Food Allergy Action Plan
Extremely reactive to the following foods:
If checked, give epinephrine immediately if the allergen was LIKELY eaten, for ANY symptoms.
If checked, give epinephrine immediately if the allergen was DEFINITELY eaten, even if no symptoms are apparent.
Epinephrine Brand or Generic:
Antihistamine Brand or Generic:
Other (e.g., inhaler-bronchodilator if wheezing):
Stay with the student; alert healthcare professionals and parents. Tell rescue squad epinephrine was given; request an ambulance with epinephrine. Note time when epinephrine was administered. A second dose of epinephrine can be given 5 minutes or more after the first if symptoms persist or recur. For a severe reaction, consider keeping student lying on back with legs raised. Treat student even if parents cannot be reached. See back/attached for auto-injection technique.
Parent / Guardian