Food Allergies and
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Epinephrine in Schools
Presented June 6, 2012Mathew Swinburne JD
Mathew Swinburne, JD
Staff Attorney
The Network for Public Health Law Eastern Region
The Network for Public Health Law -Eastern Region
Slide 1
In the United States food allergies result in
150 deaths, 2,000 hospitalizations, and 30,000
episodes of anaphylaxis.
Epidemiology
•
An exaggerated immune
response triggered by a
specific food
p
•
Eight foods account for 90%
of Food Allergies
•
15 million people in the
United States Suffered from
food allergies
food allergies
•6-8 Percent of Children
•3 7 percent of Adults
•3.7 percent of Adults
Epidemiology
• Anaphylaxis- a serious
whole body allergic reaction
that is rapid in onset and d th
may cause death c3
Slide 4
c3 I made your picture bigger
Prevention and Treatment
• No Cure for Food Allergies
• Focus on Management of Condition
1 Prevent reactions by avoiding 1. Prevent reactions by avoiding
exposure to allergen
2. Recognize and treat allergic reactions
reactions
– Epinephrine/Adrenaline auto-injector with pre-measured dose – Very safe-mild and short lasting
side effects: pallor, tremor,
palpitations, headache anxiety,
p p y
An estimated 6 million children in the
United States have food allergies
United States have food allergies.
Food Allergies and Children
1 The prevalence of food allergy among children is increasing 1. The prevalence of food allergy among children is increasing.A. Prevalence of reported food allergies increased 18% from 1997-2007 and now 1 in 25 school age children are affected by food allergies.
2. At a greater risk of a reaction from undiagnosed food allergy because of less exposure to potential allergens.
A 25% of anaphylaxis reactions in schools occur among students without a A. 25% of anaphylaxis reactions in schools occur among students without a
previous allergy diagnosis
3. Less consistent with their efforts to avoid exposure and less aware of presence of allergens
aware of presence of allergens.
A. Between 16-18% of children with food allergies have had allergic reactions resulting from accidental ingestion of an allergen while at school
State Legislative Approaches to
Food Allergies in School
Food Allergies in School
1
Self Administration
1.
Self Administration
of Medication
2.
Emergency
Stockpiling of
p
g
Epinephrine
Self Administration
•
Every State except Alabama and
•
Every State except Alabama and
West Virginia
•
Majority of States Require
j
y
q
•A prescription
•Written parental consent
•Written physician authorization •Annual renewal of authorization
•Student must prove capable of administering •Student must prove capable of administering the auto injector
School Liability
1.
Legislation has an express provision
stating that the school will incur no liability
g
y
2.
Written acknowledgement by parents will
indemnify the school and employees from
y
p y
loss or damage resulting from misuse.
3.
Good Samaritan Statutes and State Tort
Claims Acts.
Emergency Stockpiling
“When a child is having an anaphylactic
“When a child is having an anaphylactic
reaction, the only thing that can save her life is
epinephrine, 911 doesn’t get there fast enough.”
epinephrine, 911 doesn t get there fast enough.
Maria L Acebal the chief executive of the
-Maria L. Acebal, the chief executive of the
Food Allergy and Anaphylaxis Network.
Emergency Stockpiling
11 J
i di ti
•
11 Jurisdictions
•CA, DC, ILL, KS, LA, MD, MN, MO, NE, RI, and VA Require vs Encourage
•Require vs. Encourage
•
Issues to Consider
Issues to Consider
1. Who can administer the epinephrine? 2. Who can receive the epinephrine? 3. Where is the epinephrine stored? 4. What training is required for staff?
Food Allergies and Epinephrine in Schools May 20, 2013
5. How is the medication obtained? 6. Reporting Requirements?
Illinois’ Emergency Epinephrine
Act
Act
•
Allows schools to maintain a supply in locked secure locations
•
Authorizes physicians to write prescriptions in the name of the
school district
•
School nurse may administer to any student who they in good
•
School nurse may administer to any student who they in good
faith believe is experiencing an anaphylactic reaction.
•
Allows authorized personnel to administer to any student who
has their own personal prescription
•
A student with authorization to self-administer may also utilize
emergency medication from the stockpile
Illinois’ Emergency Epinephrine Act
•
To administer epinephrine to
students without prescriptions
school nurse must follow a
school nurse must follow a
standing protocol issued by a
physician
•a definitive set of treatment guidelines •State has issued sample protocol for physicians
physicians
•Statute exempts physicians who issue prescription and standing protocol from
Food Allergies and Epinephrine in Schools May 20, 2013
Federal Laws Impacting Food Allergies
Food Safety Modernization Act
• Voluntary guidelines for food allergy
management in schools
• Two year incentive grants to help with
implementationp
School Access to Emergency
Epinephrine Act (Failed Bill)
• Provide states with incentives to require
schools to maintain, and permit school
personnel to administer, epinephrine at schools
Federal Laws Impacting Food Allergies
Americans with Disability Act: Requires equal opportunities in public Americans with Disability Act: Requires equal opportunities in public
accommodations and state and local government services.
Disabled under the Act
•Physical or mental impairment that substantially limits one or more major life activities
•Record of impairment or is regarded as having such impairmentRecord of impairment or is regarded as having such impairment
Food Allergies = a Disability?
•A Court has held that food allergies are an impairment, however there is a fact specific evaluation of whether they substantially limit a major life activity.
•Land v. Baptist Medical Center (8th Circuit)
Food Allergies and Epinephrine in Schools May 20, 2013
