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Brs.pleasantvilleschools.com

PLEASANTVILLE UNION FREE SCHOOL DISTRICT
60 Romer Avenue
Pleasantville, New York 10570
Matthew Dugan, M.D.
School Physician

In an attempt to provide the best care to children and teenagers in the district, we are implementing new policies for managing severe allergic reactions. Allergic reactions can occur to a variety of foods, especially milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat. Allergic reactions can also occur after exposure to insect stings, drugs or other allergens. Severe allergic reactions typically consist of hives, facial swelling, and respiratory distress (breathing difficulties). The school district has a protocol for managing severe allergic reactions that occur in school in any child, even those without a known allergy who has their first reaction while in school. If your child has a history of severe allergy, please notify his or her school nurse. Please also ask your child’s physician to complete the enclosed form with particular instructions for managing reactions. Even if you have notified the district in the past of your child’s history, please do so again so that we have an updated list of children with severe allergies. We highly recommend that your physician complete the enclosed form. However, in the event of a severe allergic reaction in any child, the school nurse may give benadryl and/or EpiPen without prior permission. Benadryl and EpiPens are available at each school in the district. If your child has asthma or requires other medicines, please leave labeled medications and signed permission forms in the nurse’s office so they are available in an emergency situation. If your child has a food allergy, we recommend only foods prepared at home be eaten at school. If you would like you may leave a non-perishable snack in the classroom for class parties. The names of children with known food allergies will be given to the cafeteria staff. Thank you so much for your attention to this important issue. Pleasantville Union Free School District
Treatment Of Severe Allergic Reactions/Anaphylaxis
Name_______________________DOB_________Date________ o Food____________________________________________
____________________________________________

o Drugs___________________________________________
___________________________________________ o Stinging Insects:___________________________________
o Other:____________________________________________
1. If the child develops hives only - give an antihistamine. a. Dose: Benadryl_________tsps. by mouth b. Observe child closely for additional symptoms. Notify 2. If child develops signs of a severe reaction: a. Give EpiPen______(Reg. or Junior) into fleshy portion b. Arrange for transport to the Emergency Room. 4. If wheezing occurs treat with:________________________ Physician Signature:________________________Date:_________ Physician Stamp:

Source: http://brs.pleasantvilleschools.com/forms/BRS%20Forms/BRS%20Incoming%20Kindergarten/Dr%20Dugan%20Letter-Allergic%20Reaction%20Form.pdf

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