Food allergy: School policies CPS Other States Policy Recommendations Facts Food allergy: School policies Ruchi S. Gupta, MD, MPH Associate Professor of Pediatrics Ann & Robert H. Lurie Children’s Hospital of Chicago Northwestern University Feinberg School of Medicine

Basic facts of food allergy Policies: CPS Other States Policy Recommendations FACTS Basic facts of food allergy Food allergy is an overreaction of the immune system to a food Even a miniscule amount of food may cause a reaction By rubbing nose, eyes or skin, or putting fingers in mouth Cross contamination/hidden allergens Fatal reactions can occur regardless of severity of previous reactions in spite of perceived allergen avoidance and treatment Current treatment is limited to avoidance of the food prompt treatment with epinephrine

Basic facts of food allergy Common allergens Policies: CPS Other States Policy Recommendations FACTS Basic facts of food allergy Common allergens Milk Egg Soy Wheat Peanut Tree nut Shellfish Fish

Basic facts of food allergy Statistics in school Policies: CPS Other States Policy Recommendations FACTS Basic facts of food allergy Statistics in school 8% of children have food allergy Approximately 2 children per classroom Nearly 40% have had a life-threatening reaction Nearly 1 in 5 have had a reaction in school 1 in 4 first-time allergic reactions occur in school Sources: Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, Holl JL. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics 2011; 128:e9-17. Mcintyre CL, Sheetz AH, Carroll CR, Young MC. Administration of epinephrine for life-threatening allergic reactions in school settings. Pediatrics 2005; 116(5):1134-1140.

Have documented food allergies. POLICIES: CPS Other States Policy Recommendations Facts CPS policies Food Allergy Management Policy Over 3,500 CPS students Have documented food allergies. Food Allergy Management Policy was approved in January 2011 and went into effect immediately with the following mandates: Annual parent request for diagnosis (Student Medical Information Form) IEPs/504 Plans required for all students with documented food allergies Food and other life threatening, UNDERREPORTED A recent study conducted by Children’s Memorial Hospital in Chicago and the Food Allergy Initiative found that food allergies actually impact an estimated 1 in 12 (8%) children in the United States with 40% of those food allergies being life threatening (anaphylactic).  Every food-allergic reaction has the possibility of developing into a life-threatening reaction and even with proper treatment can be fatal. Medical information form, Best Practice = 504 plan Updated guidelines this year

Student Medical Information Form Sent home annually for all students Initiates process of health condition identification and follow up Food and other life threatening, UNDERREPORTED A recent study conducted by Children’s Memorial Hospital in Chicago and the Food Allergy Initiative found that food allergies actually impact an estimated 1 in 12 (8%) children in the United States with 40% of those food allergies being life threatening (anaphylactic).  Every food-allergic reaction has the possibility of developing into a life-threatening reaction and even with proper treatment can be fatal. Medical information form, Best Practice = 504 plan Updated guidelines this year

CPS policies Administration of Medication Policy Other States Policy Recommendations Facts CPS policies Administration of Medication Policy Per the Attorney General’s Office and CPS the purpose and approved use of the District Issued Epi-Pens are:   1. Self-Administration of an epinephrine auto-injector by a student with a known allergy who has forgotten his or her auto-injector or it is otherwise unavailable Section 22-30(f) of the Illinois School Code authorizes school districts and nonpublic schools to provide a student with an epinephrine auto-injector for self-administration, provided the supplied auto-injector meets the student’s personal prescription on file with the school. 105 ILCS 5/22‑30(f).

CPS policies Administration of Medication Policy Other States Policy Recommendations Facts CPS policies Administration of Medication Policy 2. Administration of an epinephrine auto-injector to a student with a known allergy Section 22-30(f) of the Illinois School Code permits “…any personnel authorized under a student's Individual Health Care Action Plan, Illinois Food Allergy Emergency Action Plan and Treatment Authorization Form, or plan pursuant to Section 504 of the federal Rehabilitation Act of 1973 to administer an epinephrine auto‑injector to the student [having an anaphylactic reaction], that meets the [student’s] prescription on file.” 105 ILCS 5/22‑30(f).

CPS policies Administration of Medication Policy Other States Policy Recommendations Facts CPS policies Administration of Medication Policy 3. Administration of an epinephrine auto-injector to a student, with an unknown allergy, having a first-time anaphylactic reaction “When a student does not have an epinephrine auto‑injector or a prescription for an epinephrine auto‑injector on file, [Section 22-30(f) of the Illinois School Code provides that] the school nurse may utilize the school district or nonpublic school supply of epinephrine auto‑injectors to respond to anaphylactic reaction, under a standing protocol from a physician licensed to practice medicine in all its branches and the requirements of this Section.” 105 ILCS 5/22‑30(f).

