Severe food allergies affect 15 million people in the United States, including 1 in 13 children under the age of 18. Another 2 million are allergic to the venom of stinging insects and are at risk for a life- threatening allergic reaction known as anaphylaxis which causes the airways to narrow, blood pressure to plummet and can lead to rapid unconsciousness and death. Students with undiagnosed allergies account for 25% of anaphylaxis cases at school.
The Centers for Disease Control conducted a study in 2013 and found that life-threatening food allergies increased by almost 50% between 1997 and 2011. The cause for this dramatic rise is unknown. Approximately 90% of allergic reactions to foods can be traced to milk, eggs, peanuts, tree nuts, soy, wheat, finned fish and shellfish. Even very small amounts of a food allergen can lead to a reaction.
Anaphylactic symptoms usually occur within minutes of exposure to an allergen. Sometimes, however, anaphylaxis can occur a half-hour or longer after exposure. Common symptoms include rashes, hives, itching, flushing or pale skin, and swelling of the lips, tongue and roof of the mouth. The airway is often affected, resulting in tightness of the chest and difficulty breathing. Life-threatening allergic reactions can also be accompanied by nausea, vomiting, stomachache, diarrhea, chest pain, low blood pressure, dizziness, headaches, restlessness and anxiety. Anaphylaxis can occur without any outward skin symptoms (no rash or hives).
There is no cure for food allergies. Early recognition and management of allergic reactions to food are important measures to prevent serious health consequences. Many students with known allergies carry an auto-injector to administer injectable epinephrine into the outer thigh (EpiPen, EpiPen, Jr. or Auvi-Q) at home or at school. An effective food allergy school treatment plan for students includes:
- Strict avoidance of problem foods
- Working with the student’s doctor to develop a Food Allergy & Emergency Care Plan
- Encouraging the student to wear emergency medical identification (e.g., bracelet)
- Allowing the student to carry injectable epinephrine at school/school events
- Having an additional supply of emergency medication available at school
- Giving or student taking medication at the first sign of a reaction (within minutes)
- Calling 911 and transporting the student to an emergency room for follow-up treatment
The School Access to Emergency Epinephrine Act, passed in 2013, encourages schools to plan and/or upgrade their capacity to respond to severe allergic reactions. The law provides financial incentives for states to pass laws allowing schools to stock epinephrine and treat children who do not have a prescription for the drug. The Act authorizes the Department of Health and Human Services to give funding preferences to states for asthma-treatment grants if they: 1) maintain an emergency supply of epinephrine (EpiPens); 2) permit trained school personnel to administer epinephrine in emergency situations, and 3) developed a plan for ensuring trained personnel are available to administer epinephrine during all hours of the school day.
The Ohio General Assembly passed Sub. HB 296, effective April 21, 2014, to allow schools and residential/day camps to procure epinephrine auto- injectors for use in emergency situations without a doctor’s prescription for a specific student. The Act permits a drug manufacturer to donate epinephrine auto-injectors to public and private schools. The law also authorizes a school district or camp to accept financial donations to purchase epinephrine auto- injectors.
If a school board or camp elects to procure epinephrine auto-injectors, the Act requires development of a policy and consultation with a licensed health care professional who is authorized to prescribe drugs to develop procedures for the maintenance and use of epinephrine auto- injectors. The policy must specify who may access and administer an epinephrine auto-injector. While the Act designates licensed school nurses and athletic trainers to administer epinephrine, other employees may also be designated if training is provided. Assistance from an emergency medical service provider must be requested immediately after an epinephrine auto-injector is used. Finally, the policy must identify the individuals, in addition to students and employees, to whom a dosage of epinephrine may be administered in emergency situations.