CINCINNATI -- When the cost of EpiPens skyrocketed late this summer, many who deal with allergies -- either their own or their children's -- were up in arms. Parents filed lawsuits over what they saw as price gouging of a device that can combat life-threatening allergies.
The leap to $500 to $600 for a two-pack of EpiPens was also a blow to schools, which must tend to children's allergy dangers as well. Schools now must be as vigilant as ever to make sure students aren't exposed to potentially deadly foods.
Food allergies affect individuals differently on a case-by-case basis. Franklin City Schools’ George H. Gerke Elementary recently had two students with peanut allergies. One student, who is no longer enrolled at the school, would experience an allergic reaction only if she ingested peanuts. The other student, who still attends the school, has an acute allergy, which can be triggered by simply coming into contact with peanut oil.
“Hopefully we never get to that point where we have to see something happen,” said Gerke Elementary Principal Steve Greenwood.
Students at the school with peanut allergies sit at a separate table, which is wiped separately to ensure there is no peanut oil or residue. This particular protocol is common and is used in other districts and schools including Monroe Primary and Milford Junior High.
In some buildings, like Franklin’s Hampton Bennett Early Childhood Center, separate tables aren’t an option.
“We only have so many tables, and they’re completely filled to the brim,” said Joni Earach, school nurse for Franklin’s early childhood center, junior high and Pennyroyal and Hunter elementary buildings.
School staff at the early childhood center accommodate students with peanut allergies by making sure no one who sits around them is eating peanuts or peanut butter. Cafeteria workers also are careful to wash their hands and their food-preparation space, change their gloves and not reuse knives when serving peanut butter sandwiches.
“That’s just routine for them,” Earach said.
In other districts, like Monroe, peanut butter sandwiches are no longer an option offered in the cafeteria. Monroe Local Schools also don’t use any foods that may contain nuts, according to Becky Nickell, general manager of food service.
The accommodations Ohio school districts make for students with food allergies are, in part, a response to regulations put in place in the past decade by the Ohio Department of Education. House Bill 1, implemented in 2009, requires districts to create food allergy policies.
While the regulations were put into place seven years ago, many districts already were following similar procedures for peanut and other food allergies as they are now.
Although peanuts and tree nuts are some of the most common food allergens, others include milk, eggs and sometimes fruits like strawberries or peaches.
Just as different individuals can tolerate varied levels of exposure to food allergens, allergic reactions can vary from mild to severe. In a mild case, a student exposed to an allergen may develop a rash.
A severe allergic reaction, or anaphylaxis, can produce symptoms including hives, swelling in the throat or other parts of the body, difficulty breathing and chest tightness, among others. If not treated properly, an anaphylactic reaction can be fatal.
Anaphylaxis can be treated with an epinephrine injection, commonly known by the trademarked name EpiPen.
Ohio law allows school districts to supply their own EpiPens, but with the cost -- around $500 to $600 for a box containing two EpiPens -- few districts can afford to do so.
“We have not adopted that policy,” Earach said. “We can’t afford it.”
Since schools typically don’t have them on hand, parents often supply one for school officials to have on hand, or for their children to carry.
“Ohio law allows students to carry their own EpiPens if they’re old enough and responsible enough,” Garchar said. “That’s allowed and encouraged.
Out of 98 students with food allergies at Kings Junior High and High School, 13 have EpiPens, she said.
While many districts have similar food allergy procedures, how they deal with food allergies varies from school to school and sometimes even from year to year.
Because of a particular student situation, Clinton-Massie Local Schools, for example, were previously a nut-free zone, with signs posted at the entrances to buildings. Since the situation no longer exists, the district is no longer a nut-free zone.
In some districts, like Milford, food is generally off-limits in the classroom. However, there are some exceptions.
“When we first got rid of it, there was a big pushback,” said Rob Dunn, principal of Milford Junior High School.
“It’s almost a no-brainer now,” he added.
When food is allowed in classrooms, home-baked treats typically aren’t allowed.
“We want to be able to have stuff where we can read wrappers,” Greenwood said.
Often, classrooms with students who have nut or other food allergies will have signs posted to let people know. The individual student’s family, age and level of responsibility are part of the equation, too.
“I think the thing about food allergies, it’s very different with every kid, based on the parent and based on their age,” Dunn said.
Older students generally don’t require as much monitoring because they know what they can and can’t have, he said.
“I just think there’s overall increased awareness -- as far as families and communities -- of food allergies,” Garchar said.