food allergy: school policies ruchi s. gupta, md, mph associate professor of pediatrics ann &...

Food allergy: School policiesRuchi S. Gupta, MD, MPHAssociate Professor of PediatricsAnn & Robert H. Lurie Children’s Hospital of ChicagoNorthwestern University Feinberg School of Medicine

FactsPolicies:

CPSOther States

PolicyRecommendations

Basic facts of food allergy

• Food allergy is an overreaction of the immune system to a food

• Even a miniscule amount of food may cause a reaction– By rubbing nose, eyes or skin, or putting fingers in mouth– Cross contamination/hidden allergens

• Fatal reactions can occur – regardless of severity of previous reactions– in spite of perceived allergen avoidance and treatment

• Current treatment is limited to – avoidance of the food– prompt treatment with epinephrine

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CPSOther States


Basic facts of food allergyCommon allergens

Peanut Tree nut Shellfish Fish

Milk Egg Soy Wheat

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• 8% of children have food allergy– Approximately 2 children per classroom

• Nearly 40% have had a life-threatening reaction

• Nearly 1 in 5 have had a reaction in school

• 1 in 4 first-time allergic reactions occur in school

Sources: Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, Holl JL. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics 2011; 128:e9-17.Mcintyre CL, Sheetz AH, Carroll CR, Young MC. Administration of epinephrine for life-threatening allergic reactions in school settings. Pediatrics 2005; 116(5):1134-1140.

Basic facts of food allergyStatistics in school

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Over 3,500 CPS students Have documented food allergies.

Food Allergy Management Policy was approved in January 2011 and went into effect immediately with the following mandates:

•Annual parent request for diagnosis (Student Medical Information Form)

•IEPs/504 Plans required for all students with documented food allergies

FactsOther States

POLICIES:CPS

CPS policiesFood Allergy Management Policy


Student Medical Information Form

•Sent home annually for all students

•Initiates process of health condition identification and follow up

Per the Attorney General’s Office and CPS the purpose and approved use of the District Issued Epi-Pens are:

1. Self-Administration of an epinephrine auto-injector by a student with a known allergy who has forgotten his or her auto-injector or it is otherwise unavailable

Section 22-30(f) of the Illinois School Code authorizes school districts and nonpublic schools to provide a student with an epinephrine auto-injector for self-administration, provided the supplied auto-injector meets the student’s personal prescription on file with the school. 105 ILCS 5/22‑30(f).

FactsOther States

POLICIES:CPS

CPS policiesAdministration of Medication Policy


2. Administration of an epinephrine auto-injector to a student with a known allergy

Section 22-30(f) of the Illinois School Code permits “…any personnel authorized under a student's Individual Health Care Action Plan, Illinois Food Allergy Emergency Action Plan and Treatment Authorization Form, or plan pursuant to Section 504 of the federal Rehabilitation Act of 1973 to administer an epinephrine auto‑injector to the student [having an anaphylactic reaction], that meets the [student’s] prescription on file.” 105 ILCS 5/22‑30(f).

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3. Administration of an epinephrine auto-injector to a student, with an unknown allergy, having a first-time anaphylactic reaction

“When a student does not have an epinephrine auto‑injector or a prescription for an epinephrine auto‑injector on file, [Section 22-30(f) of the Illinois School Code provides that] the school nurse may utilize the school district or nonpublic school supply of epinephrine auto‑injectors to respond to anaphylactic reaction, under a standing protocol from a physician licensed to practice medicine in all its branches and the requirements of this Section.” 105 ILCS 5/22‑30(f).

FactsOther States

POLICIES:CPS



• 2-4 Epi-Pens® made available to schools on the first week of class.• Epi-Pens® bar coded and assigned to schools for tracking purposes.• School Nurse will coordinate the storage & access of the Epi-Pens®.• Office of Student Health & Wellness launched an educational

campaign to educate parents/guardians, schools, and providers on what this initiative will mean to them.

• Before or shortly after the use of an Epi-Pen® or any epinephrine auto-injector, 911 must be called immediately to address emergency follow up response.

• A Report on EpiPen Administration and Incident Report must be completed IMMEDIATELY documenting incident, usage of medication, response, and follow up.

FactsOther States

POLICIES:CPS

CPS policiesStock Epinephrine Auto-injectors (Epi-Pens®)


Report on EpiPen Administration

•Report is specific to the use of the district issued EpiPens

•Report must be completed and submitted within 24 hours of administration

FactsPolicies:

CPSOTHERSTATES

States with food allergy policies & guidelines


• Virtually every state has passed legislation allowing students (with consent) to carry their prescribed epinephrine at school

• The following 19 states have school-based food allergy guidelines:• Arizona• California• Colorado• Connecticut*• Illinois• Massachusetts*• Maryland • Missouri• Mississippi• New Jersey*

• New York • Ohio• Pennsylvania• Rhode Island*• Tennessee• Texas• Vermont*• Washington*• West Virginia

Sources: Food Allergy & Anaphylaxis Network (2012) available at http://www.foodallergy.org/page/legislationAsthma and Allergy Foundation State Honor Roll available at http://www.aafa.org/display.cfm?

id=5&sub=105&cont=649

* denotes states with Honor Roll standing

FactsPolicies:

CPSOTHERSTATES

States with food allergy policies & guidelines


• In 2011, President Obama signed the Food Allergy and Anaphylaxis Management Act

• Emerging trend allows schools to obtain “stock” EpiPen auto-injectors not tied to any one student but to be used in an emergency

• Kansas passed this law in 2009

• EpiPen4Schools ™ Program

Sources: Food Allergy & Anaphylaxis Network (2012) available at http://www.foodallergy.org/page/legislation and

http://www.foodallergy.org/page/food-allergy-and-anaphylaxis-management-act-becomes-lawMylan EpiPen4Schools Program information available at http://www.epipen4schools.com

FactsPOLICY

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Policy recommendations• Establish a multi-disciplinary team to address school-wide

approach to identifying, managing, and reducing risk of student exposure to life threatening allergens

• Expand annual emergency drill program to include food allergy emergencies

• Require school-wide training on food allergies, the use of EpiPens in emergency situation and identification of location of EpiPens

• Establish stock EpiPen auto-injectors for schools

• Require school nurse EpiPen training

• Develop reporting systems for accountability

food allergy: school policies ruchi s. gupta, md, mph associate professor of pediatrics ann &...

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