We’ve talked about EpiPens before on Food Allergy Living, including how to travel with them and what to do in case of an accidental injection of epinephrine. With the new school year upon us, many parents of children with food allergies are faced with the dilemma of where to store their child’s EpiPen at school. Should they carry it with them at all times? Should it be stored in the nurse’s office? What happens on the playground or on a field trip?

Carrying an EpiPen at School

If your child is old enough, some schools will allow them to carry the EpiPen with them at school or on a field trip and self-administer in the case of a reaction. While many states have passed legislation to allow this, New York, Pennsylvania, Rhode Island and Wisconsin have not. To find out specific details about what the legislation mandates in your state, you can visit the Allergy & Asthma Network website which provides links to each state’s current law regarding anaphylaxis medications.

EpiPens in the Classroom as well as the Nurse’s Office

If your child is not old enough to carry their own EpiPen, or their school will not allow it, you will want to determine whether or not one can be stored in their classroom (in addition to the nurse’s office). If they are in multiple classrooms each day, you may want to store one EpiPen in each room to be safe. You will also want to make sure that all of your children’s teachers are properly trained in how to administer the EpiPen.

Planning for EpiPen Use When Outside the Classroom

One thing that can help you address where your child’s EpiPen or other medications are stored at school is a 504 plan. A 504 plan refers to Section 504 of the Americans with Disabilities Act, which ensures that children with special needs get a level playing field from government services like public school. Depending on the details of your child’s food allergy, he or she may qualify for a 504 plan for the school to follow. The plan will outline not only where their EpiPen is stored, but also where they will eat, what allergens are permitted on school grounds, and how teachers and other personnel are trained to react in the event of an anaphylactic reaction.

Planning ahead is key to ensuring that your child will be safe at school in the event of an allergic reaction. What plans do you have in place for your children?

- Sarah

EpiPens, for any child with allergies, can be a huge life saver. However, sending your little one to school with their EpiPen can be rather stressful for a parent. There are a thousand questions that might go through your mind, “Will they be safe even with the EpiPen?” or “Will someone know how to use the EpiPen?”.

EpiPen and Anaphylactic Shock Basics

For those of you who don’t know, anaphylaxis or anaphylactic shock can be a life-threatening allergic reaction to specific triggers, such as food proteins and medication. This results in hives or swelling of the throat or tongue, which can lead to constricted airways and/or a dramatic drop in blood pressure.

An injection from an EpiPen is imperative when anaphylactic shock occurs and can save a person’s life. An EpiPen is a premeasured dose of epinephrine, which is injected into someone’s body during a severe allergic reaction to avoid or treat the onset and symptoms of anaphylactic shock, which provides a window of time to seek further medical attention. ¹

EpiPens at Schools

If you are a parent of a child who is at risk for anaphylactic shock, you probably carry his or her EpiPen with you at all times, in case they are exposed to an allergen to which they are allergic. This is excellent for when you are with your child; however, your child could be exposed to many more allergens at school when you and your EpiPen aren’t there!

In fact, one study of children and adolescents found that 10 out of 13 fatal or near fatal anaphylactic reactions occurred outside the home. All the fatalities did not have an EpiPen and those who survived received an EpiPen shot before or within 5 minutes of developing severe symptoms.²

So, what does this mean? EpiPens can save lives! You need to ensure that the other adults who spend time with your child are trained and able to assist in any situation if you’re not around.

Don’t worry, this isn’t as difficult as it sounds! I suggest sitting down with your child’s teacher in the beginning of the school year to set up a 504 plan. This will ensure he or she receives proper care and attention when you aren’t there and that all adults that are around your child have the proper training to use an EpiPen if an emergency situation arises.

Also, there is good news for all you Massachusetts residents! Thanks to your persistent neighbors, starting March 2010, all newly hired school bus drivers in the state of Massachusetts will be required to have EpiPen training. Unfortunately, the law doesn’t mandate the existing school bus drivers to be trained; however, it’s a step in the right direction. Hopefully the other 49 states will follow suit. Good work Massachusetts!

How have you been able to ensure that your child is safe and can receive the proper care if they go into anaphylactic shock? Did it involve a 504 plan or EpiPen training?

- Nita

References:

1. www.epipen.com/
2. Sampson H, Mendelson L, Rosen J. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. 1992;327:380-384.

