Jan. 26--Even as schools across Illinois put the finishing touches on new state-mandated food allergy policies, some health care advocates question whether they go far enough to keep children safe.
The debate is especially strong in Chicago, where the death of a seventh-grader who suffered an allergic reaction reportedly to food served at a classroom party last month prompted public schools officials to re-examine their proposed policy even before it was adopted.
Even if the board approves the policy Wednesday, Chicago Public Schools officials will continue looking at issues ranging from districtwide peanut bans to whether an epinephrine injection could be given to any student suffering a severe allergic reaction at school, whether or not the potentially lifesaving hormone has been prescribed for that child.
CPS also could consider hiring a district physician or chief medical officer, a step that could potentially open the way for Chicago schools to keep a supply of epinephrine and other medicine.
"A terrible incident like this creates a point that everything has to be looked at," said Richard Smith, CPS' director of the Office of Specialized Services. "We're now looking at whether the contents (of the policy) would have helped this specific incident. We want to make sure we're refining this to the highest level."
Some parents and health officials say epinephrine auto-injectors should be as common in schools as defibrillators are, so immediate help would be available to any student suffering anaphylaxis, the severe allergic reaction that can close off breathing tubes and send the body into shock. But school districts, grappling with financial constraints and declining test scores, wonder how much more they can take on, and whether they're even capable of making emergency medical decisions in such cases.
Schools across Illinois were required to have allergy management policies in effect by the first of this year, using guidelines written by the Illinois State Board of Education and the Illinois Department of Public Health. However, many districts -- like CPS -- have not yet formally implemented those policies.
The Centers for Disease Control and Prevention reports that 1 in 25 children are affected by food allergies, many of them to multiple types of food, and the numbers keep increasing. Reported food allergies have jumped nearly 60 percent from 1997 through 2009, said Amy Branum with the CDC's National Center for Health Statistics.
For parents like Kristin Miller, who fought for the 2009 state legislation leading to Illinois' food allergy guidelines, it was a long struggle to get schools to recognize the prevalence and danger of food allergies.
Even though her daughter's elementary school in Clarendon Hills was cautious of the girl's allergies to food like tree nuts, shellfish, eggs, tropical fruit and seeds, an accidental exposure that triggered a mild reaction one day led Miller to work from home for five years so she could check on her daughter at school several times a day.
"I shouldn't have to be afraid to send (my daughter) to school, that she's going to die there," said Miller, who also helped draft the state guidelines. "Even when you have the best plan, mistakes still happen. When something goes wrong, you want schools to have something in place to save your child's life."
When someone is experiencing a severe allergic reaction, an epinephrine injection -- sometimes known by the injector's brand name EpiPen -- can open narrowing breathing tubes, improve blood circulation and reduce swelling, buying time for emergency workers. Pediatrics professor Scott Sicherer at New York City's Mount Sinai School of Medicine favors having epinephrine available in schools for use even on undiagnosed students when school nurses are available. He said epinephrine is "a safe medication and if given without need, nothing bad is likely to occur" except a faster heart rate.
For now, however, CPS says it follows Illinois law, allowing prescription medicines like epinephrine to be used only on students whose doctors prescribe it, whose parents supply it and whose student health records list it. The new state guidelines recommend that approach, but CPS says it would be supportive of legislation that lets schools get the drug for school emergency first aid kits.
Katelyn Carlson, 13, died of anaphylaxis on Dec. 17 after reportedly eating takeout food served at Edison Regional Gifted Center in Albany Park. CPS, which is investigating the incident, has revealed few details, but parents of other students in Katelyn's class said the girl had problems breathing but was not given epinephrine. Paramedics arrived to find school employees giving Katelyn CPR.
CPS spokeswoman Monique Bond said Katelyn had an updated health plan on file at the school, and the staff followed the plan. The teacher reportedly had checked with the restaurant to be sure no peanuts would be in the food.
Katelyn's parents have declined to comment. The Cook County medical examiner's office has determined that Katelyn died of anaphylaxis due to a food allergy, but it did not specify which food caused it.
Shaken by her death, officials have now declared Edison will be peanut-free by Feb. 10.
Other Chicago schools banned peanuts long before the state guidelines were announced. Schools also have taken preventive measures such as teaching staff members to recognize an allergic reaction and inject epinephrine, and allowing older students to carry their epinephrine in backpacks for emergency use.
In 2006, north suburban Lake Forest School District 67 created peanut-free tables in the lunchroom and trained cafeteria staff, bus drivers and teachers on allergic reactions, "because it could be someone without an identified allergy who can be having a problem," said Julie Cooley, the district's assistant superintendent of student services.
Ideally, said Christine Szychlinski, manager of the Food Allergy Program at Chicago's Children's Memorial Hospital, the state guidelines she helped develop should have called for school nurses at all schools or for bans on children eating lunch in classrooms to prevent exposure to crumbs or uncleaned surfaces. But experts realized those suggestions were not practical given today's economic situation.
"We were given the charge of making recommendations that had no financial consequences" for school districts, she said.
In Massachusetts, public health officials pushed for more school nurses after three allergy-related student deaths in 2000 and statistics that showed up to 27 percent of anaphylaxis occurs among students never diagnosed with a food allergy. School district physicians began writing standing orders for epinephrine so school nurses could carry a supply and use it on any student in a life-threatening emergency, said Chris Weiss with the Virginia-based Food Allergy and Anaphylaxis Network, which spent five years campaigning for national food allergy guidelines that were signed into law Jan. 4 as part of a food safety bill.
In 2009, Kansas passed state legislation opening the way for many schools to carry a supply of epinephrine. The Kansas legislation also exempts from liability "any person who gratuitously and in good faith renders emergency care ..." by administering the drug -- allowing people to feel legally secure while acting as good Samaritans.
"We hope to see more and more states coming on board," Weiss said. "If we see that significant numbers of reactions are involving kids whose allergy was unknown, then standing orders are really the avenue to have epinephrine available."
But that could be an issue in schools without nurses on staff, said Susan Voss, government relations chairman of the Illinois Association of School Nurses.
"Because of costs, school districts are choosing not to hire nurses or hire them part-time, or spread them thin among five to six schools," she said.
On a recent day, a student walked into Voss' school office, complaining of itchy lips and hands and shortness of breath. He had recently begun developing new food allergies, so his doctor had prescribed epinephrine, and Voss had the student's EpiPen on hand to administer the drug and call 911.
Would she have felt comfortable making that medical decision without the physician's prescription?
"These are not nurses' decisions," she said. "It's a doctor's decision to keep an EpiPen in school."
Similarly, in Wilmette Public Schools District 39, which developed its own allergy management policy in 2003 that became a national model, Superintendent Raymond Lechner said administering epinephrine without a doctor's order would be beyond an educator's role.
"I don't feel like it's a school's place to take the place of a medical professional," Lechner said. "I can't imagine us making medical decisions."
nahmed@tribune.com
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