In 2008, the Centers for Disease Control (CDC) estimated that almost 3 million children, or 1 in 25, had food allergy. More recently in 2011, the CDC estimated that up to 6 million children, or one in 13 children, had food allergies. Practically speaking, this means that about two children in every classroom have food allergies. Additionally, almost 40% of children with allergies have had severe reactions, and nearly 30% are allergic to multiple foods. Clearly, food allergies are becoming an increasingly serious problem for our nation’s children.
Recognizing the gravity of this problem, state legislatures are promulgating new laws to enable school staff to respond more rapidly to life-threatening anaphylactic reactions. Current legislation has allowed schools to store and administer medication; namely, EpiPens, to students having allergic reactions provided a doctor’s prescription is on file. Additionally, most states allow students to self-carry and self-administer EpiPens in the event of a reaction. This protocol is problematic, however, in the event that a child forgets his or her medication, school personnel are either unavailable or unable to access the locked medication, or the reaction is occurring in a student with an undiagnosed allergy, which unhappily occurs frequently. In fact, up to a quarter of severe allergic reactions occur in persons not previously diagnosed with food allergy, and up to 25% of first time reactions to peanuts or tree nuts have occurred in school settings. Across the country, children have died while school staff waited helplessly for paramedics after calling 911. In response, Illinois passed legislation last summer that allows schools to stock pile EpiPens, and, in an emergency, permits school nurses or other trained staff to administer medication to students with previously undiagnosed allergies who are experiencing life-threatening allergic reactions. Similar legislation is pending in five different states and in the federal government as well.
Not everyone is happy with these new laws. Parents, who for years have felt as if they have been labeled as neurotic or overbearing as they have advocated for their children, are concerned that in many states only the school nurse is allowed to use the EpiPen. Precious minutes may be wasted should the nurse either be unavailable or too far from a child having the reaction. In fact, most anaphylactic reactions occur outside the child’s classroom: on the playground, on the bus, or on a field trip. Additionally, the new Illinois law is voluntary; schools don’t have to stock the EpiPens. Conversely, physicians are concerned about non-nurses administering the medication, as in Illinois, given the side effects associated with epinephrine, including increased heart rates, as well as associated potential drug interactions.
Life threatening food allergies can legally be considered a disability. Pending determination by a student’s health care team (e.g., pediatrician and/or allergist), the student is generally considered eligible for protection under Section 504 of the Rehabilitation Act of 1973. If schools fail to protect or discriminate against students with severe allergies, families can file civil rights claims on behalf of their child. Once a child is qualified for a 504 Plan based on his or her food allergies, the school must train staff to recognize the importance of the 504 Plan and their obligation to comply with it. Additionally, individual health care plans and emergency health care plans need to be developed with input from health care providers, parents, school nurses, and school staff.
The National School Boards Association, in conjunction with the Centers for Disease Control and Prevention, has developed guidelines to help school districts formulate policies for managing students with life-threatening food allergies. The NSBA guidelines encompass a wide range of concerns from identification of students with allergies and provision of school health services; preparation of individual written management plans; provision of healthy school environments; communication and confidentiality; emergency responses; training; awareness education for students, parents, and caregivers; and finally, monitoring and evaluation. Additionally, the NSBA provides written protocols drafted by two school districts and two state Boards of Education as examples of good policy. With team effort, thoughtful planning, and good communication, students with severe food allergies should be protected while at school.