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Allergy Management in Schools

Announcements  |  Anaphylaxis  |  Schools  |  Students and Families

Food allergies are on the rise and are growing food safety and public health concern in schools throughout the country. An estimate of 5.6 million children have food allergies and every three minutes, a food allergy reaction sends someone to the emergency room. Food allergy is the most common cause of potentially life-threatening reactions, also known as anaphylaxis. Immediate administration of epinephrine is the first line of treatment for severe allergic reactions.

To ensure that District schools are prepared to manage an anaphylactic emergency, the DC Council passed legislation, Access to Emergency Epinephrine in Schools Amendment Act of 2015 (the Act), that was later signed into law by Mayor Muriel Bowser in 2016.

The Act and subsequent regulations mandate public and public charter schools in the District to have:

  • A minimum of two undesignated epinephrine auto-injectors of each dose to be used in the event of an anaphylactic emergency.
  • A minimum of two staff members, outside of the school nurse, trained in the identification of an anaphylactic reaction and the emergency administration of epinephrine.

The Allergy Management Team at OSSE supports local education agencies (LEA) in meeting emergency epinephrine law requirements by facilitating the annual Epinephrine Administration Training certification for school staff, ordering undesignated epinephrine auto-injectors through Mylan’s EpiPen4Schools program, conducting school visits, and providing direct technical assistance.

For questions about the Allergy Management in Schools Program contact OSSE Allergy Management Team at [email protected].

Announcements

Anaphylaxis

Anaphylaxis is a severe, life-threatening allergic reaction caused when the immune system overreacts to a harmless protein, an allergen. The most common allergens that cause anaphylaxis include food and non-food allergens. The eight common food allergens that cause anaphylaxis are: tree nuts, peanuts, shellfish, fish, wheat, eggs, milk and soy. Non-food allergens include insect stings, latex, medications, and, in rare cases, exercise.

The smallest amount of allergen can trigger an allergic reaction. Allergic reactions are unpredictable and their severity can vary from each episode. The only way to prevent an allergic reaction is to completely avoid the allergen. Although it may be difficult to do, some effective avoidance measures include reading food labels and staying away from food that contains allergens or food without labels, creating allergen-free zones, washing your hands, and preventing cross-contact by keeping surfaces clean, and thoroughly washing cooking utensils and containers.

The symptoms of food allergies appear within minutes to several hours after coming in contact with the allergen whether by ingestion, inhalation or skin contact. The symptoms may range from mild to severe affecting several areas of the body including the skin, the gastrointestinal tract, the respiratory tract and, in the most serious cases, the cardiovascular system. Allergic reactions may turn life-threatening in a matter of minutes. It is important to pay attention to the signs in order to quickly recognize an anaphylactic reaction, especially in young children who may use unique phrases to describe their symptoms.

Mild symptoms include:

  • localized hives, rash, redness of the skin, swelling
  • stomach pain or cramps, nausea or vomiting, diarrhea
  • nasal congestion, runny or itchy nose, sneezing, red eyes
  • itchy mouth, tongue or ear canal
  • anxiety, sense of impending doom, lethargy

Severe symptoms include:

  • significant swelling of the mouth, tongue and/or throat, tightening of the throat, difficulty swallowing
  • shortness of breath, repetitive hacking cough, tightening of the chest
  • low blow pressure, paleness, dizziness, loss of consciousness, rapid heart rate

If an individual present any of the severe symptoms or more than one mild symptom affecting multiple areas of the body they might be experiencing anaphylaxis. It is important to respond immediately. Epinephrine, also known as adrenaline, is the first line of treatment for anaphylaxis. In order to work as intended, epinephrine must be administered promptly. Delays of even 30 minutes in the administration of anaphylaxis may result in death. After receiving epinephrine, the patient must receive emergency medical care for further evaluation and treatment.

Schools

Students need a safe and healthy learning environment to succeed academically. Children with food allergies are at risk of suffering anaphylactic reactions in school where they are more likely to unintentionally get in contact with allergens. Schools must be prepared to prevent, recognize and respond to anaphylactic reactions. The Centers for Disease Control and Prevention (CDC) created a tool kit to help school staff implement the “Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs” in order to prevent and manage severe allergic reactions in schools.

