In 2012, two 7-year-old girls happily played together on the playground at recess. One shared her snack, unaware that the peanut was toxic to her friend, Ammaria. A reaction to the peanut product sent Ammaria to the school clinic aid, who attempted to treat her. Ammaria’s condition continued to deteriorate until she suffered anaphylaxis and cardiac arrest. Epinephrine, in the form of an EpiPen, may have been able to save Ammaria’slife; unfortunately, one was neither prescribed to her nor on school grounds at the time. Hopkins Road Elementary, like many schools in 2012, was only allowed to use an EpiPen that was present and prescribed to the student who needed it; school officials were prohibited from administering one child’s pre-designated EpiPen to any other children.
Over the last few years, approximately 25 percent of anaphylaxis events in schools involved children whose food allergy was undiagnosed. And many of the fatalities from anaphylaxis were primarily due to delays in administering epinephrine. As a result, encouraging access to stocked, undesignated EpiPens has become a central focus in helping schools respond appropriately to food allergy emergencies.
Symptoms of Anaphylaxis
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Allergies can affect several body functions, such as breathing and blood circulation, during anaphylaxis and result in the following symptoms:
- Difficulty breathing
- Swollen lips or tongue
- Low blood pressure—causing weak pulse, confusion or loss of consciousness
Anaphylaxis can also be unpredictable. For instance, a child who previously had only mild reactions could have a life-threatening reaction at the next exposure and a child with a history of serious reactions may have a mild one. Additionally, children at highest risk appear to also suffer from asthma and likewise delay receiving epinephrine. Anaphylaxis response should always be treated as an emergency and epinephrine delivered immediately.
Epinephrine Is the First Line Treatment for Anaphylaxis
Epinephrine can reverse symptoms of severe anaphylaxis. It is a highly effective medication that must be given quickly to be the most effective. Treatment with epinephrine must occur immediately to reverse or reduce symptoms and to prevent death, which can occur within an hour. Since 2010, there have been several reports about fatal events involving children who experienced an anaphylaxis response to food allergies while at school. The reports triggered national debate about whether schools should keep epinephrine on hand to treat any child experiencing severe allergic reactions that result in anaphylaxis.
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H.R. 2094: School Access to Emergency Epinephrine Act
Identifying epinephrine as the primary treatment for anaphylaxis is the first step. Ensuring school staff members are trained and protected from liability claims when using it is another step altogether. This is where FARE, the Food Allergy Research and Education network, comes in. For two years, FARE championed legislation that would both protect students in need of epinephrine in an anaphylaxis emergency, and protect authorized personnel who administer the epinephrine from legal liability under Good Samaritan laws. In November of 2013, the School Access to Emergency Epinephrine Act (the Act) was signed into law. The Act not only protects children whose epinephrine is not immediately accessible during an emergency, but those who do not have an EpiPen prescribed to them.
The Act does not require schools to stockpile EpiPens, but instead provides a financial incentive to states. It gives participating states preference for receiving federal grants related to children’s asthma treatment. States wishing the preference must implement laws or guidelines which:
- Allow schools to maintain an emergency supply of EpiPens for any student believed to be having an anaphylactic reaction
- Permit trained school personnel to administer epinephrine
- Develop a plan for ensuring trained personnel are available to administer epinephrine during all hours of the school day
- Contain the requisite Good Samaritan laws designed to protect trained school personnel from liability if they administer epinephrine to a child experiencing anaphylaxis symptoms
As of April 15, 2014, almost every state in the continental U.S., and Alaska, has a law requiring or allowing schools to stock emergency epinephrine and administer it to any child reasonably believed to be experiencing anaphylaxis.
Many schools have begun stocking emergency supplies of EpiPens under the new legislation. The hope is that, as more schools respond and begin to prepare for food allergy related emergencies, the threat of anaphylaxis related fatalities in schools will continue to diminish.