CPS policies Stock Epinephrine Auto-injectors (Epi-Pens®) Other States Policy Recommendations Facts CPS policies Stock Epinephrine Auto-injectors (Epi-Pens®) 2-4 Epi-Pens® made available to schools on the first week of class. Epi-Pens® bar coded and assigned to schools for tracking purposes. School Nurse will coordinate the storage & access of the Epi-Pens®. Office of Student Health & Wellness launched an educational campaign to educate parents/guardians, schools, and providers on what this initiative will mean to them. Before or shortly after the use of an Epi-Pen® or any epinephrine auto-injector, 911 must be called immediately to address emergency follow up response. A Report on EpiPen Administration and Incident Report must be completed IMMEDIATELY documenting incident, usage of medication, response, and follow up. According to the Illinois Attorney General’s Fact Sheet on Life-Threatening Allergic Reactions, 25% of first time anaphylactic reactions among children occur in school. Schools with PreK-1 will receive 2 junior pens in addition to 2 regular pens Charter also receive pens Only school nurse can administer stock Epi-Pen - they are for those students who may have left their epi at home or who are having an anaphylactic reaction with no documented allergies, these DO NOT replace the epi-pens that all students should have if they have a known allergy

Report on EpiPen Administration Report is specific to the use of the district issued EpiPens Report must be completed and submitted within 24 hours of administration According to the Illinois Attorney General’s Fact Sheet on Life-Threatening Allergic Reactions, 25% of first time anaphylactic reactions among children occur in school. Schools with PreK-1 will receive 2 junior pens in addition to 2 regular pens Charter also receive pens Form emailed to all nurses Form available for download via OSES website The completion and submission of report will trigger EpiPen replacement process Only school nurse can administer stock Epi-Pen - they are for those students who may have left their epi at home or who are having an anaphylactic reaction with no documented allergies, these DO NOT replace the epi-pens that all students should have if they have a known allergy

States with food allergy policies & guidelines CPS OTHER STATES Policy Recommendations Facts States with food allergy policies & guidelines Virtually every state has passed legislation allowing students (with consent) to carry their prescribed epinephrine at school The following 19 states have school-based food allergy guidelines: Arizona California Colorado Connecticut* Illinois Massachusetts* Maryland Missouri Mississippi New Jersey* New York Ohio Pennsylvania Rhode Island* Tennessee Texas Vermont* Washington* West Virginia * denotes states with Honor Roll standing Statewide guidelines help schools manage students with food allergies on top of their state policies- 19 states above have established guidelines Asthma and Allergy Foundation (AAFA) finds that strong state-wide policies are lacking throughout the US, with some rare bright spots AAFA has an annual research project called The State Honor Roll of Asthma and Allergy School policies – identify states with the most comprehensive and preferred statewide public policies. States with * have been named on the 2011 honor roll AAFA research and policy experts identified 18 core measures of “policy standards” to evaluate the 50 states. Policy standards cover mediation & treatment, awareness and school environment. The link above shows a review of US in 2011 with a breakdown of the 18 core measures Several public and private schools have banned peanuts, but the practicality and usefulness of such policies is still uncertain References: The Food Allergy & Anaphylaxis Network (2012) available at http://www.foodallergy.org/page/statewide-guidelines-for-schools Food Allergy & Anaphylaxis Network (2012) available at http://www.foodallergy.org/page/legislation Asthma and Allergy Foundation State Honor Roll available at http://www.aafa.org/display.cfm?id=5&sub=105&cont=649 Sources: Food Allergy & Anaphylaxis Network (2012) available at http://www.foodallergy.org/page/legislation Asthma and Allergy Foundation State Honor Roll available at http://www.aafa.org/display.cfm?id=5&sub=105&cont=649

States with food allergy policies & guidelines CPS OTHER STATES Policy Recommendations Facts States with food allergy policies & guidelines In 2011, President Obama signed the Food Allergy and Anaphylaxis Management Act Emerging trend allows schools to obtain “stock” EpiPen auto- injectors not tied to any one student but to be used in an emergency Kansas passed this law in 2009 EpiPen4Schools ™ Program Sources: Food Allergy & Anaphylaxis Network (2012) available at http://www.foodallergy.org/page/legislation and http://www.foodallergy.org/page/food-allergy-and-anaphylaxis-management-act-becomes-law Mylan EpiPen4Schools Program information available at http://www.epipen4schools.com President Barack Obama signed the Food Allergy and Anaphylaxis Management Act into law on January 4, 2011; this legislation orders the development of a voluntary policy to manage food allergy and anaphylactic risk in schools. Mylan’s EpiPen4Schools program was created to allow qualified schools to obtain EpiPen Auto-Injectors at no-cost. Each eligible school can receive up to four FREE EpiPen or EpiPen Jr Auto-Injectors References: Food Allergy & Anaphylaxis Network (2012) available at http://www.foodallergy.org/page/legislation and http://www.foodallergy.org/page/food-allergy-and-anaphylaxis-management-act-becomes-law Asthma and Allergy Foundation State Honor Roll available at http://www.aafa.org/display.cfm?id=5&sub=105&cont=649 Mylan EpiPen4Schools Program information available at http://www.epipen4schools.com/

Policy recommendations Policies: CPS Other States Facts POLICY RECOMMENDATIONS Policy recommendations Establish a multi-disciplinary team to address school-wide approach to identifying, managing, and reducing risk of student exposure to life threatening allergens Expand annual emergency drill program to include food allergy emergencies Require school-wide training on food allergies, the use of EpiPens in emergency situation and identification of location of EpiPens Establish stock EpiPen auto-injectors for schools Require school nurse EpiPen training Develop reporting systems for accountability