Approximately 1-in-20 children have life-threatening allergic reactions that can lead to hospitalization.
Schools and hospitals are not required to report most allergic reactions to state or federal sources.
Most states regulate allergy planning in school districts, not childcare facilities.
Allergic reactions to foods, insect stings, medications, or other substances (e.g., latex) can range from acute (e.g., eye/skin irritation) to life-threatening (e.g., anaphylaxis; Dribin 2022).
Muscular injection of epinephrine is nearly 100% effective at lessening an allergic reaction and can be self-administered or given by a non-medical professional. Immediate medical follow-up is recommended to ensure allergic reactions are cleared, and may require additional short-term treatments or supplemental oxygen as prescribed (Campbell 2022).
Roughly 1-in-50 adults have reported an anaphylactic reaction at some point in their lives. Between 3-6% of children have had significant reactions that led to hospitalizations, often worsened by delayed administration of epinephrine (Yu 2018).
There is no publicly available reporting mechanism in MO for anaphylactic reactions (e.g. frequency, where they occur).
No federal agency appears to collect anaphylaxis data apart from reactions to some drugs or vaccines that lead to medical interventions.
In school or childcare settings, certain strategies can reduce the risk of allergic reactions, including cleaning and sanitizing high-touch surfaces routinely, mandatory hand washing for students and/or staff, allergen-free or safe zones, or planning ahead for events and emergencies surrounding food, such as staff emergency training (DHSS 2014).
1-in-3 schools in the U.S. provide some training for school nurses or staff to recognize anaphylactic reactions.
Table 1. School or childcare facility allergy policies in MO (RSMo 167.208, RSMo 167.627, RSMo 167.621; RSMo 167.630).
NY and IL have passed ‘Elijah’s Law,’ a comprehensive law that requires state health departments to work with schools and childcare facilities to create plans for epinephrine administration, emergency protocols, exposure reduction, training of at least one staff member, and distribution of these plans to the public (NY OCFS 2023; IL 102-0413 2021).
Figure 1. States with childcare facility allergy policies. States with more preventative allergy policies (Table 1) are filled with darker blue shades. Data from Asthma & Allergy Foundation of America.
After Anaphylaxis: Learning From the Experience. (2021). Icahn School of Medicine at Mt. Sinai. Retrieved from https://www.mountsinai.org/files/MSHealth/Assets/HS/Care/Pediatrics/Allergy%20Immunology/After-Anaphylaxis-Learning-from-the-Experience-AH-Edits-2-1-21.pdf
Allergy and Anaphylaxis in the School Setting. Missouri Department of Health and Senior Services. Retrieved from https://health.mo.gov/living/families/schoolhealth/ppt/allergy_and_anaphylaxis.ppt
Allergy Awareness & Elijah’s Law. (2023). New York Division of Child Care Services. Retrieved from https://ocfs.ny.gov/programs/childcare/elijahs-law.php
Anaphylactic Policy. (2021). Illinois General Assembly. Retrieved from https://ilga.gov/legislation/BillStatus.asp?DocTypeID=HB&DocNum=102&GAID=16&SessionID=110&LegID=127914
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Guidelines For Allergy Prevention And Response. Missouri Department of Health and Senior Services. Retrieved from https://health.mo.gov/living/families/schoolhealth/pdf/mo_allergy_manual.pdf
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