The Access to Emergency Epinephrine Amendment Act of 2015 (the Act) mandates public and public charter schools in the District to stock a minimum of two pediatric dose (0.15 mg) and two adult dose (0.3 mg) of undesignated epinephrine auto-injectors to be used in the event of an anaphylactic emergency. OSSE procures epinephrine auto-injectors free of charge for all public and public charter schools in the District through Mylan’s EpiPen4Schools program. The auto-injectors shall be kept unlocked in a secure and easily accessible location.

Additionally, the Act and subsequent regulations requires public and public charter schools to have a minimum of two staff members, outside of the school nurse, trained in the identification of an anaphylactic reaction and the emergency administration of epinephrine (Certified Epinephrine Administrators or EPAs). For this, schools are required to have an Epinephrine Liaison who will support the implementation of the Allergy Management in Schools Program at their school and coordinate all program activities and communications with school personnel and OSSE.

Epinephrine Liaisons are responsible for ensuring their school has at least two EPAs, notifying OSSE of anaphylactic incidents within 24 hours of using an undesignated epinephrine auto-injector, submitting procurement forms to OSSE to replace used, damaged, lost or expired undesignated epinephrine auto-injectors, conducting inspections and submitting monthly logs, and creating and disseminating the Undesignated Epinephrine Auto-Injector (UEA) Plan. In the event there is an anaphylactic emergency, schools must activate their UEA Plan and follow the emergency protocol.

Epinephrine Liaisons and EPAs must complete an annual Epinephrine Administration Training certification. The training can be completed online, in-person at OSSE, or on-site at the requestor’s preferred location (for groups of 10-20). Schools may complete this registration form to sign up for an online or in-person training at OSSE or to request an on-site training.

Schools may refer to the District of Columbia Student Access to Emergency Epinephrine Plan to learn more about schools’ responsibilities under the Act.

Additional Resources for Schools

Students and Families

Food allergies are the most common cause of anaphylaxis, a life-threatening allergic reaction. Children with food allergies are at risk of suffering anaphylactic reactions in school where they are more likely to unintentionally get in contact with allergens.

To ensure students with life-threatening allergies are safe in District schools, the Access to Emergency Epinephrine Amendment Act of 2015 (DC Law 21-77) mandates all public and public charter schools to stock undesignated epinephrine auto-injectors and to have a minimum of two staff members, outside of the school nurse, trained in the identification of anaphylaxis and the emergency use of epinephrine auto-injectors.

If your student has been diagnosed with food allergies, it is important to notify the school so that the school can take the necessary measures to maintain a safe learning environment. Parents are encouraged to work with school administrators and their doctor to develop an Individual Health Plan (IHP) and an Action Plan for Anaphylaxis. These plans serve as an emergency protocol and include a full list of the student’s food allergens, symptoms of an allergic reaction, recommended treatment, and emergency contacts.

Additionally, food allergies may be considered a disability under federal laws, such as Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA). Parents of children with food allergies are encouraged to collaborate with their school to develop a 504 Plan, which is a written management plan outlining the school’s procedures and protocols to address the individual needs of your child, and allow your child to participate safely and equally alongside his/her peers during all normal facets of the school day. Federal law and regulations for the National School Lunch Program and the School Breakfast Program require schools to make accommodations for children who are unable to eat school meals as prepared because of a disability under Section 504. Additional examples of accommodations determined by a 504 Plan includes:

  • Restricting allergens from the classroom;
  • Training teachers and bus drivers to identify and treat anaphylaxis;
  • Not using food for rewards, crafts, and celebrations; and
  • Washing hands before and after meals and snacks.

Parents and children with food allergies should adopt effective avoidance measures at home to prevent exposure to allergens such as reading food labels and staying away from food that contains allergens or food without labels, creating allergen-free zones, washing hands, and preventing cross-contact by keeping surfaces clean, and thoroughly washing cooking utensils and containers.

View the District of Columbia Student Access to Emergency Epinephrine Plan to learn more about District schools’ responsibilities under the Act.

For more information about food allergies, visit foodallergy.org.

Additional Resources for Parents