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June 01, 2004  |   Comments (0)   |   Post a comment

How to identify and respond to insect sting allergies

by Dr. Ray Turner


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Special-needs drivers and teams must take extra precaution during the summer to protect students with disabilities and severe allergic reactions against potentially fatal insect bites, especially from bugs that seek shelter aboard school buses.

The types of insects children are most likely to have a severe allergic reaction to include wasps, honey bees, hornets, yellow jackets, ticks and ants. Some biting insects, such as mosquitoes, flies, lice, kissing bugs and fleas, can also cause severe allergies because they inject saliva to thin the blood when they bite.

Reactions
Generally, there are three kinds of reactions to insect bites or stings.

1. Normal reactions involve pain, redness, swelling, itching and warmth at the site of the sting.

2. Toxic reactions result from multiple stings. Five hundred stings will likely kill because of the quantity of venom involved, and as few as 10 stings within a short time could cause serious illness. Symptoms of toxic reactions include muscle cramps, headache, fever and drowsiness.

3. Allergic reactions have symptoms similar to toxic reactions, but may be triggered by a single sting or small amounts of venom. Any non-local reaction to a single sting should be considered allergic until proven otherwise.

Local or systemic?
Allergic reactions may be local or systemic. An allergic reaction is considered local if it involves only the stung limb, regardless of the amount of swelling. A slight systemic reaction may involve hives and itching on areas of the body distant from the sting site. Feelings of anxiety and being run down occur as well.

The most serious symptoms are the closing of airways and shock (anaphylaxis) since they can be fatal if not treated quickly and effectively. Allergic reactions may begin within 10 to 20 minutes after the sting, or they may be delayed. Usually, the sooner the reaction starts, the more severe it will be.

Standard treatments used to control the reaction are epinephrine, oxygen and intravenous fluid.

Teams should call 911 immediately when an anaphylactic reaction occurs.

Precautions
There are specific precautions in place on the special-needs bus that drivers aware of students with severe allergies onboard must take. They include:

1. Use bus air conditioning during the summer or whenever certain insects are known to exist in the environment.

2. Keep bus windows closed when special-needs children are on board during runs. At other times, and only if necessary, the windows can be opened for rider comfort.

3. Keep front exit doors closed whenever possible. Many times drivers keep the stairwell door open far longer than necessary.

4. Bus assistants must get severely allergic children boarded as quickly as possible and shut the door behind them.

5. Insect killing sprays may be necessary when insects get on an enclosed bus. Spraying must be done carefully to avoid allergic reactions from others who are sensitive to the chemicals in the spray.

Recommendations
Medical packs can be kept on the bus for use with students who may have anaphylactic reactions and can be administered by the bus assistant or driver team only if absolutely necessary.

The IEP Committee and the child’s physician must provide written orders for the driver team to have documentation on board the special-needs bus for this procedure to be done.


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