IIB 

110TH CONGRESS 

2D SESSION H. R. 2063 

IN THE SENATE OF THE UNITED STATES 

APRIL 9, 2008 

Received; read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

AN ACT 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Food Allergy and Ana3 phylaxis Management Act of 2008’’. 

4 SEC. 2. FINDINGS. 

5 Congress finds as follows: 

6 (1) Food allergy is an increasing food safety 

7 and public health concern in the United States, es8 pecially among students. 

9 (2) Peanut allergy doubled among children from 

10 1997 to 2002. 

11 (3) In a 2004 survey of 400 elementary school 

12 nurses, 37 percent reported having at least 10 stu13 dents with severe food allergies and 62 percent re14 ported having at least 5. 

15 (4) Forty-four percent of the elementary school 

16 nurses surveyed reported that the number of stu17 dents in their school with food allergy had increased 

18 over the past 5 years, while only 2 percent reported 

19 a decrease. 

20 (5) In a 2001 study of 32 fatal food-allergy in21 duced anaphylactic reactions (the largest study of its 

22 kind to date), more than half (53 percent) of the in23 dividuals were aged 18 or younger. 

24 (6) Eight foods account for 90 percent of all 

25 food-allergic reactions: milk, eggs, fish, shellfish, tree 

26 nuts, peanuts, wheat, and soy. 


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1 (7) Currently, there is no cure for food aller2 gies; strict avoidance of the offending food is the 

3 only way to prevent a reaction. 

4 (8) Anaphylaxis is a systemic allergic reaction 

5 that can kill within minutes. 

6 (9) Food-allergic reactions are the leading cause 

7 of anaphylaxis outside the hospital setting, account8 ing for an estimated 30,000 emergency room visits, 

9 2,000 hospitalizations, and 150 to 200 deaths each 

10 year in the United States. 

11 (10) Fatalities from anaphylaxis are associated 

12 with a delay in the administration of epinephrine 

13 (adrenaline), or when epinephrine was not adminis14 tered at all. In a study of 13 food allergy-induced 

15 anaphylactic reactions in school-age children (6 fatal 

16 and 7 near fatal), only 2 of the children who died 

17 received epinephrine within 1 hour of ingesting the 

18 allergen, and all but 1 of the children who survived 

19 received epinephrine within 30 minutes. 

20 (11) The importance of managing life-threat21 ening food allergies in the school setting has been 

22 recognized by the American Medical Association, the 

23 American Academy of Pediatrics, the American 

24 Academy of Allergy, Asthma and Immunology, the 

25 American College of Allergy, Asthma and ImmuVerDate Aug 31 2005 03:48 Apr 10, 2008 Jkt 069200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2063.RFS H2063

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1 nology, and the National Association of School 

2 Nurses. 

3 (12) There are no Federal guidelines con4 cerning the management of life-threatening food al5 lergies in the school setting. 

6 (13) Three-quarters of the elementary school 

7 nurses surveyed reported developing their own train8 ing guidelines. 

9 (14) Relatively few schools actually employ a 

10 full-time school nurse. Many are forced to cover 

11 more than 1 school, and are often in charge of hun12 dreds if not thousands of students. 

13 (15) Parents of students with severe food aller14 gies often face entirely different food allergy man15 agement approaches when their students change 

16 schools or school districts. 

17 (16) In a study of food allergy reactions in 

18 schools and day-care settings, delays in treatment 

19 were attributed to a failure to follow emergency 

20 plans, calling parents instead of administering emer21 gency medications, and an inability to administer ep22 inephrine. 

23 SEC. 3. DEFINITIONS. 

24 In this Act: 


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1 (1) ESEA DEFINITIONS.—The terms ‘‘local 

2 educational agency’’, ‘‘secondary school’’, and ‘‘ele3 mentary school’’ have the meanings given the terms 

4 in section 9101 of the Elementary and Secondary 

5 Education Act of 1965 (20 U.S.C. 7801). 

6 (2) SCHOOL.—The term ‘‘school’’ includes pub7 lic— 

8 (A) kindergartens; 

9 (B) elementary schools; and 

10 (C) secondary schools. 

