TORONTO – Last May, six-year-old Kofi Berkley began experiencing itching and developing skin bumps during recess at his Edmonton elementary school. The recess supervisor quickly brought Kofi to the school's office, where Principal Joanne Harle and an administrative assistant applied ice to alleviate the irritation. However, the situation escalated when Kofi's eyes swelled, his top lip enlarged, and he began gasping for breath.
Recognizing the signs of an allergic reaction, the administrative assistant called for the school's EpiPen, a device used to treat severe allergic reactions. Under Alberta law enacted in 2020, schools are now required to keep “stock” epinephrine devices, in addition to the individual EpiPens that parents provide for children with known allergies.
Food Allergy Canada indicates that although there are other provincial policies to manage severe allergic reactions, Alberta is unique in mandating that all schools maintain a supply of epinephrine injectors not designated for specific students. The advocacy group urges other provinces to implement similar legislation for the safety of students.
“Stock epinephrine is akin to having a defibrillator for emergencies where an unexpected event occurs,” stated Jennifer Gerdts, Executive Director of Food Allergy Canada. She noted that data from the U.S. reveals that 25 percent of anaphylaxis cases at school involve students who have no prior history of severe allergies; this trend is expected to be similar in Canada.
Alberta's legislation also mandates that teachers and school staff complete an “Allergy Aware” online training module provided by Food Allergy Canada, which takes about 30 minutes to finish. Kofi's father, Cristen Berkley, shared that their ongoing struggle to identify Kofi’s allergy has made it challenging to send him back to school. However, the knowledge that school staff were prepared for emergencies somewhat alleviated his worries.
Harle recounted that, after administering the epinephrine autoinjector into Kofi's thigh, his scream indicated that his airway was clear, which offered some reassurance during a tense moment. An ambulance arrived within five minutes, and the paramedics later appreciated the timely administration of the epinephrine, emphasizing the importance of readiness in such situations.
Dr. Scott Cameron, a pediatric allergist and clinical immunologist in Victoria, highlighted that the need for stocking epinephrine in schools extends beyond first-time anaphylactic reactions. The costly nature of autoinjectors—approximately $100 each—can make it difficult for families to afford multiple devices. Schools require at least one EpiPen to remain on-site, leaving families with insufficient coverage for other potentially hazardous scenarios outside of school.
In British Columbia, existing policies mandate the inclusion of automated external defibrillators (AEDs) and naloxone kits in schools. Cameron pointed out that epinephrine should be prioritized since it is needed more frequently than AEDs or naloxone. He urged the province to adopt similar regulations for stocking epinephrine in schools as part of a comprehensive safety approach.
Although B.C.'s Ministry of Education and Child Care responded that extra EpiPens are not currently required in schools, they underscored the necessity for every school to have an anaphylactic safety plan tailored to individual students' needs. These plans should involve collaboration with parents to minimize allergy triggers and outline student responsibilities for carrying their EpiPens.
Dr. Cameron noted that while fatalities from anaphylaxis are rare, rapid administration of epinephrine significantly reduces the chances of hospitalization, particularly in intensive care scenarios. Delaying the epinephrine injection, even by just 20 minutes, poses increased risks for adverse outcomes.
He encouraged a proactive approach, stating that individuals should administer epinephrine without hesitation if they suspect anaphylaxis is occurring, as the medicine poses minimal risk even if administered incorrectly. New alternatives, such as epinephrine nasal sprays, recently emerged in the Canadian market and are deemed equally effective.
This report emphasizes the critical need for comprehensive policies and training in schools to safeguard children at risk of anaphylaxis and underscores the ongoing discussions regarding the stocking of epinephrine devices in schools across Canada.
