AAAAI: Some Schools Stumble on the Meaning of Food Anaphylaxis

SAN DIEGO, Feb.27 -- Public schools can be challenged learners in protecting children with severe food allergies, researchers reported here.

Even after the Michigan legislature enacted a law in 2004 allowing children with a history of food allergy to carry epinephrine self-injecting pens (EpiPens) in school, more than a third of principals surveyed were unaware it, found Darlene Kassab, M.D., of the University of Michigan, and colleagues.

In addition, a majority of schools reported keeping at least some of the injectors in the front office, and not in the classroom or lunchroom where they might be needed most in an emergency, the researchers said at the American Academy of Allergy, Asthma & Immunology meeting here.

On the plus side, more schools reported that students with food allergies were carrying epinephrine pens than in a 1999 survey, and more lunchroom staffers were trained in their use, the investigators reported in a poster presentation.

The key to improving the situation, said Dr. Kassab, is education of the educators. "We need people to go out to schools to do training, we need educational materials to be available to the schools, and we need concrete, correct information to go out to the schools," she said.

The majority of food allergy fatalities occur outside the home and are associated with either the failure to use epinephrine or delay in administering it, the authors noted.

In a 1999 survey of schools about the use of epinephrine pens, the authors found that many school systems lacked information about food allergies, had gaps in avoidance measures, had an insufficient number of emergency treatment plans, and lacked consistency in their policies related to food allergy reactions.

The authors compared the results of the original survey with a second survey conducted after the Michigan legislature passed a bill, in 2004, permitting children ages eight years and older who had a history of food allergy to carry epinephrine pens in schools.

A 33 item on-line questionnaire, similar to one administered in 1999, and an e-mailed reminder, were sent to 3,636 Michigan school principals, and 541 responses were received representing a total of nearly 330,000 students.

They found that 63% of responders said they were aware of the 2004 bill, and 33% said they allowed children with a known history of food allergy reaction to carry their own epinephrine pens in school.

The law appeared to make a difference, in that 44% of the respondents who had heard of it allowed students to carry their own pens, compared with only 14% of those who had not heard of the new legislation (P<0.001).

Overall, 32% of children with food allergies in the later survey were reported to carry EpiPens, compared with 17% in the 1999, pre-bill survey.

In 1999, lunchroom staffers in only 6% of schools were trained to administer epinephrine, compared with 28% of schools after the bill had become law.

School secretaries comprised the largest proportion of school officials who were trained to administer epinephrine (77%), followed by administrators (70%), teachers (57%), school nurses (34%), and lunchroom staffers (proportion not shown).

"Although there is substantial progress in the availability of EpiPens compared to pre-bill practice, there is still a lack of knowledge of the bill itself," the authors wrote. "This may contribute to delay in the administration of EpiPens."

The results are cause for concern, they said, given the potential seriousness of acute food allergies, and there is a need for both standardized training in food allergies, and better means of ensuring that kids with food allergies have timely access to epinephrine pens.

In addition, all parents should be made aware of the need for having epinephrine close at hand in case of an accidental food exposure,

"The parents of kids with food allergies, we don't need to convince them," Dr. Kassab said. "We need to convince the parents of the kid who's sitting next to a kid with food allergies who has a sharp object in his backpack."