Strong Reactions: Anaphylaxis in the Workplace

Camp Courant in Hartford, Connecticut, has served the children of the community for more than 120 years. Walter Darden was a 64-year-old maintenance worker who had been at the camp for 10 years. On June 19, 2015, Darden was working at the camp when he was stung by yellow jackets that had nested inside an air conditioner. When he became ill, coworkers called 911, but Darden died at the hospital. Darden had no history of allergy to insect venom—until the medical examiner determined that anaphylaxis caused by yellow jacket venom was what had killed him.

Yesterday we looked at how anaphylactic allergies are different from ordinary allergies and the most common triggers that can cause allergic reactions. Today we’ll look at the potential impact of anaphylactic allergies in the workplace.

When to Worry About Anaphylaxis

In the workplace, concerns about anaphylaxis are threefold:

  • Workers with known anaphylactic allergies. There may be someone in your workplace who knows that he or she has an anaphylactic allergy. Typically, people with known allergies will know, and they will make an effort to avoid their triggers. They will probably also carry their own set of epinephrine injectors, and they know how to use them.
  • Workers who are exposed to common allergens on the job. Workers may not know that they are allergic to bee stings … until they’re stung by a bee, as happened to Darden. Workers who have been bitten many times by fire ants without incident may unexpectedly develop an anaphylactic reaction. When workers are exposed to allergens with the potential to cause anaphylactic allergies, they could have an anaphylactic reaction on the job, regardless of their medical history.
  • Customers, clients, or visitors who have an anaphylactic reaction in the workplace. This is a common concern in schools and restaurants, where students and customers may encounter allergens that cause anaphylaxis—sometimes, for the first time.

Prepared for Anaphylaxis

There is no record that Walter Darden was given epinephrine, either at the camp or in the ambulance. Because he did not know he was allergic, he did not carry his own EpiPens. So, if your workers are exposed to potentially anaphylactic allergens in the course of their work, or if there is an increased risk of anaphylactic reactions among customers or clients, you should probably be prepared to deal with them. Here’s what you can do:

Accommodate workers with known allergies. Anaphylactic allergies are not a protected disability under the Americans with Disabilities Act, but accommodation is fairly straightforward and not expensive. For example, if you have a worker who has a known allergy to peanuts, you may simply need to avoid serving foods that contain or are potentially cross-contaminated with peanuts (check the labels) in the workplace and at official company functions. You can also permit the individual to keep a set of EpiPens in the workplace.

Train workers to recognize an anaphylactic reaction and potential triggers. If someone who has been exposed to a known anaphylactic allergen begins to show symptoms of an allergic reaction, an immediate response may be the only way to save his or her life. Workers should know to:

  • Have the individual administer epinephrine, if he or she has his or her own injector; if there is an undesignated injector on-site, that can be used.
  • Call 911 immediately. This should be done concurrently with or immediately following epinephrine injection, if epinephrine is available.
  • Identify the allergen. If possible, tell emergency medical personnel what the person was exposed to.
  • Follow up. Individuals who have had an anaphylactic reaction should follow up with a specialist.

Keep epinephrine injectors in high risk areas (as allowed by law). In outdoor work areas or other areas where workers may encounter biting or stinging insects; in food service areas; and in medical settings where latex, anesthesia, or other triggers may be present, epinephrine injectors should be available. Many schools keep injectors in the nurse’s office; some restaurants and public buildings are now stocking injectors alongside their automated external defibrillators or in their first-aid kits.

In order to keep epinephrine in the workplace, you’ll need an “entity prescription.” State laws on this vary, but almost every state allows K–12 schools to stock epinephrine, and an increasing number of states have passed laws allowing restaurants, amusement parks, sports arenas, and other high-risk venues to stock what is called “undesignated epinephrine”—that is, epinephrine auto-injectors that are not prescribed for a specific individual. Some states require the entity to be certified and have trained employees in order to keep epinephrine on hand. Detailed state-by-state information is available here from the Network for Public Health Law.