Twitter continues to be my go-to resource for connecting with incredible healthcare professionals, especially nurses. This is where I first met Susan Kelly and contacted her after reading her Tweet suggested the need for a Food Allergy Nurse Educator, much like a Diabetes Nurse Educator. I have learned much from interacting with Susan. She is a fierce advocate for food allergy education for parents, school nurses, teachers and anyone who interacts with students.
Susan’s nursing career took a new direction after her daughter was diagnosed with a life threatening food allergy. She now works with an allergist and speaks, writes and leads forums to promote food allergy awareness. Susan understands the importance of the relationship between parents and school nurses and is dedicated to helping manage food allergies in schools to help us keep our students, like her daughter, safe, healthy and ready to learn.
While researching this blog post, I read another post that Susan wrote, which has a link in this blog. In it, she discusses the tragic death of an 11 year old girl who died after brushing her teeth with a prescription toothpaste that helped promote tooth enamel and whitens dark spots. The toothpaste included a milk protein (Recaldent is the commercial name) and this young girl had a severe milk allergy. Imagine the horror that this family has experienced. I never knew that dental products could contain milk proteins, did you? There is so much to learn about food allergies. Parents are not being difficult, they are being vigilant because the worst can and has happened. All it really takes is one time!
Here is the Tweet that caught my eye:
I knew very little about food allergies and anaphylaxis, until my second daughter had a severe allergic reaction from a tiny bite of her sister’s peanut butter and jelly sandwich back in 2007. After a trip to the emergency room, her pediatrician referred us to an allergist. He confirmed her food allergy diagnosis. We had a very serious conversation about how to keep my child safe. Above all, he emphasized the importance of always carrying two epinephrine auto injectors, reviewed the signs and symptoms of anaphylaxis and showed me how and when to use her auto injector. His instructions were straightforward: Do not hesitate. Give Epi. Call 911 for transport to the ER for monitoring. If not improving, give second epi. Any delay could result in a grave or fatal outcome. Having an anaphylaxis plan helped me navigate the two times I did have to epi her. Our conversation is seared in my memory.
I sat there like a deer in headlights, completely shocked. As an educated nurse, I was also angry. I never learned about this in college or thereafter. I believe food allergy and anaphylaxis training should be required for all nurses, just like CPR and AED usage. At a minimum, we must know the basics. I wrote this blogpost to help educate nurses like myself.
When my daughter was starting school, I felt completely overwhelmed. As a mom, I was terrified. As a nurse, I wondered how parents without a medical background accomplished this. It is a complex process, requiring knowledge, training, teamwork and excellent communication skills. I quickly learned the school nurse plays a critical role in facilitating this process. I also learned schools that follow and maintain a comprehensive food allergy and anaphylaxis management policy are better prepared to assist food allergic students. The St. Louis Children’s Hospital Food Allergy Management & Education (FAME) Toolkit is a wonderful resource for schools to develop such policies. The toolkit complies with the 2013 CDC guidelines for food allergy management in the school setting.
To protect these students, anaphylaxis prevention strategies are necessary. Beginning with the bus ride, there are numerous times in the school day when a child might accidentally ingest or come in contact with his or her allergen(s). Staff should be aware of the student’s allergies and trained in anaphylaxis recognition and response. Students with food allergies should also know to tell an adult if feeling unwell and should never go to the school nurse alone. Simple ways to reduce the risk allergic reactions are to enforce a no food/ drink/ utensil sharing rule, hand washing or wiping with a commercial wet wipe before/ after meals since hand sanitizers do not remove food proteins, reducing the chance of cross contact with allergens, safe but not isolating lunchroom seating, label reading for allergens in food and school supplies, food free celebrations for the safety and inclusion of all students. Having the student’s epinephrine auto injectors safely stored (if not self-carrying) and readily available is also extremely important. Finally, educating the entire school community helps create a caring and supportive environment. The Food Allergy & Anaphylaxis Team, FAACT has their free and downloadable Food Allergy Curricula Program for Schools.
Besides caring for students who are diagnosed with allergies, 25% of first time anaphylactic reactions happen in school to those with no known history of allergies. Therefore, it’s important to know your state’s stock epinephrine laws and update and/or develop policies as needed. I highly recommend reading this discussion paper, written by two nurses who make a strong case for stock epinephrine auto injectors and anaphylaxis preparedness in schools.
As a school nurse, it’s most important to remember an epinephrine auto injector is the first line of treatment for anaphylaxis. There are no contraindications to administering epinephrine if suspecting an anaphylactic reaction. Antihistamines will not stop anaphylaxis and will only delay the administration of epinephrine, putting the student or staff member’s life at risk. Always remember, past reactions do not predict future reactions. A mild reaction can quickly become life threatening. Anaphylaxis doesn’t always look the same or immediately involve the skin or airway. Vomiting after eating a known allergen is a sign of anaphylaxis! Every second counts during an anaphylactic reaction. Our mantra is, “Epi First, Epi Fast!” & then call 911 for transport to the emergency room.
Thank you for all you do!
Bio: Susan Kelly, BSN, RN is a 1996 graduate of the University of Scranton. She received the University’s 1996 Excellence in Nursing Award. She currently works for Allergist and Immunologist, Dr. Marc Sicklick, and is a member of Sigma Theta Tau International Honor Society of Nursing. Her clinical background includes General Medicine, Cardiology, Intensive Care and Emergency Room Nursing. Susan and her husband, Alan, have four daughters and reside on Long Island. She co-leads Friends Helping Friends Food Allergy Support Group and focuses on providing food allergy education, support and empowerment.
Her work includes writing, public speaking and educating communities on the seriousness of food allergies, as well as anaphylaxis recognition and response. Susan blogs about food allergy life at www.momnursefoodallergies.wordpress.com. She has been published in Allergic Living Magazine’s Food Allergy Anxiety Guide. She was also named Lynbrook’s 2017 Citizen of the Year for her food allergy advocacy and education efforts. She has held Food Allergy Public Awareness Forums for her local assemblyman and has helped schools create and implement inclusive food allergy management and anaphylaxis policies. Susan successfully advocated for Lynbrook’s police officers to be trained in anaphylaxis recognition and to carry stock epinephrine auto injectors for use in anaphylaxis response.
Susan was instrumental in passing food allergy training legislation for restaurants in Nassau County, Long Island. The Food Allergy Restaurant Safety Ordinance was signed into law on October 2, 2019. Susan was recently appointed as the Health and Wellness Chairperson for the Village of Lynbrook. She has served as a school board member and volunteers for her parish as a religious education instructor. Susan is consistently recognized for her positive impact on social media. You can follow her on Twitter @sheimkelly on Facebook @FoodAllergyLife on Instagram @susankelly_rn and on Linked In @SusanKelly.