Milk. Eggs. Peanuts. Shellfish. Bees. For some people - including children - coming into contact with these common things could be fatal.
Sandy Swann, director of nursing at the Trumbull County Health Department, said that there are many allergies in children today. Swann said that the worst reaction to food related allergies and bee stings is anaphylactic shock.
Anaphylactic shock is an allergic reaction to bee stings, as well as food products such as milk, wheat, eggs, peanuts and shellfish that can be fatal. Exposure to an allergen may cause symptoms such as throat swelling, low blood pressure and itchy rash, which can manifest into respiratory failure and cardiac arrest. This can affect children as well as adults.
The common medicinal solution to anaphylactic shock is epinephrine (adrenalin), which helps to diminish the swelling of the tongue and throat and prevent respiratory failure and cardiac arrest.
"School nurses are concerned about this," Swann said. "When children have anaphylactic shock they need to have an EpiPen available nearby, not just locked away somewhere. The scary part about anaphylactic shock is that it is unpredictable."
As a result, lawmakers on state and federal levels are working to pass laws to have lifesaving medication available at schools in the event of an allergic reaction.
House Bill 296
On Nov. 20, the Ohio House of Representatives passed House Bill 296, which would allow a school or school district to stock doses of epinephrine on the school premises. The legislation will allow but not require a school or district to adopt a protocol to maintain a stock of epinephrine and allow properly trained personnel to administer the epinephrine to a student, staff member or visitor who exhibits signs of anaphylaxis. The bill now goes to the Ohio Senate.
Across the nation
In 2013, 15 states enacted epinephrine laws for schools, joining 11 other states who already had laws. The laws permit schools to have epinephrine in the buildings without a prescription for an individual student and provide legal protection for school staff members who administer the epinephrine.
States that require epinephrin in schools are:
- Virginia ?Nebraska
SOURCE: The Associated Press
On Nov. 13, President Barack Obama signed into law the School Access to Emergency Epinephrine Act, which encourages states to adopt laws requiring schools to have epinephrine auto-injectors, such as the EpiPen, on hand. The Ohio House of Representatives passed House Bill 296 on Nov. 20, which would permit schools to have their own supply of epinephrine. The bill now goes to the Ohio Senate.
"The bill would enable, at a local level, to determine a protocol as to how the epinephrine auto injectors will be administered and whom will administer the epinephrine," said state Sen. Capri Cafaro, 32nd District. "The bill allows schools to stock up on EpiPens."
Cafaro said that the growing increase of food allergies in children has prompted a push to have a law in place for schools to be able to have epinephrine on hand in each school facility. She said that, for example, a child might get stung by a bee and has a reaction, but might not be aware that he or she is allergic. This child might not carry an EpiPen because they have no idea that they are allergic to bee stings.
"I think it's a simple part in keeping children healthy," Cafaro said. "EpiPens are a good proven prevention device that helps children in emergency situations. I think it's one more tool to enable our schools to be more prepared and help save lives of children."
Karen Kunkle, who serves as school nurse for Howland Middle School and Howland High School, said that it's important to have epinephrine on stock in schools because there are some situations where the school might be located 10 or 15 minutes away from a paramedic squad. She said this can put the child in anaphylactic shock at risk.
"Howland Schools District is very fortunate because we have paramedic units who are close to us and respond quickly," Kunkle said.
While it can be beneficial to have epinephrin readily available in schools, experts caution that the drug needs to be administered properly.
Dr. James Enyeart, Trumbull County Health Department commissioner, said the most important question is how epinephrine is used in schools and who is going to administer the epinephrine to the child who is in distress. He said that it's about having the proper medication. Enyeart said there are epinephrine auto-injectors for both adults and children and these devices both administer a pre-measured dose of epinephrine. Children would need the EpiPen Jr, in which the dosage of epinephrine is smaller.
"It's important to raise consciousness for this type of treatment," Enyeart said. "When an attack happens, you have 2 or 3 minutes to use the EpiPen. The problem is when it is locked up in the principal's office, far from where the episode is happening. It won't be of any use if it is five or 10 minutes away from where the child is having the attack. It's a medical emergency that has to be taken care of right away."
School staff members will also need to know how to properly administer the epinephrine.
"The dilemma is with the first responders, the people who are right there when the situation happens," Enyeart said. "The authority in the classroom has to be familiar with how to use the EpiPen or epinephrine auto-injector device. You have to take the cover off of it, you have to arm it and release the epinephrine. There is a lock on these devices, and basically it's a single-use injection device."
Kunkle warns that parents shouldn't become complacent because of the availability of epinephrine in schools.
"I think parents with children with allergies will still allow their children to carry Epi-Pens on hand, because their personal physicians will make sure they have them," she said. "The issue is the stocked Epi-Pens in schools that aren't prescribed to one child. I hope parents do not become negligent and not have their child diagnosed."
However, when an attack strikes suddenly, having epinephrine available at a school could save a life.
"I think that Epi-Pens stocked in schools is a benefit and a service to those who haven't been diagnosed with anaphylactic shock," Kunkle said.