● Continued symptoms. ● Difficulty breathing. ● Rash. ● Signs of an acute infection. ● Obvious need for allergy testing or desensitization immunotherapy. ● Prescription for epinephrine re- quired. Follow-up Actions ● Evaluate workstation to determine if allergen source is present and has been mitigated. ● Counsel employee regarding avoidance of allergen (e.g., teach about prevention of insect stings and avoidance of bright colors, floral perfumes, flower beds). ● Discuss wearing medical alert tag. (See figure on next following page.) ● Schedule the employee for a re- turn visit to assess effectiveness of treatment and symptom relief. ● Instruct employee to discuss the need to carry epinephrine with personal health care provider. 51 Obtain pertinent history. Provide symptom relief. Monitor health status. Reduce possible work exposures. ● Elicit details regarding history of symptoms, including aggravating and relieving factors, past experience, recent exposures, onset of symptoms, and occupational job descrip- tion. Also include questions about known allergies, the home environment (including pets, hobbies, tobacco use), and other per- tinent information. ● Determine possible job exposures if the symptoms are work related (worse at work, relieved during days off). ● Administer medication per standing order according to the symptoms and severity of the reaction. For example: – Topical agents for contact dermatitis. – Antihistamines or bronchodilators for res- piratory symptoms. – Diphenylhydramine or epinephrine for systemic reactions. ● Provide care in a calm and reassuring manner. ● Review history for hypertension or cardiac arrhythmias when administering or recom- mending medication (e.g., epinephrine can constrict blood vessels, increasing blood pressure, and cause tachycardia). ● Monitor vital signs and airway patency. ● Conduct walk-through with other health and safety team members (e.g., an indus- trial hygienist when possible) to determine potential allergens in the workplace. ● Collaborate with health and safety team re- garding reducing and eliminating offending allergen. ● Implement appropriate measures for aller- gen reduction (e.g., engineering controls, chemical substitution, personal protective equipment). Objectives Clinical Assessments and Interventions Referral for Medical Action