3420P: Anaphylaxis Prevention and Response

For students with a medically diagnosed life threatening allergy (anaphylaxis), which requires an epinephrine prescription, the district will take appropriate steps for the student’s safety, including fully implementing an Individual Health Plan (IHP)/504 as required by law. This procedure is to assure that employees, parents/guardians and students take appropriate precautions to reduce the risk of exposure to allergens and are prepared to respond appropriately in the event that a student exhibits symptoms of anaphylaxis (a potentially life-threatening condition).

Controlling the Exposure to Allergens

Controlling the exposure to allergens requires the cooperation of parents/guardians, students, the health care community and school employees. The district will inform parents of the presence of a student(s) with life threatening allergies in their child’s classroom and/or school. Parents/Guardians of students in these class(es) will be asked to cooperate by avoiding the inclusion of allergen(s) in their child’s snacks or other food items brought into the classroom.

While it is not possible to achieve a completely allergen-free environment, the Bellevue School District will take reasonable measures as outlined below to reduce the risk of exposure to allergens for all students, particularly students with potentially life threatening allergies.

Parents/Guardians of a Student With a Life Threatening Allergy Responsibilities

• Notify the school of the student’s medically diagnosed life threatening allergy prior to attending school as required by law. Secure updated IHP/504s and completed medication authorization form(s) which are signed by a Licensed Health Care Professional (LHCP) and parent/guardian and present to school nurse annually prior to the first day of attendance
• Collaborate with the school nurse in the development of the IHP/504
• Keep all emergency contact information current
• Provide the school with adequate medications for the student prior to the first day of attendance
• Consider providing back-up medication for students who self-carry medication
• Provide replacement medication immediately after use or upon expiration
• Support the student in the self-management of their allergy consistent with the age and developmental level of the student
• Consider sharing medical information with chaperones on field trips and with the PTSA for PTSA organized activities, clubs and events at the elementary (pre-school P-5) level
• Provide lunch and snacks from home when possible

Students with a Life Threatening Allergy Responsibilities

• Do not share or exchange food or eating utensils with others
• Do not eat food with unknown ingredients or those known to contain allergens
• Be proactive in the care and management of food allergies and reactions (based on developmental level)
• Notify a staff member immediately if any symptoms suggestive of an allergic reaction begin to develop
• Notify a staff member immediately if food items are eaten that may contain allergens
• Notify a staff member if subjected to harassment, intimidation, or bullying related to their food allergy
• Wash hands before and after eating

School Nurse Responsibilities

• Correspond (meet/phone/email) with parents/guardians of students with life threatening allergies prior to the first day of attendance to develop a current IHP/504 in coordination with student’s LHCP
• Receive appropriate forms and medication for students with life threatening allergies
• With parent input, identify the allergy(ies), symptoms of exposure and emergency response in the IHP/504
• If the treatment plan includes self-administration of medications, parents/guardians, students and staff must comply with Policy and Procedure 3419 (Self-Administration of Asthma and Anaphylaxis Medication)
• Encourage parents/guardians to provide back-up medication if student self-carries medication
• Train school-based staff who will have contact with the allergy student during the school day on the following:
• Life threatening food allergy awareness including allergen avoidance and prevention, recognizing symptoms of anaphylaxis, administering epinephrine and other emergency medication
• Information contained in Individual Health Plan (IHP)/504
• Location and access to emergency medication
• Maintain a record of school staff trainings
• Communicate with the student, staff, and parents/guardians on a regular basis, to update changes to allergy IHP/504s
• Work with school administration/school safety team to make emergency medications accessible and available at all times, including lockdown, evacuation or catastrophic event
• Maintain record of epinephrine administration
• Participate in debriefing and re-entry planning after an occurrence of an anaphylactic reaction

