Infectious Disease

California legislation requires accessible epinephrine in schools

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Healio Interviews

Disclosures:
Linde is the senior vice president of government and community affairs at FARE.

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Key takeaways:

  • The Muñoz SAFE Act requires schools to store epinephrine autoinjectors in accessible locations.
  • Activity supervisors may be trained to administer epinephrine to children in need.

When a child has an anaphylactic reaction in school, prompt administration of epinephrine can be lifesaving. Yet autoinjectors often are kept under lock and key in the nurse’s office, and school personnel lack the training to use them.

“Seven-point-six percent of all children in America have life-threatening food allergies,” jason linde, MA, senior vice president of government and community affairs with Food Allergy Research & Education (FARE), told Healio.

Priscilla Hernandez (left), a member of the FARE Board of Ambassadors, and her son Zacky Muñoz, who experienced two anaphylactic reactions at school while he was in first grade, were instrumental in developing the Muñoz SAFE Act and in other advocacy efforts with FARE CEO Sung Poblete, RN, PhD, (right) and other members of the organization. Courtesy of FARE

“That’s about 466,000 children in school in California,” he continued. “Work needs to be done on their behalf.”

The California Legislature’s Muñoz SAFE Act, AB 1651, would require schools, educational offices and charter schools to store epinephrine autoinjectors in accessible locations for emergency use.

“This law seeks to make a small but important change,” Linde said.

Jason Linde

There is no federal standard for how schools should store and administer epinephrine to students who need it, and regulations vary by state. Typically, Linde said, states require autoinjectors to be stored in secure areas.

“This can lead to situations where a nurse has the autoinjectors locked up, or it’s not well known where they are,” Linde said. “Time is of the essence. If people cannot find those epinephrine autoinjectors that can lead to a fatality.”

The law also requires schools to broadly share information about where these autoinjectors are located. Plus, it would allow schools to designate people with Activity Supervisor Clearance Certificates such as volunteers to receive training to administer epinephrine via autoinjector to people in need if a school nurse is not present.

FARE already has support for schools that want to train their personnel, Linde said.

“We have a 25-minute module that we provide to states that stock epinephrine,” Linde said.

Additional legislation

Schools face some challenges in stockpiling epinephrine for these potential emergencies, Linde said. Autoinjectors are not cheap, for example, and they eventually expire and need replacement. FARE is working with the federal government to address these issues.

“Last year, we helped get a bill passed into law. It was part of the President’s omnibus that asked the FDA to look at extending the expiration date for epinephrine autoinjectors and other critical lifesaving medicine,” Linde said. “It gives them a 2-year window to start the process.”

While studies have shown that epinephrine may be effective for 2 and even 3 years, Linde said, no school is going to want to stock an autoinjector that has expired.

“They’re just not going to take that risk,” Linde said.

Meanwhile, Linde said, FARE encourages schools to follow all state and federal regulations and guidelines. Along with California, the organization is lobbying for laws like AB 1651 in other states, in addition to legislation in New York and Oklahoma that would support training for teachers, too.

Last year, FARE worked with an advocate and the Missouri legislature to pass a bill that would allow all school personnel trained by a nurse to administer epinephrine via autoinjector to any student experiencing anaphylaxis without any civil liability.

“Schools are big, and there’s one nurse or nurse’s aide,” Linde said. “We’re working on training bills to make sure that more individuals can deliver the care that children need at the time they need it.”

FARE also is lobbying for state legislation across the country to put price caps on autoinjectors.

“This is a high priority for FARE,” Linde said. “Whether you’re in school or whether you’re a family, no one should be paying $400 to $700 in out-of-pocket costs. That’s just ridiculous.”

Additionally, FARE is lobbying for legislation to require EMS personnel and other first responders to carry epinephrine autoinjectors as well as FDA approval of different epinephrine delivery systems such as the neffy nasal spray (ARS Pharmaceuticals).

“In a few weeks, the FDA is going to have a hearing,” Linde said.

Airlines currently are required to carry epinephrine in their emergency kits, and many of them carry it in vials.

“A vial of epinephrine doesn’t do anyone any good for the most part, simply because if you don’t have a doctor or a professional there, who is going to administer it?” Linde said. “We want to see ease of use.”

Behind the scenes

The Muñoz SAFE Act is named after Zacky Muñoz, a boy with food allergies who experienced two anaphylactic reactions in school while he was in first grade. His mother, Priscilla Hernandez, is a member of FARE’s Board of National Ambassadors.

“They’re the superheroes behind this bill,” Linde said. “We support them with a whole bunch of different resources, but they are the ones doing the heavy lifting.”

According to Linde, Hernandez drove FARE’s efforts in working with the California Legislature to develop AB 1651. She and Zacky also both recently were in Washington, DC, as part of FARE’s legislative fly-in, where they met with Congressional staff.

“Zacky is a wonderful advocate,” Linde said.

Last year, Hernandez worked with the California Legislature to pass Zacky’s Law, AB 2640, which requires California to provide a compendium of information about food allergy to schools, parents and other stakeholders.

“When you look for information on food allergies online, you’re just flooded,” Linde said. “Zacky’s Law provides a one-stop shop for schools, children and parents to find out all they need to know about food allergies.”

Linde noted that food allergies are underdiagnosed. For example, he said, only one-tenth of children with food allergies on Medicaid are diagnosed.

“Because of that disparity, especially in underserved populations, Zacky’s Law really aims to get that information out to people.”

Children with food allergies who have not been diagnosed often will discover their allergy when they have an unexpected reaction to an allergen, Linde said.

“A child will go to school. They’ll be served something, or someone will have a snack, and they’ll have an anaphylactic attack, and there is no history of food allergies for the child,” Linde said.

Considering recent fatalities, Linde applauded the family’s work and dedication to improving outcomes for all children with food allergies.

“They’re doing the absolute best work that can be done,” Linde said.

For more information:

Jason Linde, MA, can be reached at [email protected].

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