Cathy Owens was a nurse at Murrieta Valley High School in 1997 when she encountered a student in the throes of a severe allergic reaction, unable to breathe and fading fast. Owens called for an ambulance, but the teen was deteriorating too quickly. She made a split-second decision to use another student’s prescription epinephrine injector.
Her action was a breach of federal law, but a necessary one under the circumstances, she said. “That’s not a choice anyone should have to make, but I had to make it,” Owens said. “We didn’t want a child to die.”
Now, with the passage of a new law in September, all schools in California will be required to stock at least one injector that is prescribed to the school or district, rather than a specific person, and to train at least one staff member on how to use it.
Modesto City Schools plans to have injectors and trained personnel in place by January, when the law takes effect, said Aurora Licudine, chairwoman of the district’s school nurses. She said she sees the need, as allergy-related close calls have happened in Modesto, too.
“There are many, including accidental exposure to peanuts, peanut products and bee stings,” Licudine said by email Wednesday.
“We are committed to student safety,” she said. Students with severe allergies do not always have prescription auto-injectors at school, and about a quarter of all injections given at schools that had them were to students who did not know they had a severe allergy, she added, citing information from the American College of Allergy, Asthma and Immunology.
Turlock Unified school sites have at least one person trained at every school, but auto-injectors are available only for specific students who provided them, said Superintendent Sonny Da Marto.
This fall, Turlock school nurse Esther Harris retrained school staff members on using the epinephrine injectors, Da Marto said by email. “We are currently researching the options available to purchase and find funds to purchase and make them available at the sites,” he said.
“We have had some students in the past with severe allergies where the classroom teacher was also trained as a backup,” Da Marto said, adding that there have been no recent incidents.
The new law was the result of more than a decade of legislative battles by allergy activists, who in 2001 backed a bill that allowed, but did not require, the use of injectors not prescribed for a particular student. The push for a requirement intensified last year when 13-year-old Natalie Giorgi of Carmichael died from an allergy attack – medically termed anaphylaxis – after taking one bite of a Rice Krispies treat that her family believes contained a peanut ingredient at Camp Sacramento near Lake Tahoe. Giorgi died despite receiving injections of epinephrine from her father, a doctor.
Anaphylaxis, a severe and potentially life-threatening allergic reaction, can occur within seconds of encountering an allergic trigger, such as food, medicine, an insect bite, latex or exercise. Symptoms include the narrowing of airways, rashes or hives, nausea or vomiting, a weak pulse and dizziness.
Once an anaphylactic attack begins, it’s critical to inject the allergic person with epinephrine, the drug used to combat the attack, as quickly as possible, said Dr. Ruchi Gupta, associate professor of pediatrics at Northwestern University and spokeswoman for EpiPen4Schools, a nationwide program that provides free injectors to about 1,500 schools throughout California. The injectors are commonly known as pens, and EpiPen is one of the major brands.
The program, started in 2012 by EpiPen manufacturer Mylan Specialty, announced late last month that it would expand its resources to keep up with the national trend toward anaphylaxis preparedness. California is one of eight states now requiring schools to stock up on epinephrine, according to the nonprofit Food Allergy Research and Education.
Injectors are available from several manufacturers, and are typically administered to the outer thigh during emergencies and held there for 10 seconds. The drug, which can be injected through clothing, counters the effects of the allergen by relaxing the muscles around airways and tightening blood vessels to maintain respiratory and cardiovascular function. After epinephrine administration, children should seek emergency care, as they may be susceptible to additional attacks.
“This can happen in adults and children very similarly – the big issue in children is they may not be able to communicate what’s happening in their body as well to an adult,” Gupta said. “They may say things like, ‘I feel funny,’ or things that are not as descriptive.”
Food allergies among children increased about 18 percent from 1997 to 2007, according to the U.S. Centers for Disease Control and Prevention, and affect an estimated 4 percent to 6 percent of children in the nation.
Researchers report that about 25 percent of anaphylactic attacks occur during school hours to children who were not previously diagnosed with a food allergy.
That’s because kids are constantly trying new foods and sharing foods at school, said Owens, now the coordinator of student support for Murrieta Unified School District and state public relations chairwoman for the California School Nurses Organization. Owens is leading a committee that is working with the California Department of Education to update the state’s current training standards on auto-injector use.
Opponents of the law were initially concerned about asking nonmedical personnel to administer the drug. But the injector is simply designed and easy to use, said Owens, and would have minimal negative effects on a child if it were used erroneously. The bill requires that every school have at least one trained volunteer capable of using the injector.
Natalie Giorgi’s mother, Joanne Giorgi, testified in support of the law, even though her daughter’s life could not be saved even with an injector on hand. Giorgi, whose three other children also have food allergies, said having the injectors at schools is an important safety measure and that she feels better knowing that nurses and teachers will be able to help allergic children.
“For any parent of a child with food allergies, it’s a constant worry, it’s a constant fear,” she said. “It’s a reality that parents like us know all too well. … Whatever we can do to help with the safety and well-being of the kids while they’re at school, it’s there. It’s just a safeguard.”