School Administrator Responsibilities

• Designate time for annual staff training by the school nurse on life threatening allergies, including specific training on:
• Risk reduction actions such as requiring hand washing before and after eating, increasing food allergy awareness
• Allergy student IHP/504s and emergency procedures included in the IHP/504
• Allergens/items that cause the life threatening allergy
• Prevention of exposure
• Recognition of student symptoms of anaphylactic reaction and appropriate response
• Management of the emergency including how to administer epinephrine
• Support potential exclusion of students in accordance with Policy and Procedure 3413 (Student Immunizations and Life Threatening Health Conditions) if provider orders are incomplete, parent forms are incomplete, or medication is not provided to the school as required
• Provide the option for students to eat in allergen aware eating areas in school cafeteria. Students may invite classmates to share this allergen aware space, if classmates have an allergen aware lunch
• Prohibit at the elementary level (P-5), the collection of and redistribution of unopened, packaged food/drink items to students
• Ensure that uneaten food items, including unopened, packaged food items in cafeterias are discarded
• Support staff in the full implementation of this procedure during the instructional day and at all school sponsored activities, clubs and events outside of instructional time 
• Ensure that any distribution of snacks to elementary (P-5) students by staff during the instructional day occurs only after consultation with the school nurse. No snacks will be provided to elementary students with life threatening allergies unless parents/guardians have provided documented authorization for specific food items. There are no requirements under this procedure regarding snacks for secondary school students (grades 6-12)
• Ensure that staff have reviewed allergy student IHP/ 504s before any food items are distributed by staff in classrooms
• Help school nurse maintain allergy aware signage in schools outside classroom doors and at school entry
• Ensure that classrooms and school activities, clubs and events that occur outside of instructional time, sponsored by the school (organized by staff) and organized by outside groups, are inclusive of all students, particularly allergy students, in accordance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA)
• Ensure at the elementary level (P-5), that the planning of all school sponsored (organized by staff) activities, clubs and events that occur outside of instructional time include consultation with the school nurse. Organizers of school sponsored activities; clubs and events must plan and consult with the school nurse at least ten school days before the activity or club begins or the event. There are no requirements related to school sponsored activities, clubs and events that occur outside of instructional time for secondary school students (grades 6-12)
• Ensure that all activities, clubs and events that occur outside of instructional time and organized by outside groups including the PTSA, take into consideration those students with life threatening food allergies and reduce the exposure to allergens. School nurses are available to outside groups for consultation at least ten school days before the activity or club begins or the event. There are no requirements related to activities, clubs and events that occur outside of instructional time and organized by outside organizations for secondary school students (grades 6-12)
• Prohibit the use of latex gloves or latex balloons in classrooms or smaller spaces without adequate ventilation
• Participate in debriefing and re-entry planning following an occurrence of an anaphylactic reaction and communicate with the school community as necessary

Classroom Teacher/Specialist Responsibilities

• Have accessible a copy of all allergy student IHP/504s
• Ensure substitute teacher plans clearly identify students with allergy IHP/504s, and that copies of IHP/504s are included in the sub folder for substitute teachers to read and review
• Do not use food items for rewards and incentives during instructional time. Food items may be used as edible reinforcers when included in a student’s Individual Education Plan (IEP) or by teachers in centered special education programs after consultation with the program supervisor, school nurse, and parents/guardians regarding students with allergies
• Receive annual training from the school nurse and specific training for any student(s) with life threatening allergies enrolled in their class(es)
• Do not distribute food items except under the following permissible circumstances:
• Snacks: At the elementary level (P-5), if teachers choose to allow morning and/or afternoon snacks, parent/guardians may provide their child with an individual snack(s). If snacks are distributed by the school staff, regardless of the source of the snack, consultation with the school nurse regarding students with allergies is required prior to any snack distribution. Nurses are not authorized to and will not provide approval for the distribution of food items. Teachers will provide ample time for consultation with school nurse and parents/guardians. No snacks will be provided to students with life threatening allergies unless parents/guardians provide documented authorization for specific food items.
• Celebrations and Cultural Events: Teachers must review allergy student IHP/ 504s before any food items are distributed for classroom celebrations and consult with the school nurse regarding students with allergies at least ten school days before the celebration or cultural event. Nurses are not authorized to and will not provide approval for the distribution of food items. Parent/guardians of elementary students (Preschool - 5) with allergies must be notified and provide documented authorization for the distribution of specific food items to their student. Store bought, packaged food with clear ingredient lists is strongly encouraged in order to avoid the distribution of food containing allergens.
• Curriculum: Food items that are specifically required by the District curriculum may be used after consultation with the school nurse regarding students with allergies. Nurses are not authorized to and will not provide approval for the distribution of food items. Parent/guardians of students with allergies must be notified in advance of the lesson(s)/unit(s) and provide documented authorization for any distribution of food items to their student. For instructional activities such as arts/crafts, projects, science, counting, etc. teachers are expected to avoid the use of food items containing allergens unless required by the District curriculum.
• Review the use of instructional materials that include food items and non-food items that contain allergens such as paints, glue and “play-doh” with the school nurse in classrooms with allergy students
• Carry epinephrine and copies of allergy IHP/504s on school-sponsored field trips and contact school nurse for epinephrine administration instruction if needed. Coordinate well in advance with school nurse when planning field trips.
• Prohibit latex balloons in the classroom
• Implement food distribution practices that are inclusive of all students, particularly students with life threatening allergies

