Food Allergies and Epinephrine in Schools

Transcription

1 c1 Food Allergies and Epinephrine in Schools Presented June 6, 2012 Mathew Swinburne, JD Staff Attorney The Network for Public Health Law -Eastern Region

2 Slide 1 c1 cmeneses, 5/29/2013

3 In the United States food allergies result in 150 deaths, 2,000 hospitalizations, and 30,000 episodes of anaphylaxis. - National Institute of Allergy and Infectious Diseases

4 An exaggerated immune response triggered by a specific food Epidemiology Eight foods account for 90% of Food Allergies 15 million people in the United States Suffered from food allergies 6-8 Percent of Children 3.7 percent of Adults

5 c3 Epidemiology Anaphylaxis- a serious whole body allergic reaction that is rapid in onset and may cause death

6 Slide 4 c3 I made your picture bigger cmeneses, 5/29/2013

7 Prevention and Treatment No Cure for Food Allergies Focus on Management of Condition 1. Prevent reactions by avoiding exposure to allergen 2. Recognize and treat allergic reactions Epinephrine/Adrenaline autoinjector with pre-measured dose Very safe-mild and short lasting side effects: pallor, tremor, palpitations, p headache anxiety, and nausea

8 An estimated 6 million children in the United States have food allergies.

9 Food Allergies and Children 1. The prevalence of food allergy among children is increasing. A. Prevalence of reported food allergies increased 18% from and now 1 in 25 school age children are affected by food allergies. 2. At a greater risk of a reaction from undiagnosed food allergy because of less exposure to potential allergens. A. 25% of anaphylaxis reactions in schools occur among students without a previous allergy diagnosis 3. Less consistent with their efforts to avoid exposure and less aware of presence of allergens. A. Between 16-18% of children with food allergies have had allergic reactions resulting from accidental ingestion of an allergen while at school

10 State Legislative Approaches to Food Allergies in School 1. Self Administration of Medication 2. Emergency Stockpiling of Epinephrine

11 Self Administration Every State except Alabama and West Virginia Majority of States Require A prescription Written parental consent Written physician authorization Annual renewal of authorization Student must prove capable of administering the auto injector Discipline for improper use of medication

12 School Liability 1. Legislation has an express provision stating that the school will incur no liability 2. Written acknowledgement by parents will indemnify the school and employees from loss or damage resulting from misuse. 3. Good Samaritan Statutes and State Tort Claims Acts.

13 Emergency Stockpiling When a child is having an anaphylactic reaction, the only thing that can save her life is epinephrine, 911 doesn t get there fast enough. -Maria L. Acebal, the chief executive of the Food Allergy and Anaphylaxis Network.

14 Emergency Stockpiling 11 Jurisdictions CA, DC, ILL, KS, LA, MD, MN, MO, NE, RI, and VA Require vs. Encourage Issues to Consider 1. Who can administer the epinephrine? 2. Who can receive the epinephrine? 3. Where is the epinephrine stored? 4. What training is required for staff? 5. How is the medication obtained? 6. Reporting Requirements?

15 Illinois Emergency Epinephrine Act Allows schools to maintain a supply in locked secure locations Authorizes physicians to write prescriptions in the name of the school district School nurse may administer to any student who they in good faith believe is experiencing an anaphylactic reaction. Allows authorized personnel to administer to any student who has their own personal prescription A student with authorization to self-administer may also utilize emergency medication from the stockpile.

16 Illinois Emergency Epinephrine Act To administer epinephrine to students without prescriptions school nurse must follow a standing protocol issued by a physician a definitive set of treatment guidelines State has issued sample protocol for physicians Statute exempts physicians who issue prescription and standing protocol from liability

17 Federal Laws Impacting Food Allergies Food Safety Modernization Act Voluntary guidelines for food allergy management in schools Two year incentive grants to help with implementation School Access to Emergency Epinephrine Act (Failed Bill) Provide states with incentives to require schools to maintain, and permit school personnel to administer, epinephrine at schools Modeled on Illinois stockpiling law

18 Federal Laws Impacting Food Allergies Americans with Disability Act: Requires equal opportunities in public accommodations and state and local government services. Disabled under the Act Physical or mental impairment that substantially limits one or more major life activities Record of impairment or is regarded as having such impairment Food Allergies = a Disability? A Court has held that food allergies are an impairment, however there is a fact specific evaluation of whether they substantially limit a major life activity. Land v. Baptist Medical Center (8 th Circuit)

19 Conclusion Admirable start in addressing food allergies in schools Additional focus on emergency stockpiling of epinephrine, education, and training

20 Mathew Swinburne, JD Staff Attorney The Network for Public Health Law - Eastern Region mswinburne@law.umaryland.edu l d