Are Schools Prepared to Handle Food Allergy Emergencies?
Officials in the state of Virginia are investigating the death of a 7-year-old Chesterfield County girl who appears to have died as a result of a severe peanut allergy reaction. School officials are investigating the procedure that the child’s elementary school followed during the emergency to evaluate if the staff was adequately prepared to handle such incidents. Unfortunately, with the increase in the number of children with food allergies combined with the reduction in education staffing due to financial constraints, this type of tragedy could easily happen anywhere. How prepared are our schools to handle children with severe health conditions such as food allergies?
According to the Food Allergy and Anaphylaxis Network (FAAN), approximately 8% of American kids have an allergy to a food ingredient. The most common are peanuts, tree nuts, eggs, milk, fish, shellfish, soy and wheat. Symptoms can range from mild itching to severe anaphylaxis within minutes of eating the offending food. There is no “cure” for a food allergy; strict avoidance is the only way to avoid a reaction.
Obviously, children spend the majority of their waking hours at school. Most eat at least one meal there, as well as a snack or two. Parents of food-allergic children typically work closely with school officials to ensure that everyone is aware of the allergy, what the child’s plan of care is in the case of an emergency, and usually strictly monitors what a child eats. Unfortunately, as in the case of first-grader Ammaria Johnson, accidents do happen.
Ammaria was allergic to peanuts. She complained to her teachers of hives and shortness of breath during recess after “eating something bad.” It is unclear where she got the offending food, or even exactly what it was. Unfortunately, communication mix-ups appear to have played a role in her death, as the school did not have medication to reverse the anaphylaxis.
Epinephrine (adrenaline) is the first-line treatment for severe allergic reactions. Delayed use of epinephrine has been associated with deaths, says the FAAN. In the case of severe allergies, a doctor will prescribe an epinephrine auto-injector, commonly called an Epi-Pen. In schools, the most common procedure for allergic children is to have parents provide prescribed medication to the school along with an authorization form on how to use the medication if it is needed.
In Ammaria’s case, there was not an Epi-Pen at the school prescribed specifically for her. The school nurse could not give the girl medication prescribed to someone else.
Schools keep many over-the-counter products on hand for emergencies – band-aids, antiseptic for cuts, etc. But should they keep other types of medications that potentially save lives? The FAAN is working with legislators on a bill that would require schools to stock epinephrine auto-injectors to be used for anaphylactic emergencies. Data shows that up to 25% of all epinephrine administrations occur in the school setting, and that many involve students who were unaware of their allergy.
The “School Access to Emergency Epinephrine Act (S.1884) was introduced in the Senate on November 17th, 2011 and in the House of Representatives (HR.3627) on December 8th. The bill complements one passed last year called the “Food Allergy and Anaphylaxis Management Act (FAAMA)” which requires the US Secretary of Health and Human Services to develop and make available to schools a voluntary policy to manage the risk of food allergy and anaphylaxis in schools and to provide for school-based food allergy management incentive grants to support implementation of public school guidelines.
Should the law pass, this extra safety effort should not replace basic education to school staff. "It's very straightforward. There is no magic to this," said Maria Acebal, head of the FAAN. “When consequences can be life-threatening, then you've got to have schools prepared for an allergic reaction. It's absolutely doable to keep kids with food allergies safe at public school, but it requires education and preparedness." She notes that Ammarie's death "just underscores the need for all teachers to have the basics of food allergy safety as part of their orientation and continuing education."
Parents should also have open communication with their child’s school and have an Individual Health Care Plan (IHCP) in place should there be an emergency situation. Creating a multi-disciplinary team that includes the school nurse, the principal, the child’s teacher(s), the cafeteria/food service manager and any other staff member involved during the school day (ie: bus driver, athletic coach) can go a long way to creating a safe atmosphere for a food-allergic person.
Another piece of legislation that would help parents keep their food allergic child safe at school would be to include the labeling of food ingredients, including food allergens, on school menus. The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires the labels of all foods containing major allergens to declare so in plain language. Unfortunately, this law does not extend to the food that is ultimately served to our children at school lunch. A 14-year-old high school freshman hopes to one day change that.
Lauren Maunus of Florida has written a bill and presented it to state legislators after seeing what her mom had to go through to keep Lauren’s 11-year-old food allergic sister safe at school. "My mom would have to go the county offices to see the labels of foods in the school cafeteria, and if any of the labels changed, she was not informed of it," Lauren said. "It was really scary. This bill would allow my sister, every time she was about to put something in her mouth, to know what was in it before she ate it."