Tony Hopko, an incoming seventh-grade student at Brunswick Middle School, is allergic to nuts.
He has never had a severe allergic reaction at school because he carefully avoids not only food or snacks that contain nuts, but also those that could have been cross-contaminated with nuts during preparation, such as Twix bars, Kit-Kats and M&M’s.
Knowing even a single nut can cause him to have a life-threatening allergic reaction, Tony’s mother Dawn Hopko made sure that he had an epinephrine auto-injector ready for him in case of an emergency. At first, it stayed in school but as soon as Tony was old enough to use it on his own — in the sixth grade — he began carrying it around wherever he went.
“The only thing that stands between my son’s life and death is the EpiPen pen,” Hopko said.
Knowing the real danger of allergies, Hopko and her son testified in favor of state legislation that requires schools do more to protect students with food allergies.
The law, which was signed into law by Gov. Martin O’Malley (D) this year, took effect July 1.
Before the new law went in effect, in cases where students displayed signs of anaphylaxis — a life-threatening allergic reaction — school personnel could not administer a shot of epinephrine if the student had not previously reported the allergy.
Instead, they had to call 911 and wait for trained medical staff to administer the life-saving medication.
The new law also requires school systems statewide to train school personnel to recognize the signs and symptoms of anaphylaxis and respond immediately by administering a shot of epinephrine, regardless of whether a student has any known allergies or has an epinephrine prescription, Frederick County Health Specialist Christa Williams said.
Frederick County Public Schools already have some measures in place designed to protect students with severe nut allergies. In some schools, such as Deer Crossing Elementary, students with allergies can request to eat at a separate table.
Staff members also ask students not to share food and allows only store-bought and packaged foods for birthdays and parties.
Prompted by cases like that of Amarria Johnson, a 7-year-old who died in January at a school in Virginia after an allergic reaction to a peanut, the new law aims to protect children by providing them with immediate help, Williams said.
A shot of epinephrine helps slow down an allergic reaction, giving time to first responders to arrive at the scene.
Amarria, for example, did not receive a shot of epinephrine, and by the time first responders got to her school, she had gone into cardiac arrest and could not be resuscitated, according to news reports.
In Frederick County, the mother of a 5-year-old student at Hillcrest Elementary attempted to sue the school system as well as the state and the Department of Education, claiming that in 2005 her daughter, who is allergic to peanuts, was served a peanut butter sandwich.
The girl, who was then in kindergarten, told the food service staff that she could not eat the sandwich, but staff mistook that as misbehavior — rather than a food allergy.
The girl went into anaphylactic shock and was given a dose of epinephrine to relieve the symptoms.
The county settled out of court, and the case against the state agencies was dismissed in Frederick County Circuit Court and appealed until it reached the Court of Appeals.
Maryland’s highest court ruled in February that state agencies are not required to ensure children aren’t served food to which they are allergic.
While supporters say the new law will help protect students who suffer from food allergies, it also is likely to carry a cost, officials say.
Under the law, schools are required to fund staff training as they await additional guidance on the mandate from the state, Williams said.
Frederick County schools will also most likely have to pay to stock up on epinephrine, Williams said.
“It would be Frederick County Public Schools trying to fund this,” she said. “There are a lot of steps we are trying to take.”
The school system is already working with the Frederick County Health Department to develop training for school personnel, Williams said. But to complete that, school officials still need specific guidelines from the state that are consistent with other jurisdictions, she said.
“We don’t have a nurse in every school, so you would have to have very clear guidance,” Williams said. “I would like to know what to do before school starts.”
Although the new law is vague when it comes to asking school systems to stock up on epinephrine, Williams and school system officials around the state expect it will be a requirement.
Currently, Frederick County schools pay $234 for a twin pack of epinephrine auto-injectors known as EpiPens. If the school system is required to have two in stock at every school that could cost up to $50,000 a year, Williams said. Because epinephrine auto-injectors have an expiration date, they would have to be replaced frequently, which adds to the cost, Williams said.
According to Williams, these are still preliminary numbers and the school system is still in the process of researching the best way to follow the requirement.
This year, Frederick County schools have 1,008 reported students with severe food allergies, and 815 of them have EpiPens, Williams said.
According to Williams, the school system plans to hold an online training course for all staff members on the signs and symptoms of anaphylaxis, while health department nurses will assist with hands-on training in administering the epinephrine.
“... There is no cost for the online training module, but it will take approximately 20 to 25 minutes of (staff members’) time to receive the education,” Williams said.
Williams said the school system has asked the state for additional guidance about the new mandate and hopes to have everything in place before the start of the school year.