Background

Two deaths in Ontario during the summer of 1994 caused by a severe peanut allergy have heightened awareness of the serious hazard of anaphylaxis.

Anaphylaxis is an acute systemic (whole body) allergic reaction, which has a collection of symptoms affecting multiple systems in the body. It occurs when a person has become sensitized (i.e. the immune system has been triggered to recognize a substance as a threat to the body). The most dangerous symptoms are breathing difficulties and a drop in blood pressure or shock, both of which are potentially fatal. Common examples of potentially life-threatening allergies are certain foods and insect bites/stings. However, these severe allergic reactions may also be caused by medications, exercise, chemicals (especially volatile organic compounds - VOCs, and solvents) and latex.

What are the symptoms?

Symptoms of anaphylactic shock may be a combination of any of the following:

• hives
• itching (of any part of the body)
• swelling (of any part of the body)
• red, watery eyes
• runny nose
• stomach cramps
• change of voice
• coughing
• wheezing
• throat tightness or closing
• difficulty swallowing
• difficulty breathing
• sense of doom
• fainting or loss of consciousness
• change of skin colour
• vomiting
• diarrhea

Emergency Treatment

• Treatment protocols must be prescribed by a physician for that individual.
• Epinephrine is the only drug which should be used in the emergency management of anyone having this potentially life-threatening allergic reaction.
• Epinephrine injection is available in several self-administrating delivery devices; such as, the pre-loaded syringe (Ana-Kit), or in a spring-loaded self-injectable system (EpiPen).
• These epinephrine auto-injector devices are usually preferred because of their simplicity of use.
• Epinephrine must be administered as soon as possible after the onset of symptoms of severe allergic response.
• Since adequate warning signs are not always present before a serious reaction occurs, it is recommended that epinephrine be given at the start of any reaction occurring in conjunction with a known or suspected allergy contact.
• All individuals receiving emergency epinephrine must immediately be transported to the hospital.

General Recommendations

• The employer should inquire during the commencement of employment if a worker has a life-threatening allergy to certain foods, insect bites, medications or other materials.
• Any worker who carries an epinephrine injector (e.g. EpiPen) should inform the employer and supervisor of its location.
• The employer requests the worker's permission to make information and identification sheets of the susceptible worker (photographs, allergens to avoid and an emergency response plan) readily available to other workers in the workplace.
• All workers should be trained to understand and treat anaphylaxis.
• Any worker who has allergies should wear a Medic-Alert bracelet or necklace, or other suitable identification.
• Workers should provide their supervisor with written authorization for the use of epinephrine in the event of a severe allergic reaction.
• Workers should never sign a waiver absolving the employer of responsibility if epinephrine is not injected.
• Every worker who has been prescribed an epinephrine auto-injector should have one labelled with his or her name and kept in a readily available location in the workplace.
• When planning excursions away from the workplace, it is important that consideration be given to prompt access to a hospital and/or emergency services in case a worker experiences anaphylaxis.
• Assistance should be provided immediately if a worker is unable to self-administer the EpiPen due to the severity of the anaphylactic symptoms.

Sabrina’s Law

On January 1, 2006, Sabrina’s Law came into effect.  In essence the law requires that school boards have policies and procedures in place to deal with anaphylaxis.  The legislation requires school boards to have policies that include:

• Training for school staff on dealing with life-threatening allergies on an individual basis.
• Creating individual plans for pupils who have an anaphylactic allergy and,
• Having emergency procedures in place for anaphylactic pupils.

The law also permits employees to administer medication when authorized (sec.3.1) or when there is an emergency (sec.3.3) and offers immunity to employees who administer an epinephrine auto-injector in good faith (sec.4).

If you work for a school board, you are required to comply with the school board’s policies and procedures regarding anaphylactic reactions.

Further Information

Contact your local Public Health Office or the Health and Safety / Workplace Safety and Insurance Act Committee through OSSTF/FEESO Provincial Office, 49 Mobile Drive, Toronto, Ontario, M4A 1H5 at 416-751-8300 or 1-800-267-7867.