Safe at Summer Camp: Epinephrine for Severe Allergies

Canoe trip in the morning. Nature hike in the afternoon. After dinner, a kickball game before the evening campfire. Summer camp is chock-full of adventures, games and memories. But if your child has food or insect venom allergies, it’s essential to be prepared in case of a severe allergic reaction.

That means epinephrine – the first-line treatment for a severe allergic reaction, also called anaphylaxis. The medication comes primarily via nasal spray or auto-injector.

First, make sure the camp has an updated copy of your child’s Allergy and Anaphylaxis Emergency Plan (PDF).This should include:

• known allergens (food, insect venom, medication, latex)
• symptoms of a food reaction, including anaphylaxis
• how to use the epinephrine device (if you are providing one to the camp or your child self-carries)
• emergency contact information

Check camp policies on epinephrine. Find out if the camp stocks emergency supplies of epinephrine in a clinic or elsewhere on site. Where is it stored and is it easily accessible in an emergency? Are camp staffers and counselors trained in signs and symptoms of anaphylaxis and administering epinephrine?

Find out the camp’s emergency response plan following epinephrine treatment for an allergic reaction. This may include medical care at an emergency department or hospital if needed. Camp staff should alert you and your child’s doctor as soon as possible and discuss next steps.

Preparation and clear communication with camp staff can help ensure a safe and worry-free adventure for campers and peace of mind for parents and guardians. Remember, the goal is for your child to focus on making memories – not managing emergencies.

Can campers self-carry epinephrine?

In most U.S. states, youth campers are permitted to self-carry and use epinephrine. But the rules and regulations vary by state. Prior to the start of camp, review the state laws and check with camp administration on policies for kids who self-carry epinephrine.

Parents or guardians should consider whether their child is mature enough to self-carry epinephrine. Some children as young as 9 or 10 may be able to self-carry and use epinephrine in an emergency. In general, camps may require signed consent or permission forms from the child’s doctor and from parents or guardians.

Before camp, check the expiration date of your child’s epinephrine. If it’s expired or close to expiring, make an appointment with a doctor to get a new prescription.

“I recommend campers bring two 2-packs of epinephrine to camp, if they are able to afford it,” says Nancy Polmear-Swendris, RN, program coordinator at the University of Michigan Food Allergy Program and a camp nurse for 30+ years. “One 2-pack could stay with the camper and the other 2-pack could stay with the camp nurse in the clinic.”

Advice for parents or guardians:

• Make sure your child is able to self-identify signs and symptoms of an allergic reaction.
• Confirm your child knows how to correctly use the epinephrine device. Ask your child to demonstrate proper usage with a trainer before camp.
• Devise a plan with your child about where to keep the epinephrine so it is safe and secure. This includes various weather conditions and excursions.

Ask about the emergency response for an anaphylactic reaction. Find out procedures for contacting parents or guardians.

How to pack epinephrine at camp

It might be best for your child – if age-appropriate – to self-carry epinephrine. But where and how should the devices be stored?

Keep the epinephrine devices in a case or pouch. Some can clip on to your belt for safekeeping and easy access. Label your name and contact information on the case or pouch.

Carry bags, backpacks or fanny packs are great options for carrying epinephrine. Nasal sprays are typically small and compact enough to be kept in a pocket. Auto-injectors are usually a little more bulky. (Remember, there are two devices in each pack.) Keeping epinephrine in your pocket might not be best for many camp activities, such as a canoe trip, high-ropes course, ziplining, or games like kickball or basketball.

The important thing is to ensure the epinephrine is safe, secure and accessible at all times.

Epinephrine nasal sprays

Epinephrine is best kept at room temperature (68-77 degrees Fahrenheit). But that’s not always possible at summer camp.

Studies show the epinephrine nasal spray neffy® can maintain potency and effectiveness in extreme heat – up to 122 degrees Fahrenheit – but only for “excursions.” Prolonged exposure to heat should be avoided.

Do not freeze neffy, keep it in a cooler, or store it with ice packs. If it does freeze, the device will not spray. But do not throw it out. Once thawed, neffy will still work and be effective.

How to use neffy® (epinephrine nasal spray) in a child ages 4 years and older (33 to 66 pounds)

Epinephrine auto-injectors

Epinephrine auto-injectors should also be kept at room temperature. They should not be exposed to extreme heat or cold temperatures. They should not be stored inside a car, kept in a refrigerator, freezer or cooler, or stored with ice packs.

However, the package insert says short-term activities in temperatures as high as 86 degrees and low as 59 degrees are permitted.

“If an epinephrine auto-injector gets too hot or too cold, it can degrade the epinephrine and it may not work as needed,” Michael Pistiner, MD, MMSc, pediatric allergist, says. “On hot days at camp, when kids need to seek shade and cooler temperatures, the auto-injectors should go with them. Don’t leave them baking in the sun.”

Auto-injectors should not be exposed to sunlight. Keep the devices in a protective case. If exposed to air or light, the epinephrine can change quickly to a pink or brown color. Before using an epinephrine auto-injector, check the medicine’s viewing window. If there is any discoloration, or if the medicine appears cloudy or there are particles, the device should not be used.

Is epinephrine waterproof?

No, epinephrine nasal sprays and auto-injectors are not waterproof. Some cases used to carry the devices are waterproof, though.

Going on a canoe, kayak or rafting trip at camp? Pack epinephrine in a waterproof, floatable container or Ziploc bag. If it’s not practical to bring a backpack or wear a fanny pack inside a canoe or kayak, then tie it tightly to the vessel.

“Campers often flip their canoe over, and if the epinephrine device is not secured, it’ll be lost in the water,” Polmear-Swendris says.

Managing food allergies at summer camp

Summer camp is an exciting time for kids, but managing food allergies requires careful preparation – for parents, campers and camp staff.

Parents can start by informing the camp staff about their child’s food allergies well in advance. Provide a detailed Emergency Care Plan that lists symptoms to watch for and emergency procedures.

Find out how the camp’s kitchen staff prepares meals. Check the menu for each day. (If possible, speak with someone from the kitchen staff prior to camp.) Ask about ingredient labels, cross-contamination and food handling protocols, and allergen-free meal options.

Food is often served buffet-style at camps. Ask if the kitchen staff can use dedicated pans and serving utensils for campers with food allergies.

Also, confirm that epinephrine is readily available in the cafeteria and any place where campers eat.

If your child is mature enough, teach them to self-advocate. This includes asking about ingredients before eating and avoiding shared food. Prior to camp, role-play situations they might encounter, such as turning down snacks or asking staff for help. Encourage your child to talk with bunkmates and friends about food allergies and how they can provide support in an emergency.

Managing insect venom allergies at summer camp

Summer camp requires extra precautions for children with a known insect venom allergy.

Parents should inform camp staff of the allergy and provide a detailed Emergency Care Plan. The plan should list insect sting and allergy symptoms to watch for, as well as emergency procedures.

Self-carry may be best for your child if age appropriate. An insect sting can happen anytime, anywhere, at camp. Teach your child how to self-administer by practicing before camp.

Talk with camp staff about reducing exposure to stinging insects, especially during outdoor activities. Some tips:

• Keep food and drinks covered.
• Avoid using scented products that attract insects.
• Steer clear of flowering plants.
• Don’t swat at insects; instead move away.

If it’s not too hot, recommend your child wear long sleeves and long pants when outside.

Educate your child and provide camp staff with information about stinging insects. These may include wasps, bees, hornets, yellow jackets and red ants (also called fire ants). This can help you identify and avoid insects.

Supported by: