Policy 5534.1 – Anaphylaxis

Every allergic reaction has the potential for developing into a life-threatening event known as anaphylaxis. Anaphylaxis is always a medical emergency as students can have the onset of symptoms within minutes to hours, and if untreated, it can lead to collapse and death shortly thereafter.

Anaphylaxis is usually an immediate reaction occurring within seconds or minutes to an hour following exposure to an allergen (food, insect sting, latex, medication). There is no predictable pattern with anaphylaxis. Each subsequent episode may be the same, more severe, or less severe.

For severe allergic reactions, epinephrine is the drug of choice for treatment. Every student with a history of anaphylaxis should have at least one Epinephrine delivery device in the health office. Some students may have additional Epinephrine delivery devices at school or may carry an epinephrine delivery device on their person. A completed medication authorization form signed by the parent or legal guardian AND a prescriber must be on file in the office. Medication authorization forms must be renewed annually.

Individuals not known to be at risk of anaphylaxis

A student not known to be at risk of anaphylaxis may also display symptoms of severe allergic reaction. Per the National Institute of Health, 16- 18% of children experience their first reaction at school. In such circumstances, school staff should assess the situation and take action as would be appropriate for any other illness/injury/emergency incidents. This includes calling 911 if anaphylaxis is suspected.

Any school staff or volunteer, or school bus operator validly authorized under state law to operate the school bus, he/she is operating, may use an epinephrine delivery device to administer epinephrine to any pupil who appears to be experiencing a severe allergic reaction if, as soon as practicable, the school bus operator, employee or volunteer reports the allergic reaction by dialing the telephone number “911” or, in an area in which the telephone number “911” is not available, the telephone number for an emergency medical service provider.

When given intramuscularly (IM) in the outer thigh, the onset of action is quick and peaks within 9 minutes. When given intranasally, it is absorbed through the nasal mucosa and onset of action is within 1 minute. It must be given as soon as possible to treat and reverse symptoms. Administering epinephrine buys time to get to an emergency room for additional care. If epinephrine is given, 911 or emergency services should be called immediately.

A second Epinephrine delivery device may be administered if no improvement in symptoms occurs within 15-20 minutes, regardless of which delivery device is used. When in doubt, administer Epinephrine delivery device and immediately call 911. Due to the short duration of action of epinephrine and the high potential that additional emergency treatment will be needed, prompt activation of the local EMS by calling 911 and subsequent transport to a medical facility is imperative. Unfortunately, epinephrine and other treatments for anaphylaxis are not fail-safe; deaths can and do occur despite administration of emergency medications. The only truly effective treatment is absolute avoidance of the allergen.

When a student known to be at risk for anaphylaxis displays initial symptoms, it must be presumed that the student is in need of the assistance outlined in the student’s emergency health plan. Immediate intervention is essential. It will not harm the student if his/her prescribed medication is given even if anaphylaxis is not present. When a trained employee, except healthcare professionals, administers epinephrine to a staff member, volunteer, or visitor displaying symptoms of anaphylaxis, it is presumed that the person administering the stock epinephrine delivery device is acting in good faith and is immune from civil liability unless the act or omission constitutes a high degree of negligence.

LEGAL REF.:

  • Wisconsin Statutes
    • 118.125 Confidentiality/maintenance of student records
    • 118.29 Medication administration by school personnel; policy/procedure requirements
    • 121.02(1)(g) Emergency nursing services standard
    • 146.81-146.83 Confidentiality of patient health care records
    • PI 8.01(2)(g) Wisconsin administrative code emergency nursing services requirements; medication administration procedures required

CROSS REF.:

AFFIRMED:

  • August 27, 2013
  • October 22, 2024
  • August 26, 2025