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School Nursing Evidence-Based Clinical Practice Guideline: Students with Allergies and Risk for Anaphylaxis

Release Date: 09/20/2023
Expiration Date: 09/20/2028

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Aimee Keller, DNP, FNP-BC

Kimberly Stanislo DNP, APRN-CNP, LSN, CPNP-PC

Allergic conditions affect approximately 50 million children and adults living in the United States (American Academy of Allergy Asthma & Immunology [AAAAI], 2020), including allergic rhinitis, asthma, eczema, allergic reactions, and many other allergic disease processes. In the United States food allergies affect about 32 million people (FARE, 2023), medication allergies affect about 7% of the population (FARE, 2023), and stinging insect allergies can result in potentially life-threatening allergic reactions in 0.4% – 0.8% of children and 3% of adults (ACAAI, 2023). In the pediatric population latex allergy can also be problematic, specifically in children with spina bifida, as latex allergy affects 40-65% of children with this condition (FARE, 2023). Regardless of the allergen, identification of symptoms consistent with an allergic reaction and anaphylaxis are critical to ensure timely treatment and care of the individual experiencing the reaction. About 16-18% of students will experience their first food allergic reaction at school (Tsuang & Wang, 2016) and up to 25% of epinephrine administered in schools is for students and staff with an unknown allergy (FARE, 2016). A safe and supportive school environment for students with allergies is critical for their safety and learning, including preparedness of the student, families, classrooms, and staff to proactively plan and implement risk reduction strategies to minimize actual or potential allergen exposures.

Based on the most recent and highest quality evidence available, the purpose of this Guideline is to provide best practice recommendations and strategies to assist school nurses in their role in implementing high quality care and improving the health and safety of the school-aged child at risk for an allergic reaction and anaphylaxis. The focus of this Guideline is to provide safe, supportive school and classroom settings for the student to learn in a low-risk environment. Student goals resulting from successfully implementing the guideline include:

  • Improved management of allergen exposure and minimizing the risk for allergen exposure in school settings
  • Decreased time spent out of the classroom.
  • Improved student academic success.
  • Full participation in all school activities.
  • Decreased allergic reactions and episodes of anaphylaxis.
  • Improved quality of life.
  • Improved mental well-being.
  • Decreased social isolation.

NOTE: This guideline is a decision-making tool and is not intended to replace application of nursing judgment.

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