Food allergies and emergency epinephrine in Washington State schools

August 19, 2013 Kevin Dooms, MD

Food allergies have been on the rise in recent years.  Studies suggest that up to 1 in 13 children are affected by a food allergy.  Egg and cow’s milk are the most common food allergies for infants and toddlers.  Fortunately, most children will lose a milk or egg allergy by the time they enter school.  Peanut and tree nut allergies are also becoming more common.  Unfortunately, only 10-20% of children will ever outgrow a nut allergy.

Currently there is no cure for food allergies.  Instead, doctors rely on an accurate diagnosis, avoiding food triggers, and being prepared in the event of a severe reaction.  Making the situation more challenging, nearly half of children with a food allergy may be at risk for a potentially life-threatening reaction called anaphylaxis. 

Symptoms of anaphylaxis may include:

  • hives or itchy welts
  • swelling
  • vomiting or diarrhea
  • difficulty breathing (cough, wheeze or shortness of breath)
  • dizziness or passing out

During a severe food allergy reaction, epinephrine (“adrenaline”) can be a life-saving medication. Epinephrine is typically injected into a thigh muscle with an “auto-injector” device like EpiPen® or Auvi-Q™.  Oral antihistamines like Benadryl, Allegra, or Zyrtec can help with some anaphylaxis symptoms, but are not considered life-saving treatment.

Emergency Epinephrine in Schools

Until recently, only certain students in Washington State could receive a life-saving epinephrine injection while at school.  They needed to be diagnosed with a food allergy and already have an epinephrine injector in the health room.  However, some students may not have an injector at school, or they have their first serious allergic reaction while at school.  In that case, the school could only call 911 and hope they arrived in time to save a life.

In January 2013, Senator Mark Mullet of Issaquah introduced ESB 5104, allowing schools to keep a supply of “stock” epinephrine on school property, school buses, and even field trips.  The bill passed the legislature and became law on July 28, 2013.  Now in Washington State, licensed health care providers may write epinephrine prescriptions directly to a school.  If a student with a known food allergy has a life-threatening allergic reaction at school, they may receive stock epinephrine from a nurse or trained school employee.  If a student has a first-ever serious reaction, only a nurse may give a stock epinephrine injection.

The new law applies to both public and private schools.  Schools may decide whether or not they choose to participate.  The new law also gives doctors, nurses, and schools legal protection in the unlikely event of a reaction to epinephrine.  Food allergy experts agree that the benefits of epinephrine far outweigh the risks associated with an unnecessary dose.

State officials are currently working on an implementation plan for the upcoming 2013/2014 school year.  Many details are still being decided.

Ultimately, supporters of ESB 5104 hope the new law will help make schools safer for Washington State students with severe allergies.  Parents can participate by asking their health care provider to write a stock epinephrine prescription for their child’s school.

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