Schools should prepare for allergies

Posted: September 17, 2012

By Terri Faye Brown-Whitehorn

In a typical classroom of 20 children, one is likely to have a food allergy that could cause a severe reaction. And one in six children with a food allergy will have his or her first allergic reaction at school.

Despite growing awareness of food allergies, tragedies continue to occur. Earlier this year, a Virginia 7-year-old, Ammaria Johnson, ate a peanut at recess and died from a severe allergic reaction.

Epinephrine, a medication that may have been able to save Ammaria's life, was not available at her school. The drug works quickly to reverse the effects of a severe allergic reaction, and it can often buy enough time to get a victim to an emergency room for further treatment.

Ammaria's death led Virginia lawmakers in April to pass "Ammaria's Law," which requires that epinephrine auto-injectors be available in every school in Virginia. Testifying before a congressional committee last month, Ammaria's mother argued that every school in America should do the same.

Pennsylvania does not have such a law in place, which puts its students at greater risk of similar tragedies. At the Children's Hospital of Philadelphia's allergy division, we receive more than 3,500 visits a year from children with food allergies. Food is the most common cause of childhood allergic reactions necessitating emergency-room visits.

While we often associate allergies with peanuts and tree nuts, other common causes of severe allergic reactions include milk, eggs, and wheat. In fact, milk is the most common cause of allergic reactions in schools.

Despite the best attempts to avoid exposures to these foods, they are occurring, and school is certainly a place where they can and do occur. As a result, schools need to be prepared to treat severe allergic reactions.

Education about reactions, what they look like, and how they should be treated is crucial. But it's not enough.

Epinephrine is the treatment of choice for severe allergic reactions. A review of the available pediatric safety data shows that for a child thought to be having an allergic reaction, there is no downside to using epinephrine. (At CHOP, there are epinephrine auto-injectors on every hospital floor, emergency room, and outpatient facility.)

However, there is a significant downside to not using it. Failure to use epinephrine or to administer it soon enough are the greatest risk factors identified in fatal and near-fatal allergic reactions.

Not all food-allergic children have a prescription for epinephrine, and even if they do, not all parents fill the prescription or take the medication to school. That's why we need a state law requiring its presence in schools.

Earlier this year, State Rep. Matt Smith (D., Allegheny) introduced legislation that would permit schools to obtain prescriptions for supplies of epinephrine auto-injectors to be used for allergic reactions. It would also shield from liability any individual who administers epinephrine to a child believed to be having an allergic reaction.

Smith's bill is still awaiting action by the House Education Committee. With students now starting another school year, this is a good time to act.

Dr. Terri Faye Brown-Whitehorn is an allergist and immunologist at the Children's Hospital of Philadelphia and an associate professor of clinical pediatrics at the University of Pennsylvania's Perelman School of Medicine. She is also a member of the medical advisory team of the Doylestown-based Kids with Food Allergies Foundation.

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