Nutrition Services Staff Responsibilities

• Know the ingredients of school food items
• Communicate allergens that exist in food items in an allergen product list displayed on the website as well as daily menu signs displayed on the serving line in the cafeteria
• Review food labels routinely, as the manufacturing of various food products are subject to change
• Work with family to avoid allergens by following dietary order form. At the request of a parent/guardian, label all meals ordered for the students with life threatening allergies with the student’s name and allergy
• Prevent cross contact of allergenic food products
• Display the photo alert list of allergy IHP/504s in the kitchens and made available to all kitchen staff
• Make menu accommodations as needed based on allergy student IHP/504s

Office Staff Responsibilities

• Review enrollment forms to identify students with life threatening allergies. Notify school nurse of any student with life threatening allergies
• Provide parent with school nurse contact information
• Provide pertinent medical paperwork to nurse promptly
• Remind substitute teachers to review substitute folders for any students who may have life threatening conditions

Transportation Department Staff Responsibilities

• Receive annual anaphylaxis awareness training. Review allergy IHP/504s provided to the Transportation Department
• Maintain First Aid certification that includes the signs and symptoms of allergic reaction and administration of epinephrine
• Enforce “no eating” policy on regular bus routes. Exceptions may occur for students who have a medical need for access to food and during trips where the length of the trip or extenuating circumstances necessitate food consumption

Custodial Staff Responsibilities

• Thoroughly clean all tables and chairs after food consumption • Clean Allergen-Aware tables using a separate rag or disposable wipe

Lunchroom/Playground Staff Responsibilities

• Follow District protocols and procedures regarding students with life threatening allergies
• Receive annual training from the school nurse

Epinephrine Administration

Antihistamines are useful for relieving hives and symptoms of mild allergic reactions, but they do not treat severe symptoms and/or life-threatening symptoms of anaphylaxis. Epinephrine is the only recommended first-line treatment for anaphylaxis.

• For students with a medically diagnosed life-threatening allergy (anaphylaxis), school nurses will document on the student’s IHP/504 that epinephrine is to be administered for signs and symptoms of anaphylaxis when the school nurse is not on site. The nurse will instruct all school staff accordingly
• If antihistamine has been ordered by LHCP it will be noted on IHP/504 to be given after the administration of epinephrine when the school nurse is not on site
• Epinephrine must be accessible and available, stored in a secure location and at the appropriate temperature and not exposed to light

Incident Documentation

If a student has an anaphylactic reaction, with or without administration of epinephrine, complete Anaphylaxis Form (3420P Exhibit A) and send copies of the completed document to student’s parent/guardian, the Special Education Department, and the Office of the Superintendent.

Exclusion from School

Students who have a medically diagnosed life-threatening allergy and no medication and/or completed treatment order and/or completed parent/guardian paperwork presented to the school, may be excluded from school consistent with Policy 3413 with federal requirements for students with disabilities under the Individuals with Disabilities Act and Section 504 of the Rehabilitation Act of 1973, and pursuant to the following due process requirements:

• Written notice to the parents, guardians or persons in loco parentis is delivered in person or by certified mail;
• Notice of the applicable laws, including a copy of the laws and rules; and
• The order that the student will be excluded from school immediately and until both appropriate emergency medication completed treatment orders, and completed parent paperwork are provided as well as student specific information provided (by the school nurse) to teachers, teacher’s assistants, office clerical staff, nutrition services workers and bus drivers who will have known contact with a diagnosed student.