Many children hate school, but few can seriously claim that it may kill them to go.
Twelve-year-old Ceasar Sanchez is one of those few. Any exposure to seafood or nuts could mean going into anaphylactic shock, and needing an epinephrine shot to save his life.
In Colorado, kids need a prescription to receive epinephrine at school. Often, the child must either self-administer the medication, or have it provided by a school nurse. Children who forget their shot (often referred to by the brand name "EpiPen"), or children with an undiagnosed allergy, usually must wait for an ambulance. Since anaphylaxis worsens rapidly without medicine, that can be deadly.
"He's been hospitalized twice," says Ceasar's mother, Renee Gonzalez. "They said if he were to eat nuts again, and he didn't have epinephrine, the chances are that he'd die within five minutes."
Protecting kids with these allergies can be a daunting task for school districts. But House Bill 1171, which has already passed the Colorado House and moved on to the Senate, aims to ease the burden. If made law, it will allow schools to stock EpiPens. Trained teachers and staff may administer the shots to kids in need — whether or not they have a diagnosed allergy — without fear of most legal repercussions.
"This bill is important to me because it could save lives by giving schools who want to participate more discretion in administering life saving measures to a child who may be experiencing anaphylactic shock," the bill's sponsor, Rep. Dianne Primavera, tells the Independent via e-mail.
A few snags
Liana Burns, spokesperson for the Asthma and Allergy Foundation of America, says such laws are trending nationwide because severe allergies are more common now. Between 1997 and 2007, for instance, the Center for Disease Control and Prevention noted an 18 percent increase in childhood food allergies, with nearly 4 percent of children diagnosed with the disorder.
Locally, Academy School District 20 had 399 students with a diagnosed deadly food allergy in the 2007-2008 school year. It now has 639.
Still, there are a few snags — big and small — in HB 1171 that may need to be worked out.
On the smaller side: The bill includes very little funding, meaning schools will need to pay to purchase EpiPens and train staff. Some of those costs, however, could be defrayed. Mylan Specialty L.P. — maker of the EpiPen, and a big proponent of laws that bring their medication into schools — offers grants through its EpiPen4Schools Program. Qualifying schools can receive four free shots.
According to a Mylan fact sheet, more than 20,000 schools have received free medication since the program was introduced in August 2012. Additional medication may be purchased by schools at a discount.
Then there are the more complex issues. Jennifer Miles, lobbyist for Colorado Association of School Nurses, says her organization is working with the Colorado Association of School Executives, the Colorado Education Association and Cherry Creek School District to draft an amendment addressing three problems.
First, the bill may require schools to get a pharmacy license to stock the EpiPen. Second, there's concern that the bill suggests that schools can prescribe the medication, when actually, only a doctor can do that. Third, it's unclear whether the plan allows schools to cherry-pick parts of the law — which may be necessary, because schools must comply with prescribing doctors' wishes.
Cherry Creek, for instance, does stock EpiPens, thanks to a doctor's prescription. But the doctor has specified that the drugs are only for children with an existing prescription, and that only specific staff members may administer them.
Many school districts may want to follow the Cherry Creek model, because doctors may not be willing to take greater risks. While EpiPens are generally safe, there are concerns that they could adversely affect children with certain pre-existing conditions, or that they could injure children if administered incorrectly.
Making it work
Still, experts say an EpiPen is more likely to save a child than hurt one.
It perhaps could have rescued a Virginia first-grader who died last year after being given a peanut on the playground. Never administered an EpiPen, the little girl had gone into cardiac arrest by the time an ambulance arrived. It's that scenario that scares Gonzalez, who already has had to remove her son from a Boys and Girls Club program in which his EpiPen wasn't welcome ("No allergies allowed," News, Jan. 5, 2012).
"If I knew there was a teacher there that could administer something to [Ceasar] immediately, by all means, go for it," she says. "And if you injure him doing it, you know what, at least you tried."
Miles agrees that HB 1171 makes sense, and she's hopeful concerns can be ironed out so that the plan is adopted by as many schools as possible.
Gonzalez says she'll be watching the bill's progress.
"It opens up a lot of possibilities for these kids, as far as taking a lot of worry off them," she says. "[It's] knowing that they don't have to carry the burden of, 'What if I get sick and don't have what I need on me?'"