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Who’s to Blame for Another Allergy Tragedy?

Virginia’s Chesterfield County police have determined that there was no criminal negligence on the part of the school personnel in the tragic food-allergy death of 7-year-old Amarria Johnson [1] on January 2, 2012.

Also cleared of criminal wrongdoing, thankfully, was the child on the school playground who, not knowing of the allergy, handed Amarria the fateful peanut – which Amarria then popped in her mouth and swallowed. I can only imagine the particular hell that child, and also the teacher and health-clinic aide who attempted to help Amarria in the short period before her death all must feel today.

Of course, I wish they had all acted differently that day. I especially wish that clinic aide had taken one of the auto-injectors available at the school, but prescribed to other children, and ripped off the safety cap, injected it into Amarria’s thigh as she descended into anaphylaxis – an injection that most likely would have saved her life. But it was against the school’s rules to do so, possibly against the law as epinephrine in Virginia, as in so many states, can be taken to school, but can only be administered to the person named on the prescription label.

In the online aftermath of this tragedy, some are admonishing Amarria’s mother Laura Pendleton, asking why she hadn’t provided an epinephrine auto-injector to the school. But I can’t find it in my heart to blame a mother mourning the loss of her little girl. In her shoes, what mother wouldn’t already be plagued by self-recrimination and “if only I hads”. Besides, we don’t even know whether it was the school’s fault or Pendleton’s oversight that Amarria didn’t have an auto-injector at school.

As CNN reported [2], Pendleton has said she asked a school official about sending an auto-injector in with her daughter, but was told, no, please just keep it at home. The school has said only that there was no device provided for the child. It gets murky and he said/she said. The only point of raising this is: a big part of the preventing future tragedies has to be that epinephrine is available at all times to any child at risk of anaphylaxis at school.

Now here’s where I do find fault, with all of us as an allergy community and with the lack of communication about the importance of the auto-injector, most commonly known being the EpiPen brand. As a community of parents and advocates, we spend an awful lot of time talking about the fact that an allergen like peanut can kill, but we don’t give equal time to talking about epinephrine, the drug that can turn off the anaphylactic reaction like a faucet.

Nor do we remember that we need to continuously impress upon others the relative safety of that drug and, thirdly, the absolute need for speed when a food or sting allergy reaction is in progress. We grow so familiar with this knowledge that we at times forget to share it. Let’s consciously change that.

Next: A lifesaver of a drug

From previous page

In the aftermath of Amarria’s death, a spokesman for Hopkins Elementary, the school Amarria attended, suggested that there might be a problem if a child was given the drug in error. Hogwash.

People think “drug” and they worry about what it might do or about giving it in the wrong circumstance. Epinephrine may be a drug, but allergists who are experts on it say that if you used auto-injector by mistake on a person who didn’t need it, that person might get the jitters, maybe a stomach ache, or at worst, vomiting. In other words, it is considered a very safe drug. The consequences of not using it when needed are far greater than those of administering it when its use is questionable.

At a medical conference back in 2005, I interviewed Dr. Estelle Simons, an allergist and renowned expert on anaphylaxis and epinephrine. We were speaking about the lack of public awareness of anaphylaxis and of what to do in an emergency. After our interview, she tracked me down to add: “We need to get the message out: It should be public policy to teach people that anaphylaxis can be fatal and that lives can be saved by prompt injection of epinephrine.”

She was right then and she’s right today. And more can be done to change the situation in schools.

If you live in the United States, what you can do to help with emergency prevention in the schools is to lobby Congress for a very important proposed piece of legislation: the School Access to Emergency Epinephrine Act [3], dubbed the “stock” epinephrine law for short. It encourages states to require schools to have a stock of auto-injectors that can be used for any student who is having an allergic reaction. The bill was introduced by two Illinois senators after a 13-year-old in Chicago inadvertently ate peanut at a class party and died. Another young life needlessly lost, another tragedy where epinephrine could have made the difference.

While Virginia’s current self-carry allergy and asthma medications statute requires that epinephrine at school only be used for the student with a prescription, school staff everywhere need to be aware that all states (and provinces in Canada) have Good Samaritan’s Laws. Most will protect people to follow their instincts in an anaphylaxis emergency, without fear of being sued.

Virginia’s says: “Any person who, in good faith, renders emergency care or assistance, without compensation, to any ill or injured person at the scene of an accident, fire, or any life-threatening emergency … shall not be liable for any civil damages for acts or omissions resulting from the rendering of such care or assistance.”

We who are familiar in our daily lives with food allergies clearly need to help educate the educators at our local schools. When you impress upon your child’s teachers the seriousness of the allergy, don’t forget to also stress that they need not fear the auto-injector nor the medication that’s in it.

As a community, we have to convey that you don’t wait to see what the ambulance worker will think or to see if the reaction will get worse. By the time the ambulance arrived for Amarria, she was in cardiac arrest. This just didn’t have to be.

Let’s do what we can to change the climate of fear around epinephrine. It’s only a needle, one that will save a child’s life.

Note: Tell your school about a great new learning resource at: http://allergyready.com/ [4]
Column published: Jan. 18, 2012