II 110th CONGRESS 1st Session S. 1232 IN THE SENATE OF THE UNITED STATES April 26, 2007 Mr. Dodd introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To direct the Secretary of Health and Human Services, in consultation with the Secretary of Education, to develop a voluntary policy for managing the risk of food allergy and anaphylaxis in schools, to establish school-based food allergy management grants, and for other purposes.

1.

Short title

This Act may be cited as the Food Allergy and Anaphylaxis Management Act of 2007.

2.

Findings

Congress finds as follows: (1)Food allergy is an increasing food safety and public health concern in the United States, especially among students. (2)Peanut allergy doubled among children from 1997 to 2002. (3)In a 2004 survey of 400 elementary school nurses, 37 percent reported having at least 10 students with severe food allergies and 62 percent reported having at least 5. (4)Forty-four percent of the elementary school nurses surveyed reported that the number of students in their school with food allergy had increased over the past 5 years, while only 2 percent reported a decrease. (5)In a 2001 study of 32 fatal food-allergy induced anaphylactic reactions (the largest study of its kind to date), more than half (53 percent) of the individuals were aged 18 or younger. (6)Eight foods account for 90 percent of all food-allergic reactions: milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soy. (7)Currently, there is no cure for food allergies; strict avoidance of the offending food is the only way to prevent a reaction. (8)Anaphylaxis is a systemic allergic reaction that can kill within minutes. (9)Food-allergic reactions are the leading cause of anaphylaxis outside the hospital setting, accounting for an estimated 30,000 emergency room visits, 2,000 hospitalizations, and 150 to 200 deaths each year in the United States. (10)Fatalities from anaphylaxis are associated with a delay in the administration of epinephrine (adrenaline), or when epinephrine was not administered at all. In a study of 13 food allergy-induced anaphylactic reactions in school-age children (6 fatal and 7 near fatal), only 2 of the children who died received epinephrine within 1 hour of ingesting the allergen, and all but 1 of the children who survived received epinephrine within 30 minutes. (11)The importance of managing life-threatening food allergies in the school setting has been recognized by the American Medical Association, the American Academy of Pediatrics, the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the National Association of School Nurses. (12)There are no Federal guidelines concerning the management of life-threatening food allergies in the school setting. (13)Three-quarters of the elementary school nurses surveyed reported developing their own training guidelines. (14)Relatively few schools actually employ a full-time school nurse. Many are forced to cover more than 1 school, and are often in charge of hundreds if not thousands of students. (15)Parents of students with severe food allergies often face entirely different food allergy management approaches when their students change schools or school districts. (16)In a study of food allergy reactions in schools and day-care settings, delays in treatment were attributed to a failure to follow emergency plans, calling parents instead of administering emergency medications, and an inability to administer epinephrine.

3.

Definitions

In this Act: (1)

ESEA definitions

The terms local educational agency, secondary school, and elementary school have the meanings given the terms in section 9101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801). (2)

School

The term school includes public— (A)kindergartens; (B)elementary schools; and (C)secondary schools. (3)

Secretary

The term Secretary means the Secretary of Health and Human Services, in consultation with the Secretary of Education.

4.

Establishment of voluntary food allergy and anaphylaxis management policy

(a)

Establishment

Not later than 1 year after the date of enactment of this Act, the Secretary shall— (1)develop a policy to be used on a voluntary basis to manage the risk of food allergy and anaphylaxis in schools; and (2)make such policy available to local educational agencies and other interested individuals and entities to be implemented on a voluntary basis only. (b)

Contents

The voluntary policy developed by the Secretary under subsection (a) shall contain guidelines that address each of the following: (1)Parental obligation to provide the school, prior to the start of every school year, with— (A)documentation from the student’s physician or nurse— (i)supporting a diagnosis of food allergy and the risk of anaphylaxis; (ii)identifying any food to which the student is allergic; (iii)describing, if appropriate, any prior history of anaphylaxis; (iv)listing any medication prescribed for the student for the treatment of anaphylaxis; (v)detailing emergency treatment procedures in the event of a reaction; (vi)listing the signs and symptoms of a reaction; and (vii)assessing the student’s readiness for self-administration of prescription medication; and (B)a list of substitute meals that may be offered to the student by school food service personnel. (2)The creation and maintenance of an individual health care plan tailored to the needs of each student with a documented risk for anaphylaxis, including any procedures for the self-administration of medication by such students in instances where— (A)the students are capable of self-administering medication; and (B)such administration is not prohibited by State law. (3)Communication strategies between individual schools and local providers of emergency medical services, including appropriate instructions for emergency medical response. (4)Strategies to reduce the risk of exposure to anaphylactic causative agents in classrooms and common school areas such as cafeterias. (5)The dissemination of information on life-threatening food allergies to school staff, parents, and students, if appropriate by law. (6)Food allergy management training of school personnel who regularly come into contact with students with life-threatening food allergies. (7)The authorization and training of school personnel to administer epinephrine when the school nurse is not immediately available. (8)The timely accessibility of epinephrine by school personnel when the nurse is not immediately available. (9)Extracurricular programs such as non-academic outings and field trips, before- and after-school programs, and school-sponsored programs held on weekends that are addressed in the individual health care plan. (10)The collection and publication of data for each administration of epinephrine to a student at risk for anaphylaxis. (c)