11 (3) SECRETARY.—The term ‘‘Secretary’’ means 

12 the Secretary of Health and Human Services, in 

13 consultation with the Secretary of Education. 

14 SEC. 4. ESTABLISHMENT OF VOLUNTARY FOOD ALLERGY 

15 AND ANAPHYLAXIS MANAGEMENT POLICY. 

16 (a) ESTABLISHMENT.—Not later than 1 year after 

17 the date of enactment of this Act, the Secretary shall— 

18 (1) develop a policy to be used on a voluntary 

19 basis to manage the risk of food allergy and anaphy20 laxis in schools; and 

21 (2) make such policy available to local edu22 cational agencies and other interested individuals 

23 and entities, including licensed child care providers, 

24 preschool programs, and Head Start, to be imple25 mented on a voluntary basis only. 


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1 (b) CONTENTS.—The voluntary policy developed by 

2 the Secretary under subsection (a) shall contain guidelines 

3 that address each of the following: 

4 (1) Parental obligation to provide the school, 

5 prior to the start of every school year, with— 

6 (A) documentation from the student’s phy7 sician or nurse— 

8 (i) supporting a diagnosis of food al9 lergy and the risk of anaphylaxis; 

10 (ii) identifying any food to which the 

11 student is allergic; 

12 (iii) describing, if appropriate, any 

13 prior history of anaphylaxis; 

14 (iv) listing any medication prescribed 

15 for the student for the treatment of ana16 phylaxis; 

17 (v) detailing emergency treatment 

18 procedures in the event of a reaction; 

19 (vi) listing the signs and symptoms of 

20 a reaction; and 

21 (vii) assessing the student’s readiness 

22 for self-administration of prescription 

23 medication; and 


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1 (B) a list of substitute meals that may be 

2 offered to the student by school food service 

3 personnel. 

4 (2) The creation and maintenance of an indi5 vidual health care plan tailored to the needs of each 

6 student with a documented risk for anaphylaxis, in7 cluding any procedures for the self-administration of 

8 medication by such students in instances where— 

9 (A) the students are capable of self-admin10 istering medication; and 

11 (B) such administration is not prohibited 

12 by State law. 

13 (3) Communication strategies between indi14 vidual schools and local providers of emergency med15 ical services, including appropriate instructions for 

16 emergency medical response. 

17 (4) Strategies to reduce the risk of exposure to 

18 anaphylactic causative agents in classrooms and 

19 common school areas such as cafeterias. 

20 (5) The dissemination of information on life21 threatening food allergies to school staff, parents, 

22 and students, if appropriate by law. 

23 (6) Food allergy management training of school 

24 personnel who regularly come into contact with stu25 dents with life-threatening food allergies. 


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1 (7) The authorization and training of school 

2 personnel to administer epinephrine when the school 

3 nurse is not immediately available. 

4 (8) The timely accessibility of epinephrine by 

5 school personnel when the nurse is not immediately 

6 available. 

7 (9) Extracurricular programs such as non-aca8 demic outings and field trips, before- and after9 school programs, and school-sponsored programs 

10 held on weekends that are addressed in the indi11 vidual health care plan. 

12 (10) The collection and publication of data for 

13 each administration of epinephrine to a student at 

14 risk for anaphylaxis. 

15 (c) RELATION TO STATE LAW.—Nothing in this Act 

16 or the policy developed by the Secretary under subsection 

17 (a) shall be construed to preempt State law, including any 

18 State law regarding whether students at risk for anaphy19 laxis may self-administer medication. 

20 SEC. 5. VOLUNTARY NATURE OF POLICY AND GUIDELINES. 

21 The policy developed by the Secretary under section 

22 4(a) and the food allergy management guidelines con23 tained in such policy are voluntary. Nothing in this Act 

24 or the policy developed by the Secretary under section 4(a) 


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1 shall be construed to require a local educational agency 

2 or school to implement such policy or guidelines. 

Passed the House of Representatives April 8, 2008. 

Attest: LORRAINE C. MILLER, 

Clerk. 


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