All About Epinephrine
“Often the first indication that a child has a life-threatening allergy is when they have their first reaction,” says Carolyn L. Duff, RN, president of the National Association of School Nurses. “By allowing stock epinephrine in schools, rapid, necessary treatment by a school nurse is available and can potentially save a child’s life.”
The eighth-grade boy who came to Donohue’s office is among those students who experience their first anaphylactic reaction while at school. In fact, 25 percent of epinephrine administrations in schools involve students or staff members who weren’t known by the school to have a diagnosis of a potentially life-threatening allergy, according to a Massachusetts study.
“Stock epinephrine laws are important for the child or staff member who has unknown severe allergies. These laws are also important for the kids who have known allergies but haven’t notified their school and don’t have available auto-injectors,” says Michael Pistiner, MD, MMSc, pediatric allergist for Harvard Vanguard Medical Associates and a voluntary consultant for the Massachusetts Department of Public Health.
Laws vary by state. Nevada is one of four states (along with Nebraska, Tennessee and Virginia) with a mandate that requires all schools to stock emergency epinephrine auto-injectors. The other states with stock epinephrine laws give schools the option.
Laws can vary in terms of who is permitted to administer the epinephrine for diagnosed and undiagnosed students—school nurses or any trained personnel—and what locations are covered, such as buses, sports events or field trips.
Caroline Moassessi, author of gratefulfoodie.com and co-founder and co-leader of the Northern Nevada Asthma and Food Allergy Parent Education Group, started working to create a law in her state in 2012 after learning about the death of Amarria Johnson. Moassessi was especially concerned about how the system and rules in place were not adequate to save the young girl’s life.
“Everyone did what they were supposed to,” says Moassessi, who has two children with food allergies. “This could happen here to any of our kids.”
So Moassessi created the Nevada Food Allergy and Anaphylaxis Alliance and began mapping out a plan with Nevada Senator Debbie Smith. The goal was to make the law a mandate for public schools (and give authorization for private schools). The group they formed carefully considered input from various parties to ensure the regulation would be realistic. They asked the chief nurse from the two largest school districts in the state to review the bill to make sure there were no conflicts with existing state laws. And they went to lawmakers with a plan for funding the initiative, pointing to the EpiPen4Schools program, which offers free EpiPen or EpiPen Jr. auto-injectors to public and private schools throughout the United States.
“Truly our hope is that we just save a life, that we never lose a child or never have a situation where there isn’t epinephrine when it is needed,” Moassessi says of the Nevada law, which went into effect in July 2013. “Our goal is that we will always have immediate access if it’s needed. That’s why we wanted the mandate.”
Kevin Dooms, MD, an allergist with Allergy and Asthma Associates in Bellevue, Washington, agrees that more access is needed. He wrote the law in Washington state that allows schools to keep their own supply of stock epinephrine auto-injectors. Dooms worked with the mom of a food-allergic child, her son and another teen to advocate for the state legislation, which was signed into law in May 2013.
“These are just the small steps toward liberalizing the availability and thinking about epinephrine as less a medication that needs a prescription and special training and more a lifesaving medication that should be available,” Dooms says.
Elizabeth Goldenberg, founder of Onespot Allergy and co-founder of EpiCenter Medical, wants access to epinephrine expanded to all public areas that allergic children and adults frequent, such as large venues, airplanes and restaurants, much in the way defibrillators are available.
“Ultimately, I would like to see epinephrine kits become mandated in the places that allergic people go and I would like to see training mandated,” Goldenberg says.
Indeed, Kathy Donohue, the middle school nurse in Illinois, says she wondered what would have happened had the eighth-grade boy walked into town that Friday afternoon with his friends rather than come to her office.
“Would the kids know what to do?” Donohue says. “His parents were very grateful that it happened here and that we did have the undesignated EpiPen.”
Next: Fear of Injection