Protecting food allergic kids in school

Here’s an article about food allergies from the Palm Beach Post – with a couple of quotes from me.

Dr. Gershman

New laws aim to save schoolchildren from deadly allergic reactions

By Stacey Singer – Palm Beach Post Staff Writer

Waffles. That’s what sent 8-year-old Emma Serle to the emergency room.

Allergic to five different foods, Emma eats only wheat-free, egg-free waffles.

On a busy weekday morning, her dad, David Serle, accidentally mixed up her waffle with her sisters’ regular ones, and soon, Emma’s stomach hurt. Her throat swelled. Hives appeared. Her mother whisked her to Boca Raton Regional Hospital where she was treated with steroids.

“I was scared,” the little girl acknowledged.

Luckily, she responded quickly to the drugs and was sent home. But food allergies in children can have serious, life-threatening consequences, leading to 90,000 emergency room visits and an estimated 1,500 deaths nationwide each year. Every time there’s news of a child’s death from allergic exposure, David Serle’s mind races.

This fall, 14-year-old Giovanni Cipriano of New York’s Long Island died after eating trail mix he didn’t realize contained peanuts. His parents had given him Benadryl rather than injecting him with his EpiPen, a device that injects epinephrine. He had a heart attack on the way to the hospital.

Katelyn Carlson, 13, of Carmichael, Calif., died after eating a Rice Krispies summer camp treat that she didn’t know contained peanuts. She was administered epinephrine, but too late.

Before them, Ammaria Johnson, 7, had a heart attack in the school nurse’s office in Chesterfield County, Va., while awaiting an ambulance. The school had no epinephrine.

In response to these incidents, new federal and state laws are in place to try to coax school districts to keep lifesaving emergency epinephrine on hand and ensure that school staff is trained and allowed to use it on children without a doctor’s prescription and without fear of a lawsuit.

That’s because studies show one in four life-threatening allergic reactions happens to a child who had no previous food allergies. Plus, allergic reactions are so unpredictable, and sometimes so sudden and severe, that calling 911 isn’t fast enough.

In Florida, new state law protects both public and private schools from liability and gives them permission to keep epinephrine pens on hand without a specific student’s name on the drug, said Boca Raton allergist Dr. Neil Gershman, who heads the Florida chapter of the American Academy of Allergy, Asthma & Immunology.

It’s an important step forward, he said, but too few schools are aware of the law.

Palm Beach County School District’s policy hasn’t been updated since 2010.

“In another state, a kid died because an EpiPen didn’t have a name on it, and the nurse was afraid to give it,” Gershman said. “This kind of covers the backside of the nurses and school people to give epinephrine that doesn’t have a name on it to somebody.”

The Palm Beach County Health Department issued a standing order in 2008 giving school nurses the right to administer epinephrine in case of emergency, department spokesman Tim O’Connor said. The agency gives school nurses a vial of epinephrine, syringes and a full protocol for what to do and what dose to give when the tell-tale signs appear: skin warmth, itching, tingling and hives; abdominal pain, vomiting, and diarrhea; sneezing; swelling of the face, mouth, and tongue; a lump or tightness in the throat; hoarseness, difficulty inhaling, shortness of breath, wheezing; headache, low blood pressure, light-headedness, loss of consciousness, slow heart rate; and feelings of apprehension, anxiety, or “impending doom.”

But the school district’s policy, and state law, require the drug to be kept under lock and key. The exception is students who have explicit permission from their parents and doctor to keep their epinephrine with them. Epinephrine, also known as adrenaline, is a hormone that can cause the heart to race.

Both the Centers for Disease Control and Prevention and advocacy groups recommend keeping epinephrine in a secure, but unlocked, location if state and local laws allow it, said Nancy Gregory, a spokeswoman for Food Allergy Research & Education in Washington.

“As the first-line treatment for anaphylaxis (a serious allergic reaction), which can occur suddenly and progress rapidly, epinephrine should be readily available in schools,” she said.

For private and charter schools that don’t have school nurses and may not be able to afford the $250 to $400 cost for a self-injectable epinephrine device, there’s another option.

Mylan Pharmaceuticals, which makes the EpiPen, offers every school — public and private — four free EpiPens a year. The application form is available at www.EpiPen4Schools.com/. A company spokeswoman said more than 30,000 schools nationwide have taken advantage of the program, including 578 in Florida

The issue is hot now because President Barack Obama signed into law the School Access to Emergency Epinephrine Act in November, noting that his daughter, Malia, is allergic to peanuts.

The law gives preference for federal asthma education grants to states that require schools to stock emergency epinephrine and educate school personnel on their use. Only four states have this requirement, according to FARE. Florida isn’t one of them.

Emma Serle’s parents own two brands of self-injectable epinephrine, the Audi-Q, and the EpiPen. Her schoolteacher has one. Her grandparents have another. They keep one at home and one goes with them when they’re out and about, too.

“Emma has severe food allergies to wheat, eggs, tree nuts, peanuts, sesame, and shellfish. It’s a lot,” David Serle said.

After the waffle accident, he decided he needed to better understand what his daughter’s life was like. So he put himself on the Emma diet and challenged others to do so as well. He created a Facebook website, www.facebook.com/eatlikeemma. It was tough, he said. At restaurants, waiters would roll their eyes when he asked detailed questions about ingredients. Chefs would shrug off his concerns. It was a real education, he said.

“You can’t just grab a snack,” he said. “You literally have to plan your meals, which I never did.”

Two months later, Emma is back in gymnastics, enjoying school and planning a family vacation, eating sweet potatoes and chicken for dinner. Is she still mad at her dad for mixing up the waffles? She shrugs.

“I forgive him,” she said.

Food allergy deaths in the news:

Oct. 1: Giovanni Cipriano, 14, of New York’s Long Island, died after eating trail mix he didn’t realize contained peanuts. He had a heart attack on the way to the hospital.

July 26: Natalie Giorgi, 13, of Carmichal, Calif., died after eating a Rice Krispies summer camp treat that she didn’t know contained peanuts.

Jan. 4, 2012: Ammaria Johnson, 7, died after eating a peanut during recess in Chesterfield County, Va. She had a heart attack in the school nurse’s office.

Dec. 17, 2010: Katelyn Carlson, 13, died in a Chicago school after eating Chinese food apparently prepared with peanut products.