction. In addition, blood pressure should be taken every 15 minutes.

7. If, at the end of 30 minutes, the child is feeling well and has normal vital signs, the child may return to class. The teacher and parent should be made aware that the child suffered an exposure to an allergen or sting.

8. If the child demonstrated any evidence of anaphylaxis within these 30 minutes, the Epi-pen protocol should be followed.

9. Notify parents of reaction, exposure or insect sting, and give information related to signs of anaphylaxis, so that they can monitor the child at home.

10. Parents should notify the child’s primary care physician within 24 hours.

[Adopted: November 2004]

[Reviewed: January 2006]