Prevention and management of allergic reactions to food in child care centers and schools: Practice guidelines.

Food allergy management in child care centers and schools is a controversial topic, for which evidence-based guidance is needed. Following the Grading of Recommendations Assessment, Development, and Evaluation approach, we conducted systematic literature reviews of the anticipated health effects of selected interventions for managing food allergy in child care centers and schools; we compiled data about the costs, feasibility, acceptability, and effects on health equity of the selected interventions; and we developed the following conditional recommendations: we suggest that child care centers and schools implement allergy training and action plans; we suggest that they use epinephrine (adrenaline) to treat suspected anaphylaxis; we suggest that they stock unassigned epinephrine autoinjectors, instead of requiring students to supply their own personal autoinjectors to be stored on site for designated at-school use; and we suggest that they do not implement site-wide food prohibitions (eg, "nut-free" schools) or allergen-restricted zones (eg, "milk-free" tables), except in the special circumstances identified in this document. The recommendations are labeled "conditional" due to the low quality of available evidence. More research is needed to determine with greater certainty which interventions are likely to be the most beneficial. Policymakers might need to adapt the recommendations to fit local circumstances.

Atopic Dermatitis: Management in the School Setting.

Atopic dermatitis, a form of eczema, has a physical, psychological, and social impact on students at school. The purpose of this article is to provide current information surrounding the symptoms and treatment of this disorder. School nurses can be a partner in atopic dermatitis care and improve health outcomes for these students.

Steps to Stock: Keeping Students Safe With Fully Implemented Stock Epinephrine.

Laws have been passed across the United States to either allow or mandate the use of stock epinephrine in the school setting. The challenge remains for our schools to fully implement the use of this life-saving medication. Barriers to implementation exist, but quality tools are available to support the school nurse.

Current trends in food allergy-induced anaphylaxis management at school.

OBJECTIVE: To review the evidence and current policies regarding the use of epinephrine at schools and child care centers DATA SOURCES AND STUDY SELECTIONS: A narrative review was performed based on the result of conference proceedings of a group of interprofessional stakeholders who attended the USAnaphylaxis Summit 2017 presented by Allergy & Asthma Network. RESULTS: Anaphylaxis is a well-recognized medical emergency that requires prompt treatment with intramuscular epinephrine. Anaphylaxis can be associated with poor quality of life. There is renewed recent focus on anaphylaxis management in schools. This interest has been spurred by an increase in the number of children with food allergy who are attending school, data that support up to 25% of first-time anaphylactic events occurring on school grounds, and a well-publicized fatality that helped to initiate a movement for stock, undesignated, non-student-specific epinephrine. Stock epinephrine is now available in 49 states, with an increasing number of states instituting mandatory reporting for use of such devices. Nursing efforts are paramount to support and implement stock epinephrine programs. Many states do not have clarity on delegation of authority for who can administer stock epinephrine, and there is evidence of variability in storage of stock devices. Few states have outcomes data that support successful implementation of stock epinephrine programs. CONCLUSION: Additional data are needed to demonstrate successful implementations of stock epinephrine programs and their outcomes. Such programs should include support for school nursing and clearer delineation of authority for medication administration as well as standards for where and how devices are stored.

Caring for the Student With Asthma at School: What's Out There to Help the School Nurse?

Asthma is a high impact health issue in the school setting. One in 10 children comes to school with asthma, and it is the leading cause for absenteeism causing 13.8 million missed school days each year. Where can the school nurse turn for help? The following article provides evidence-based resources to assist school nurses in caring for their students with asthma.

Latex Safe at School: A Student-Centered Approach.

Providing a safe environment for students at risk for anaphylaxis from a latex allergy requires care coordination and collaboration of all members of the school community. Strategies for allergy management include educating the school community, identifying potential exposure to latex, preparing to respond in an emergency, and creating a plan for the future. With the student at the center of sound planning, the school can provide a secure and healthy environment.

To Give Epinephrine or Not to Give Epinephrine-That Is (No Longer) The Question!

It is vital that school nurses be able to assess students who are at risk for anaphylaxis and that nurses train school staff to identify the symptoms of a life-threatening allergic reaction. When a reaction occurs, school nurses and staff must be prepared to administer epinephrine immediately.

