AMA meeting: Schools urged to plan response for kids' anaphylaxis

Chicago -- Students at risk for anaphylaxis should be allowed access to epinephrine or other appropriate medications, and schools should have emergency-response plans to deal with this possible circumstance. School personnel who initially respond to an incident should be allowed to administer the necessary medications, according to a report from the AMA's Council on Science and Public Health, adopted as policy at last month's Annual Meeting.

"An epinephrine injection at the first sign of a reaction is critical," said AMA Trustee Rebecca J. Patchin, MD. "All states should have laws that allow children to protect themselves by carrying lifesaving tools like epinephrine or other prescribed medication."

The organization took this stand because anaphylaxis, though relatively rare, can be deadly if not dealt with immediately. Also, a growing number of children have allergies and asthma and are at risk, but barriers remain to ensuring they receive proper care.

"As a parent of two kids who have had anaphylaxis, I have to say you can raise them up as little kids. You can try to take care of them. But the moment they enter the school system you have no control over what happens," said Mohamed Khan, MD, PhD, who, as chair of the council, presented the report. "Depending on the school district, they can be in great danger."

Only 32 states have laws that allow students to carry epinephrine, which is the usual treatment, and some states have laws preventing school personnel from administering it. In addition, educational institutions may not necessarily be prepared to react appropriately to this type of emergency. According to data from the Centers for Disease Control and Prevention, most schools have medical emergency response plans, but many have never practiced them.

"It's very important that these procedures are in place and children can be protected," said Dr. Khan. "There are some legal changes that need to be made and some training that needs to occur at schools."

The AMA's recommendations apply from preschool to 12th grade and call for individual students known to be at risk to have a personalized emergency plan developed in conjunction with a physician. In addition, the organization wants more research to lead to improved understanding of the causes, epidemiology and treatment of anaphylactic reactions.

Experts say the hesitation about prompt action for children at risk for anaphylaxis is the fact that the preferred drug is injected. In a related action, the AMA intends to study the best way to improve care of children with diabetes in schools.