Food Allergy and Anaphylaxis Emergency Care Plan

Food Allergy Action Plan

Please correct the errors described below.

NOTE: Do not depend on antihistamines or inhalers (bronchodilators) to treat a severe reaction. USE EPINEPHRINE.

FOR ANY OF THE FOLLOWING:

SEVERE SYMPTOMS

  • LUNG - Short of breath, wheezing, repetitive cough
  • HEART - Pale, blue, faint, weak pulse, dizzy
  • THROAT - Tight, hoarse, trouble breathing/ swallowing
  • MOUTH - Significant swelling of the tongue and/or lips
  • SKIN - Many hives over body, widespread redness
  • GUT - Repetitive vomiting, severe diarrhea
  • OTHER - Feeling something bad is about to happen, anxiety, confusion
  • OR A COMBINATION of symptoms from different body areas.

1. INJECT EPINEPHRINE IMMEDIATELY. 2. Call 911. Tell them the child is having anaphylaxis and may need epinephrine when they arrive.

• Consider giving additional medications following epinephrine: » Antihistamine » Inhaler (bronchodilator) if wheezing Lay the person flat, raise legs and keep warm. If breathing is difficult or they are vomiting, let them sit up or lie on their side. • If symptoms do not improve, or symptoms return, more doses of epinephrine can be given about 5 minutes or more after the last dose. • Alert emergency contacts. • Transport them to the ER even if symptoms resolve. A person should remain in the ER for at least 4 hours because symptoms may return.

MILD SYMPTOMS

  • NOSE - Itchy/runny nose, sneezing
  • MOUTH - Itchy mouth
  • SKIN - A few hives, mild itch
  • GUT - Mild nausea/ discomfort

FOR MILD SYMPTOMS FROM MORE THAN ONE SYSTEM AREA, GIVE EPINEPHRINE.

FOR MILD SYMPTOMS FROM A SINGLE SYSTEM AREA, FOLLOW THE DIRECTIONS BELOW:

  1. Antihistamines may be given, if ordered by a healthcare provider.
  2. Stay with the person; alert emergency contacts.
  3. Watch closely for changes. If symptoms worsen, give epinephrine.

MEDICATIONS/DOSES

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

EPIPEN® (EPINEPHRINE) AUTO-INJECTOR DIRECTIONS

  • Remove the EpiPen Auto-Injector from the plastic carrying case.
  • Pull off the blue safety release cap.
  • Swing and firmly push orange tip against mid-outer thigh.
  • Hold for approximately 10 seconds.
  • Remove and massage the area for 10 seconds

AUVI-Q™ (EPINEPHRINE INJECTION, USP) DIRECTIONS

  • Remove the outer case of Auvi-Q. This will automatically activate the voice instructions.
  • Pull off red safety guard.
  • Place black end against mid-outer thigh.
  • Press firmly and hold for 5 seconds.
  • Remove from thigh.

ADRENACLICK®/ADRENACLICK® GENERIC DIRECTIONS

  • Remove the outer case.
  • Remove grey caps labeled “1” and “2”.
  • Place red rounded tip against mid-outer thigh.
  • Press down hard until needle penetrates.
  • Hold for 10 seconds. Remove from thigh.
Treat the person before calling emergency contacts. The first signs of a reaction can be mild, but symptoms can get worse quickly.

EMERGENCY CONTACTS — CALL 911

OTHER EMERGENCY CONTACTS

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Your message will be encrypted.