While we usually write about common food allergy symptoms, such as diarrhea or eczema, more severe reactions like anaphylaxis are possible for many children and adults with allergies. Allergens that cause anaphylaxis include food, insect stings, drugs, latex, and even exercise.  When anaphylaxis happens as a result of contact with an allergen, a rapid immune reaction occurs that can quickly make breathing very difficult.  For those patients an immediate injection of epinephrine can prevent very serious complications.  Sometimes even the few minutes it takes emergency medical care to arrive is too long, and a personal device with automated injectable epinephrine, an auto-injector, such as the EpiPen® Auto-Injector, is essential.

The EpiPen, made by Dey Pharma, works by delivering a quick shot of epinephrine to the thigh.  There are also similar devices available, such as the Adrenaclick® and TwinJect®, both made by Shionogi Inc. Twinject is unique in that it has a built-in backup dose of epinephrine, which can take the place of two auto-injectors in an emergency.

Epinephrine helps the body to keep the airway open so that breathing does not become as difficult, allowing time for emergency medical care to arrive. But many parents worry that one auto-injector might not be enough or that something might go wrong that could require additional auto-injectors. For instance, someone nearby might experience a severe allergic reaction and need to use your child’s auto-injector. Or what if your child’s only auto-injector was unknowingly broken? What if the auto-injector were accidentally put in the fridge or left in the sun? What if the contents were cloudy? Or if it had expired? So many scary possibilities!

So, what is the right number of auto-injectors? The answer to that question depends on a number of factors. Bear in mind that the Twinject has two doses of epinephrine, but according to the company the second dose should only be used as a backup to the first dose and should not be saved for future allergy emergencies.

How Many to Carry?

On their websites, Dey Pharma and Shionogi recommend that patients at risk for allergic emergencies carry two doses of epinephrine. This is because up to 20% of patients who have an allergic emergency requiring epinephrine will require a second dose. At all times the injector should be kept close to room temperature, out of sunlight, and replaced by the expiration date. You can even sign up for an expiration date reminder on either of the websites. It’s a good idea to occasionally check the solution in the auto-injector to make sure it hasn’t discolored, which can be a sign of a possible loss of effectiveness.

If a long trip is planned, especially one overseas where similar products may not be readily available in pharmacies; two auto-injectors (or one that contains two doses) may not be enough.

Should you or your child carry more than two auto-injectors? Not necessarily. Additional backups would likely be for peace of mind. A second dose of epinephrine may be needed in an emergency, but more than two doses during an emergency should only be given with medical supervision. Some caregivers choose to carry two auto-injectors from different lots for added precaution.

Multiple Locations

Some patients who use auto-injectors prefer to carry the standard two with them and also keep backup injectors in one or more strategic locations. These might include an extra one or two at work, school, daycare, and/or a relative’s house. These are great because they can serve as backup in case someone forgets their daily go-everywhere auto-injectors. Just make sure you follow the recommended storage instructions everywhere you keep an auto-injector and check your backups for discoloration and expiration dates. Knowing that you have extra auto-injectors in places like this, in addition to the daily carry-with auto-injectors you have, may bring you more comfort.

How about you? How many auto-injectors does your family keep on hand, and where? Please share your thoughts in the comment section of this blog post.

- Rob

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It’s time for back to school and whether it’s your child’s first day of school or they’re returning to school for another year, introducing a child with food allergies into a new environment can be nerve-racking.  This is why it is important to educate and remind your children’s teachers and caregivers about food allergy precautions and safety before school starts.

Here are some simple steps you can follow to make sure that the transition is a safe one for your child:

1. Schedule a back-to-school checkup with your pediatrician or allergist to make sure that your current treatment plan is still effective.
2. Document your child’s allergies and treatment plan in school or daycare paperwork.
3. Provide teachers and caregivers with brochures and information on your child’s allergy to prevent accidents.
4. Create a one page “Cheat Sheet” with information about your child’s allergies for substitutes or new employees.
5. Discuss what to do in case of an emergency.  Ask your pediatrician about keeping an EpiPen on-site.  Be sure to train the caregiver on when and how to use one.
6. Make sure that your child fully understands what can trigger their allergy.
7. Look at upcoming lunch or snack menus and identify safe options, also provide the school with a list of safe foods that your child can enjoy at any time.
8. If no safe options are available, pack food from home and warn your child not to trade food with his/her classmates.
9. Offer to bring in allergy-safe treats for holidays and special events.  This way you know that your child is safe, and they won’t feel excluded from the fun!

Communication and education is the most important part of going back to school with food allergies.  Hopefully these tips will provide you with some ideas on how to best educate your child’s new classroom on living with food allergies.

If you have any creative strategies to help prepare for a safe school year, we’d love to hear about them in the comments!