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By Melissa Tennen, HealthAtoZ writer
Part one of a two-part series.
Jacqui Corba smelled peanut butter.
Then, something stirred. An instinct or maybe even a sixth sense told her she could die if she didn't get help right away.
And before that thought could finish, she raced to the nurse's office.
Corba, now 13, was in fifth grade when that happened. She has a life-threatening allergy to peanuts. Just the smell of peanuts can cause her airways to close in minutes.
The school nurse had an epinephrine shot (also known as adrenaline), which is the first line of treatment for anaphylaxis, or a systemic allergic reaction that happens when a person is exposed to a protein or allergen. The symptoms can get worse quickly, and within minutes a child could die. So the injection as soon as possible can help save a child's life by buying time to get to the emergency room.
But some children with severe food allergies may not have the medication in their reach to save their lives. Possible allergens include peanuts, tree nuts (walnuts, pecans and more), fish, shellfish, eggs, milk, soy and wheat. These vary from child to child.
Federal law says that all children attend school, but for students with anaphylaxis, this can be risky. Most U.S. schools maintain drug-free zones, which unfortunately includes prescribed lifesaving medications for anaphylaxis and asthma.
Because of these laws and regulations, children who need medications to save their lives may be unintended victims.
Kids do die from anaphylaxis - at school bus stops, on field trips, in hallways, classrooms, playing fields and cafeterias. States and schools that prevent students from having and using prescribed lifesaving medications need to change the rules, some experts say.
During the workweek, children spend at least half their waking hours at school. Yet, the very medications that parents and kids might carry in everyday life usually aren't as close by as they should be.
Doctors tell children to carry their medication with them at all times because they can have a reaction at any time and the parent isn't always around. Yet the school can unintentionally interfere with the doctor/patient relationship by saying the child can't carry the medication at all times.
State of the States
Only 30 states have legislation protecting students' rights to carry and self-administer medication for asthma; of these, six states have laws allowing kids to carry and self-administer life-saving medication for food allergy reactions. These states are Georgia, Illinois, Louisiana, Massachusetts, New Jersey and Wisconsin. Most states leave it up to each school district to set its own policies.
Congress soon could consider a bill called the National School Emergency Medicine Bill. Introduced by Rep. Clifford Stearns (R-Florida) and Rep. Patrick Kennedy (D-Rhode Island), the legislation supports the rights for children in all states to carry asthma inhalers and epinephrine shots while in school.
Food allergy is the leading cause of anaphylaxis outside the hospital setting. It accounts for an estimated 30,000 emergency room visits and 2,000 hospitalizations each year.
In the Schools
Some schools may fear that kids will abuse the medications or may let other kids play with it. However, very few kids are going to let it out of their sight and very few don't know how to use it.
Teachers' unions tend to shy away from letting teachers give medications for fear of lawsuits. But most schools make sure teachers know if a child has a severe food allergy and what to do in an emergency.
With no regulations or state laws in place, many schools take each child with severe allergies on a case-by-case basis on whether or not that child can carry the shot.
Schools prefer to have someone like a school nurse with medical training to do the shots. If no nurse is available at those crucial moments, someone on staff, whether it's a principal or some other staff member, needs to know how to do it.
There's a lot to be said for good old-fashioned prevention by educating teachers and staff. Schools could plan with the parent, the doctor and the child to provide a safe school environment.
Schools are encouraged to use the Food Allergy and Anaphylaxis Network's Food Allergy Action Plan. This is a customized written directive for what a teacher or other school staff member should do. What are the signs? What medication should be given? Who should be called first?
Teachers can be made to recognize the signs and symptoms. They can be told not to bring into the classroom any foods that don't have the ingredients listed. They can also be warned about projects that include foods and empty food containers that are used to store classroom items.
Also, letters can be sent home to the families of the child's classmates about the dangers of packing foods and school items in containers with allergens such as peanuts in lunches and snacks.
Some state laws say only a school nurse can give a life-saving shot, but some schools have snipped nurses from their budgets, or one nurse serves several schools at once.
Prevention can only do so much. A study done by the American Academy of Asthma Allergy and Immunology (AAAAI) showed 28 percent of callers to a food allergy awareness organization had reactions to what they thought were safe foods and later learned these foods had unlabeled food allergens.
The Medication
One way to give a shot of epinephrine is a shot called EpiPen® and EpiPen® Jr. This is considered easy to administer because it has a single pre-measured dose using a concealed, spring-loaded needle. It takes a few seconds to give the shot because speed is critical in an emergency. The device must be held for five to 10 seconds and is automatically injected into the muscle. The shot can be given through clothes, even denim.
Epinephrine halts the potentially fatal symptoms of anaphylaxis and allows some time for patients to reach emergency medical care. The medicine improves blood pressure, relaxes smooth muscles in the lungs to improve breathing, stimulates the heartbeat and works to reverse hives and swelling. The effects of one dose last 10 to 20 minutes and the patient must get medical help right after the shot is given. People with severe allergies should carry the device with them at all times.
Parents take charge
With no across-the-board state laws and school policies, parents must be vocal, vigilant and proactive. Parents need to educate schools that this problem is real and potentially fatal, says Diane Corba, Jacqui's mom.
"I haven't been able to change policy," Corba says. "But I've been able to have peanut-free zones where the kids at surrounding tables in the school cafeteria can't have peanuts or products with peanuts in them. And just so she doesn't have to cross the cafeteria to throw out her food, the school has a garbage can near her."
"We have an EpiPen on her at all times, in her classrooms, at the nurse's office. I have met quarterly with the teachers. I tell them what it looks like when she has a reaction, what they need to do," Corba says. "In the elementary school, she didn't need to carry one on her. But in the middle school, she's all over the place. You have to have it within a minute away. That's the only way to keep her safe."
It can be tough, Corba says. Reading labels or even just suspecting peanuts are being used in the food manufacturing plant requires constant vigilance. She says the family can't eat certain crackers anymore because of the trend of using peanut butter on the products. There's a chance the products are being made in the same facility. Just cross-contamination is enough to do the trick because even dust can set off a reaction. Some manufacturers include warnings on their labels that fine dust from peanuts may have gotten into the product, even though peanuts aren't listed as an ingredient.
As a result, she makes a lot of homemade breads and candies.
"We don't have a lot of trust," she says of foods made outside the home.
This article was reviewed and updated June 2007.
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