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School nurses have spent dozens of years taking care of and comforting ill students: handing out ice packs for bumps and bruises, bandages for cuts and scrapes, and administering prescribed medications.
But when it comes to an allergic reaction -- a condition that could be life threatening -- there's nothing they can do without a doctor's order.
"Currently, if I have epinephrine for child X, I can only administer it to that child," said Maureen Knowles, a registered nurse of more than 30 years and member-at-large for the Ohio Association of School Nurses. "We'd like to be able to administer it to any child having a true anaphylactic reaction, with or without an order."
For a child suffering from an allergic reaction, an EpiPen could mean the difference between life and death. The auto-injectors contain one dose of the drug epinephrine and are used as emergency treatment for potentially deadly allergic reactions that lead to anaphylactic shock.
As food allergies in children increase, parents and school nurses across Ohio are urging state lawmakers to pass a law requiring every school to have an EpiPen that can be used for any student who needs it whether it has been prescribed or not. The organization is working with parents and physicians to draft the bill.
"We feel that our children need to be protected," Mrs. Knowles said. "You don't know that you're allergic to something until you have a reaction to it."
Other states across the country are following suit and in Virginia, a law requiring schools to stock EpiPens took effect earlier this month. The Virginia law was sparked by the death of 7-year-old Amarria Johnson, who died at her elementary school in January after suffering an allergic reaction to peanuts.
Ohio students are allowed to carry doctor-prescribed EpiPens at school. The medication cannot be used on any students other than the student prescribed the medication. Parents are asked to keep updated orders and EpiPens on file at school.
Under the law, teachers and school administrators would be trained on how to use the pens. They would be trained on the signs of anaphylaxis, a severe, whole-body, life-threatening allergic reaction, which includes swelling of the face, eyes or tongue, difficulty breathing or swallowing and hives.
Close to 8 percent of children in the United States have food allergies. Nearly 40 percent of those children have severe reactions, researchers said in a survey published in January in the journal Pediatrics.
According to the Centers for Disease Control and Prevention, food allergies in children increased 18 percent between 1997 and 2007. A 2010 study published in the Journal of Allergy and Clinical Immunology found peanut allergies in children tripled between 1997 and 2008.
"Schools are carrying everything, including defibrillators. But at this time, school personnel cannot administer epinephrine to a child who is not diagnosed and may be having a reaction for the first time," said Dr. M. Ravi Rafeeq, a Toledo area allergist. "It's this group of children we need to protect."
One EpiPen costs about $100 and is effective for one year.
Ninety percent of food allergies are due to eight foods: milk, eggs, soy, wheat, peanuts, tree nuts, fish, and shellfish, Dr. Rafeeq said, adding that his practice is currently treating 10 times as many children as it did 10 years ago.
There is no cure for food allergies other than avoidance, and "unfortunately, avoidance can't happen all the time," Dr. Rafeeq said.
Brandy Brown of Lake Township has cleared her cabinets of all peanut products in an effort to prevent her 5-year-old son, Ethan, from having another allergic reaction.
"After his reaction, I had to educate myself," Mrs. Brown said. "I started reading food labels to see where products are manufactured and what they're made of."
At 14-months-old, Ethan developed hives after eating peanut butter toast.
"We both have medical backgrounds, but I guess we never really understood the severity of it until Ethan's reaction," Mrs. Brown said of her and her husband, Derick. Mrs. Brown has already spoken with school nurses and Ethan will carry an EpiPen when he starts kindergarten this school year. He'll pack his lunch and isn't allowed to eat anything other than what his mother prepares for him.
"After it happens, you're fearful," she said. "If he takes one bite it could be horrible."
Doctors don't usually condone administering prescription drugs to patients who haven't been prescribed the medication, but in the case of epinephrine, the risk are minimal, Dr. Rafeeq said.
"It's not going to do any harm to a child who doesn't need it and doesn't have any other health problems." Dr. Rafeeq said. "But not having it for a child who needs it could result in a fatality."
Contact RoNeisha Mullen at firstname.lastname@example.org or 419-724-6133.