Asthma and Vocal Cord Dysfunction: Can You Tell the Difference?

School nurses care for students with asthma on a daily basis, but what happens when the asthma medication is administered and symptoms persist? As a part of care coordination, the school nurse provides ongoing assessment and care for students with asthma. When symptoms persist despite treatment, school nurses need to consider other issues such as Vocal Cord Dysfunction (VCD). The purpose of this article is to highlight the similarities and differences in the pathophysiology and treatment of both asthma and VCD.

Enhancing Asthma Medication Delivery: Spacers and Valved Holding Chambers.

Asthma is one of the most prevalent chronic diseases managed by school nurses, and its management often includes the administration of bronchodilators delivered via a metered dose inhaler (MDI). The use of an MDI requires coordination and mastery of steps that must be performed correctly and in the proper order. These steps are greatly enhanced, especially in the pediatric population, through the use of medical devices-spacers and valved holding chambers. The purpose of this article is to review the rationale and implications for the use of these devices in the school setting.

School Food Allergy and Anaphylaxis Management for the Pediatrician--Extending the Medical Home with Critical Collaborations.

Community pediatricians, working in consultation with allergists, create a medical home that is the central focus of care for the child with life-threatening food allergies. They participate in coordinating mutual and critical collaborations within schools that support families and children. They can provide leadership and guidance to both families and schools to safeguard children and adolescents, thereby extending the medical home goals into the school setting.

Recognition and treatment of anaphylaxis in the school setting: the essential role of the school nurse.

Since anaphylaxis is unpredictable, rapid in onset, and potentially life threatening, it is critical for school staff to recognize and respond to its symptoms quickly. The symptoms of anaphylaxis can be challenging to differentiate, particularly in school-age children who may have trouble explaining what they are experiencing. School staff must understand the distinctive ways in which children describe and manifest anaphylactic symptoms, and the school nurse has a key leadership role in providing this training. The school nurse should create and coordinate individualized emergency care/action plans for students with known allergies, as well as a comprehensive care plan for all students, to ensure a safe environment and a rapid response to any life-threatening allergic reaction. This should include having epinephrine stocked and readily accessible so that it can be given promptly in the case of an anaphylactic emergency.

Nasn 2011--our annual checkup: a look at the organization's vital statistics.

NASN continually monitors information of importance to the health of the organization and is dedicated to sharing this information with its stakeholders. Our Weekly Digest provides real-time updates in a concise manner to address the needs of the busy school nurse. This article, "Our Annual Checkup," will provide more depth and include information regarding membership and finances, as well as information pertaining to each area of NASN's strategic plan: Programs, Research, Public Relations, and Advocacy. It is the goal of NASN to utilize the July issue of the NASN School Nurse to provide an annual update to the membership.

Treating and managing head lice: the school nurse perspective.

School nurses often are the first healthcare professionals to diagnose lice infestations in children. Although lice do not transmit disease, many schools send children home if they detect live head lice. It is the position of the National Association of School Nurses that children who have been treated for lice infestations should not be excluded from school because of the presence of residual nits. The primary goals of the school nurse in controlling infestations are to identify children with head lice and to break the cycle of reinfestation. Routine screening of children for head lice is often part of infestation management policies in school districts. A thorough screening of a child's head can take several minutes. If a school's policy is to screen all students, the total time for examination adds significantly to the school nurse's caseload. The use of the school nurse's time for universal screening must be measured against other responsibilities, including health problem management, medication management, health assessments, and vision and hearing screening. Once a child is identified as having lice, the school nurse can play a key role in working with the child's family to eradicate the infestation. Education about treatment options and environmental cleaning are topics the nurse can address with the family. The school nurse also can function as a case manager who coordinates various aspects of treatment for an affected child. Because infestations can be very upsetting to students and to their families, the nurse can provide support and reassurance to the family as the child is treated. Participation of school nurses in developing appropriate and consistent policies and procedures within the school district is vital to the overall management of infestations. Their efforts to control and reduce infestations are necessary for the overall health of the school population.