Relation to State law

Nothing in this Act or the policy developed by the Secretary under subsection (a) shall be construed to preempt State law, including any State law regarding whether students at risk for anaphylaxis may self-administer medication.

5.

School-based food allergy management grants

(a)

In general

The Secretary may award grants of not more than $50,000 to local educational agencies to assist such agencies with implementing voluntary food allergy management guidelines described in section 4. (b)

Application

(1)

In general

To be eligible to receive a grant under this section, a local educational agency shall submit an application to the Secretary at such time, in such manner, and including such information as the Secretary may reasonably require. (2)

Contents

Each application submitted under paragraph (1) shall include— (A)a certification that the food allergy management guidelines described in section 4 have been adopted by the local educational agency; (B)a description of the activities to be funded by the grant in carrying out the food allergy management guidelines, including— (i)how the guidelines will be carried out at individual schools served by the local educational agency; (ii)how the local educational agency will inform parents and students of the food allergy management guidelines in place; (iii)how school nurses, teachers, administrators, and other school-based staff will be made aware of, and given training on, when applicable, the food allergy management guidelines in place; and (iv)any other activities that the Secretary determines appropriate; (C)an itemization of how grant funds received under this section will be expended; (D)a description of how adoption of the guidelines and implementation of grant activities will be monitored; and (E)an agreement by the local educational agency to report information required by the Secretary to conduct evaluations under this section. (c)

Use of funds

Each local educational agency that receives a grant under this section may use the grant funds for the following: (1)Creation of systems and databases related to creation, storage, and maintenance of student records. (2)Purchase of equipment or services, or both, related to the creation, storage, and maintenance of student records. (3)In partnership with local health departments, school nurse, teacher, and personnel training for food allergy management. (4)Purchase and storage of limited medical supplies, including epinephrine and disposable wet wipes. (5)Programs that educate students as to the presence of, and policies and procedures in place related to, food allergies and anaphylactic shock. (6)Outreach to parents. (7)Any other activities consistent with the guidelines described in section 4. (d)

Duration of awards

The Secretary may award grants under this section for a period of not more than 2 years. In the event the Secretary conducts a program evaluation under this section, funding in the second year of the grant, where applicable, shall be contingent on a successful program evaluation by the Secretary after the first year. (e)

Maximum amount of annual awards

A grant awarded under this section may not be made in an amount that is more than $50,000 annually. (f)

Priority

In awarding grants under this section, the Secretary shall give priority to local educational agencies that receive Federal funding under title I of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6301 et seq.). (g)

Administrative funds

A local educational agency that receives a grant under this section may use not more than 2 percent of the grant amount for administrative costs related to carrying out this section. (h)

Progress and evaluations

At the completion of the grant period referred to in subsection (d), a local educational agency shall provide the Secretary with information on the status of implementation of the food allergy management guidelines described in section 4. (i)

Supplement, not supplant

Grant funds received under this section shall be used to supplement, and not supplant, non-Federal funds and any other Federal funds available to carry out the activities described in this section. (j)

Authorization of appropriations

There is authorized to be appropriated to carry out this section $30,000,000 for fiscal year 2008 and such sums as may be necessary for each of the 4 succeeding fiscal years.

6.

Voluntary nature of policy and guidelines

(a)

In general

The policy developed by the Secretary under section 4(a) and the food allergy management guidelines contained in such policy are voluntary. Nothing in this Act or the policy developed by the Secretary under section 4(a) shall be construed to require a local educational agency or school to implement such policy or guidelines. (b)

Exception

Notwithstanding subsection (a), the Secretary may enforce an agreement by a local educational agency to implement food allergy management guidelines as a condition on the receipt of a grant under section 5.