Food Allergy Canada urges laws requiring schools to stock epinephrine

TORONTO — Food Allergy Canada is calling on provinces to pass laws requiring schools to stock epinephrine devices that are not assigned to a specific student. The group says Alberta is the only province to legislate such a requirement for all schools, though education ministries elsewhere have policies for preventing and responding to serious allergic reactions.

The group points to the case of Kofi Berkley, who was six when he developed itching and bumps while playing with friends at recess last May. The Grade 1 student, who had no known allergies, was brought to the office at George P. Nicholson School in Edmonton. Principal Joanne Harle and an administrative assistant applied ice, but his eyes and upper lip soon swelled and he gasped for air.

The school had two EpiPens because of Alberta’s 2020 law requiring stock epinephrine in addition to devices parents provide for children with known food, bee or wasp allergies. Staff injected an epinephrine autoinjector into Kofi’s thigh. Harle said his scream was reassuring because it showed his airway was clear, and an ambulance arrived in about five minutes. Paramedics later told staff that administering epinephrine quickly had been important.

Jennifer Gerdts, executive director of Food Allergy Canada, compared stock epinephrine to a defibrillator: an emergency resource for an event that was not anticipated. She cited U.S. data suggesting 25 per cent of anaphylaxis cases at school involve students without a known history of severe allergy, and said there was no reason to expect a different prevalence in Canada. Alberta’s law also requires teachers and other school staff to complete Food Allergy Canada’s approximately 30-minute Allergy Aware online training module.

Kofi’s father, Cristen Berkley, said an allergy clinic has not yet determined what triggered his son’s reaction, though the family will keep trying. He said sending Kofi back to school was difficult without knowing the trigger, but confidence that teachers were prepared eased his concerns. Harle said medical emergencies should be practised alongside fire and lockdown drills.

Dr. Scott Cameron, a pediatric allergist and clinical immunologist in Victoria, said first-time anaphylactic reactions are only one reason schools should keep epinephrine. At about $100 per autoinjector, some families of children diagnosed with food or insect-sting allergies cannot afford more than one. If that single device must remain at school, he said, the family may not have one at home, at a friend’s house or at a restaurant.

British Columbia requires schools to have automated external defibrillators and naloxone kits, according to the provincial website. Cameron said epinephrine would likely be used more often and urged the province to extend its school-safety approach. Food Allergy Canada says it has discussed stock epinephrine with B.C.

B.C.’s Ministry of Education and Child Care said Friday that it is aware of the request and appreciates the organization’s advocacy. Extra EpiPens are not currently required, though schools may carry them under local policy and according to need. The ministry said every school must have an anaphylactic safety plan for affected students, including measures developed with parents to reduce allergy triggers, student responsibilities for carrying an EpiPen where appropriate, and actions to take during a reaction.

Cameron said prompt epinephrine reduces the likelihood of hospitalization, including intensive care, and that a delay of even 20 minutes is a major risk factor for serious outcomes. He said people should not hesitate when they believe anaphylaxis is occurring: unnecessary use may cause pallor, a slightly shaky hand and a modestly faster heartbeat, but is otherwise safe. Epinephrine nasal spray has recently entered the Canadian market, he added, and it and autoinjectors are equally effective and safe.