SOURCES: Scott Sicherer, M.D., professor, pediatrics, allergy and immunology, Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York City; Charlotte Collins, J.D., senior vice president, policy and programs, Asthma and Allergy Foundation of America
FRIDAY, Sept. 19, 2014 (HealthDay News) -- More states are passing legislation permitting or requiring schools to stock the medication epinephrine to use for any child having a severe allergic reaction.
Epinephrine auto-injectors are the primary treatment for "anaphylaxis," an allergic reaction that can lead to throat swelling, breathing difficulties, a steep drop in blood pressure and even death.
In people with severe allergies to certain foods, such as peanuts or tree nuts, insect venom or certain drugs, anaphylaxis can occur within moments of exposure to the allergen, explained Dr. Scott Sicherer, a professor of pediatrics, allergy and immunology at the Jaffe Food Allergy Institute at Mount Sinai School of Medicine in New York City.
But if given soon enough, epinephrine can halt the anaphylactic reaction, saving the child's life, Sicherer said.
"An anaphylactic reaction can progress rapidly and can be fatal," he said. "What we know is the theme for individuals who died from it is they did not get prompt epinephrine -- either they were delayed in getting it or they didn't get it at all."
While many parents of children with serious food allergies supply a prescription epinephrine auto-injector (brand names: EpiPen, Auvi-Q) to the school nurse or teacher, not all kids have an epinephrine auto-injector prescribed specifically for them. And, about 25 percent of first-time food allergy reactions happen at school, according to the American Academy of Allergy, Asthma and Immunology (AAAAI). Those parents may not even realize the child has an allergy.
Those statistics, along with a highly publicized case in 2012 in which a 7-year-old Virginia girl died after eating a peanut on the playground, have prompted a recent wave of legislation intended to make epinephrine available to any child in case of an emergency.
Most states now have laws that allow schools to stock epinephrine for general use, according to Food Allergy Research & Education (FARE), a national nonprofit organization. Some states go further, requiring that schools keep epinephrine auto-injectors on hand. Those states include Delaware, Maryland, Michigan, Nebraska, Nevada, North Carolina and Virginia, according to FARE. California Gov. Jerry Brown signed similar legislation this week.
"Legislatures have recognized that schools need to have this emergency capability in case a child or even a staff member has an anaphylactic incident because they have been exposed to something they're allergic to, whether it's food or an insect sting," said Charlotte Collins, senior vice president of policy and programs for the Asthma and Allergy Foundation of America.
Of the remaining states with no current laws allowing epinephrine to be stocked at school, legislation to permit schools to stock epinephrine is pending in most of them. Only two states -- New Hampshire and Rhode Island -- have no current or pending legislation regarding stocking epinephrine in schools, according to FARE.
About one in 13 U.S. children -- or as many as two in every classroom -- have at least one food allergy, according to FARE and the AAAAI. The most common cause of food-related anaphylaxis is peanuts, but other common allergens, including dairy, sesame or tree nuts such as cashews, pecans or walnuts, can also cause severe reactions.
The stock epinephrine movement was helped along by federal legislation signed into law by President Barack Obama in November 2013. The School Access to Emergency Epinephrine Act gives states incentives for passing legislation requiring that schools have epinephrine on hand and training personnel how to use it in case of emergency. Obama's daughter, Malia, has a peanut allergy.
While ideally all states would require schools to stock epinephrine, laws that at a minimum allow schools to provide epinephrine for use in an emergency are also important because the laws typically contain language permitting staff members to use any available epinephrine, even an auto-injector prescribed to another child, if needed, Collins explained.
"The laws are saying, 'We don't want you to hesitate to try to help this child,'" Collins said.
Yet even in states that require schools to stock epinephrine, actually getting the medication into the schools will take time, she added. Schools need to find funds to purchase the medication. Rules and protocols set by other agencies may also need to be changed. For example, in some states, pharmacy boards need to change rules to permit physicians to write a prescription to a school district rather than an individual patient, Collins said.
The good news is that training staff doesn't take long, Sicherer said. Epinephrine auto-injectors are preloaded with medication that's automatically dispensed through a short needle when pressed against the upper thigh.
Even in states with laws requiring epinephrine in schools, parents should still provide an epinephrine auto-injector prescribed to their child, make sure that teachers are trained to use it, and ensure there is a written plan for how school staff will respond in case of an emergency involving an allergic reaction, Sicherer said.
Food Allergy Research & Education has a map detailing states with epinephrine auto-injector legislation.