Food Allergy Action Plan s2

BEE ALLERGY ACTION PLAN

Student’s Name: ______D.O.B: ______Building: ______

ALLERGY TO: ______Asthma: Yes (higher risk for severe reaction) No

TREATMENT

Symptoms Give Circled Medication (to be determined by physician)

 Child has been stung , but NO SYMPTOMS: Epinephrine Antihistamine  Mouth: Itching, tingling, swelling of lips, tongue, mouth Epinephrine Antihistamine  Skin: Hives, itchy rash, swelling of face or extremities Epinephrine Antihistamine  Gut: Nausea, vomiting, cramps, diarrhea Epinephrine Antihistamine  Throat: Tightening of throat, hoarseness, cough Epinephrine Antihistamine  Heart: Thready pulse, fainting, pale, blueness Epinephrine Antihistamine  Other: ______Epinephrine Antihistamine

Medication/Doses : Epinephrine (brand and dose):______

Antihistamine (brand and dose): ______

MD Signature: ______

Any Severe Symptoms after suspected sting INJECT EPINEPHRINE IMMEDIATELY and CALL 911

 Pull off gray safety cap  Place black tip on outer thigh (flesh is preferred, but it can be given through clothing.  Using a quick motion, press hard into thigh until Auto-Injector mechanism functions. Hold in place and count to 10. Remove EpiPen and give to EMS when they arrive.

Lenawee Intermediate School District 05/11 1