Last May, six-year-old Kofi Berkley started getting itchy and developing bumps on his skin while he was playing with his friends at recess.
The recess supervisor brought the Grade 1 student, who didn’t have any known allergies, to his Edmonton elementary school’s office.
Principal Joanne Harle and an administrative assistant applied ice on his skin to try to soothe the irritation.
“Truly to goodness within ā€” it felt like an hour but it wasn’t, it was probably maybe a minute ā€” you could see his eyes swell. His top lip grew. He was gasping to breathe,” said Harle.
“That’s when we, the admin assistant said, ‘I think we have an allergic reaction. We need the EpiPen.'”
They had two EpiPens on hand at George P. Nicholson School because of an Alberta law enacted in 2020 that requiresĀ schools to have “stock” epinephrine devices, in addition to the EpiPens that parents provide for their kids with known food, bee or wasp allergies.
Food Allergy Canada says although other provincial education ministries have policies in place to prepare for and deal with serious allergic reactions, Alberta is the only one that legislates all schools to stock epinephrine devices that aren’t designated for a particular student.
The advocacy group is calling for all provinces to put similar legislation in place, rather than leaving it up to individual schools and school boards to take that initiative.
“Stock epinephrine, the way to think about that, is it’s like a defibrillator. It’s there for emergencies in an individual where you didn’t actually expect that to happen,” said Jennifer Gerdts, executive director of Food Allergy Canada.
Data from the U.S. suggests that 25 per cent of anaphylaxis cases that happen at school are among students who didn’t have a known history of severe allergy, Gerdts said ā€” and there’s no reason to believe that prevalence would be any different in Canada.
Alberta’s legislation also requires teachers and other school staff to do Food Allergy Canada’s “Allergy Aware” online training module, which takes about 30 minutes to complete.
Kofi’s dad, Cristen Berkley, said an allergy clinic still hasn’t been able to figure out exactly what his son is allergic to, but they’ll keep trying.
“It wasn’t easy to let him go back to school, especially not knowing what exactly triggered the allergy,” Berkley said.
“Knowing that the teachers were prepared in case of an event happening … that definitely helped ease my mind a little bit.”
Harle said as soon as they jabbed the epinephrine autoinjector into Kofi’s thigh, he screamed, which “was a relief” because it let them know his airway was clear.
An ambulance arrived within about five minutes. Harle said the paramedics came back later to tell the school staff how important it was that they had given Kofi the epinephrine quickly.
“To have had required legislated training, as well as required legislated EpiPens in the building … you’re ready for what’s gonna come,” she said.
“You practise for fire drills, you practise for lockdown drills. You should be practising for medical emergencies too.”
Dr. Scott Cameron, a pediatric allergist and clinical immunologist in Victoria, said first-time anaphylactic reactions are just one reason why epinephrine devices should be stocked in schools.
At about $100 per autoinjector, many families of kids with diagnosed allergies to food or insect stings can’t afford to buy more than one, he said, but schools require them to provide one that stays at school at all times.
“We have families where they have one injector and it lives at the school. So while accidents definitely happen at school and we need an injector present there, for that family to not have one with meals at their home or when they go out to a friend’s house or a restaurant ā€” all these other places where accidents could take place ā€” is really unfortunate,” Cameron said.
His home province of B.C. has a policy mandating automated external defibrillators (AEDs) and naloxone kits in all its schools, according to the province’s website.
“We’re going to be using epinephrine far more often than the AEDs or the naloxone kits that are being put there,” Cameron said.
“So we’re really asking the province, ‘Hey, you’ve taken this great approach in policy towards safety in schools. Please take it a step further and apply it to the other condition that happens even more commonly in schools that need an emergency medication available.'”
Gerdts, of Food Allergy Canada, said the organization has been in discussions with B.C. about stocking epinephrine in schools.
In an email sent to The Canadian Press on Friday, B.C.’s Ministry of Education and Child Care said it is “aware of the request by Food Allergy Canada and appreciates their advocacy.”
“At this time, it is not a requirement for schools to carry extra EpiPens, though schools may choose to do so in accordance with local policies and need,” the email said.
“However, itā€™s essential for every school to have an anaphylactic safety plan for students with anaphylaxis.”
Those plans include working with parents to “help keep the school free of allergy triggers,” as well as “outlining student responsibilities for carrying their EpiPen when appropriate,” and defining specific actions to be taken if a student has an anaphylactic reaction, the ministry said.
Cameron said although death from anaphylaxis is rare, getting epinephrine quickly decreases the likelihood of requiring hospitalization, including intensive care.
“Delaying epinephrine by even 20 minutes is known to be a big risk factor for any of those bad things occurring,” he said.
Cameron also emphasized that people shouldn’t hesitate to administer epinephrine if they believe an anaphylactic reaction is happening.
Even if it turns out the person isn’t having an allergic reaction, the epinephrine won’t do any harm, he said.
“If we gave epinephrine to somebody who didn’t need it, they’d go pale and their hand would get a bit shaky and their heart would go a tiny bit quicker,” he said.
“So it’s a very, very safe medicine to be wrong about. And hesitating to use it is a problem.”
Epinephrine nasal spray as an alternative to the autoinjectors have just entered the Canadian market, Cameron said.
“Both methods work equally well and are perfectly safe.”
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