Food Allergy Action Plan - University of Michigan

University OF Michigan HOSPITALS & HEALTH CENTERS DIVISION OF Allergy & CLINICAL IMMUNOLOGY BIRTHDATE: NAME: MRN: food Allergy Action plan Date: _____ Weight: _____ lbs Allergy to: _____ Asthma: Yes (high risk for severe reaction) No Action FOR MINOR REACTION 1. If only symptom(s) are: A few localized hives, give ANTIHISTAMINE. (see dose below) 2. Stay with student; call parents or emergency contacts. 3. Continue to observe child, if symptoms progress or fail to improve in 30 minutes, follow steps for MAJOR REACTION BELOW. SIGNS OF AN ALLERGIC REACTION Systems Symptoms MOUTH Itching or swelling of the lips, tongue or mouth THROAT Itchy throat, sensation of tightness, swelling, hoarseness, hacking cough SKIN Diffuse hives, itchy rash, redness swelling about the face or extremities STOMACH Nausea, abdominal cramps, vomiting, diarrhea LUNG Shortness of breath, repetitive coughing, wheezing HEART Weak pulse, passing out The severity of symptoms can quickly change.

A food allergy response kit should contain at least two doses of epinephrine, other medications as noted by the student’s physician, and a copy of this Food Allergy Action Plan. A kit must accompany the student if he/she is off school grounds (i.e., field trip).

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  Food, Plan, Action, Allergy, Food allergy, Food allergy action plan

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