All schools have a duty to provide a safe environment for children and to act appropriately in an emergency. We know that nearly six million children have a food allergy-which equates to approximately two per classroom! Additionally, according to the CDC, food allergies have dramatically increased since 1997 and many individuals do not have their epinephrine with them at all times. So, schools need to be prepared to handle allergic reactions-not only in the child with a known allergy, but with those who have not yet been diagnosed.
My passion and advocacy for protecting students with food allergies in school came about because I had to make a decision to give a student another student’s epinephrine auto-injector when the student was suffering from severe anaphylaxis and paramedics had not yet arrived and unfortunately, he had no previous history of anaphylaxis so had no medication at school. Because of my actions, he was able to be safely transported to the hospital and recovered but it did shed light on the fact that without epinephrine available to any student suffering from anaphylaxis, the outcome could be much different.
As a result, California passed a law allowing schools to stock epinephrine for undiagnosed cases of anaphylaxis, but that is not enough because it doesn’t protect all the children, since schools have a choice. A law, Senate Bill 1266, is now pending that will require epinephrine to be stocked in all schools. But it is important for parents and schools to partner together to reduce the risk of exposure and to ensure quick access to epinephrine.
Parents should work collaboratively with their school nurse, the cafeteria staff, administration and teaching staff with regards to classroom activities involving food (e.g. no peanut products should ever be used for classroom projects or snacks) as well as developing a plan for the cafeteria. Having an identified table for students to be able to sit at is an option or using paper placemats as a means to protect the child’s food from surface contamination and to identify it as a ‘safe zone’ for their food is another option.
Storage and access to the epinephrine should also be discussed. It should be easily accessible (if in a locked cabinet, all staff needs to have a key to the cabinet so critical seconds are not lost waiting for someone to unlock the cabinet. If the student carries their epinephrine, a plan needs to be in place as to who knows where it is and is the backpack with the student at all times. Additionally, field trips and other activities away from the classroom/health office (where the epinephrine is stored) need to be discussed and a plan needs to be developed.
Besides ensuring a safe classroom/cafeteria and storage issues, training of staff is a critical piece of the plan. Staff should be trained on the use of the epinephrine as well as signs and symptoms of anaphylaxis. An individualized plan such as a 504 plan should be in place for all students with a known food allergy.
In conclusion, parents should work together with their schools and school nurse to develop a plan for a safe environment and also advocate for standing orders for epinephrine! It is important to remember that there is no absolute contraindication for giving epinephrine when someone is having breathing difficulties and most importantly, a child’s life may be saved!