Report 1 of the Council on Science and Public Health (A-07)

Childhood Anaphylactic Reactions

Summary

Objectives.  To review the recent scientific literature on the incidence of anaphylactic reactions in children, the specific strategies aimed at reducing these reactions, and the legislative efforts to ensure that children have appropriate access to necessary medical interventions in school settings.

Methods. The report is based on information obtained from the scientific literature; a recently published book; and material from the national Food Allergy and Anaphylaxis Network (FAAN), an educational group formed in 1991 to raise awareness of food allergies. English-language literature was identified from a PubMed search using the terms anaphylaxis, anaphylactic reaction, and food allergy covering the period 1980 through 2006. Additional key studies and resources were identified from the articles reviewed.

Results and Conclusions. Although anaphylactic reactions are relatively rare, they are serious medical emergencies that can cause death within minutes if not treated immediately. Because most children are unlikely to outgrow their allergies to peanuts and tree nuts, parents and their children must be diligent about checking the ingredients of foods they ingest. Parents should also work with their physician and school to ensure that school nurses have an updated emergency health plan that authorizes the nurse to administer auto-injectable epinephrine. When appropriate for age, student responsibility, and school circumstances, children should carry auto-injectable epinephrine and be instructed on when and how to administer the drug. Although most schools have trained health personnel, they often lack experience in handling acute medical emergencies caused by anaphylaxis and severe asthma. In addition, too few schools have a detailed and practiced emergency response plan. However, federal and state advocacy efforts are helping parents and children to be better informed about food ingredients.

RECOMMENDATIONS

The following statements, recommended by the Council on Science and Public Health, were adopted by the AMA House of Delegates as directives at the 2007 AMA Annual Meeting:

1. The AMA urges all schools, from preschool through 12th grade, to:

a. Develop Medical Emergency Response Plans (MERP);
b. Practice these plans in order to identify potential barriers and strategies for improvement;
c. Ensure that school campuses have a direct communication link with an emergency medical system (EMS);
d. Identify students at risk for life-threatening emergencies and ensure these children have an individual emergency care plan that is formulated with input by a physician;
e. Designate roles and responsibilities among school staff for handling potential life-threatening emergencies, including administering medications, working with EMS and local emergency departments, and contacting families;
f. Train school personnel in cardiopulmonary resuscitation;
g. Adopt the School Guidelines for Managing Students with Food Allergies distributed by the Food Allergy and Anaphylaxis Network; and
h. Ensure that appropriate emergency equipment to deal with anaphylaxis and acute asthmatic reactions is available and that assigned staff are familiar with using this equipment. (Directive)

2. The AMA will work to expand to all states laws permitting students to carry prescribed epinephrine or other medications prescribed by their physician for asthma or anaphylaxis. (Directive)

3. The AMA supports increased research to better understand the causes, epidemiology, and effective treatment of anaphylaxis. (Directive)

4. The AMA urges the Centers for Disease Control and Prevention to study the adequacy of school personnel and services to address asthma and anaphylactic emergencies. (Directive)

5. The AMA urges physicians to work with parents and schools to ensure that all their patients with a food allergy have an individualized emergency plan. (Directive)

6. The AMA will work to allow all first responders to carry and administer epinephrine in suspected cases of anaphylaxis. (Directive)

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