I 
109TH CONGRESS 
1ST SESSION H. R. 4063 
To direct the Secretary of Health and Human Services to develop a policy 
for managing the risk of food allergy and anaphylaxis in schools. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 17, 2005 
Mrs. LOWEY (for herself, Mrs. MALONEY, Mr. EMANUEL, Mr. OWENS, Mr. 
MEEK of Florida, Ms. JACKSON-LEE of Texas, Ms. MILLENDER-MCDON-
ALD, Mr. SHERMAN, Mr. SANDERS, Mr. LEVIN, and Mr. WEXLER) intro-
duced the following bill; which was referred to the Committee on Energy 
and Commerce, and in addition to the Committee on Education and the 
Workforce, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To direct the Secretary of Health and Human Services to 
develop a policy for managing the risk of food allergy 
and anaphylaxis in schools. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Food Allergy and Ana-
phylaxis Management Act of 2005’’. 
SEC. 2. FINDINGS. 
The Congress finds as follows:
(1) Food allergy is an increasing food safety 
and public health concern in the United States, es-
pecially among children. 
(2) Peanut allergy doubled among children from 
1997 to 2002. 
(3) In a 2003 survey of 400 elementary school 
nurses, 37 percent reported having at least 10 stu-
dents with severe food allergies; 62 percent reported 
having at least 5. 
(4) Forty-four percent of the elementary school 
nurses surveyed reported that the number of chil-
dren in their school with food allergy had increased 
over the past 5 years; only 2 percent reported a de-
crease. 
(5) In a 2001 study of 32 fatal food-allergy in-
duced anaphylactic reactions (the largest study of its 
kind to date), more than half (53 percent) of the in-
dividuals 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 aller-
gies; strict avoidance of the offending food is the 
only way to prevent a reaction.
(8) Anaphylaxis, or anaphylactic shock, is a 
systemic allergic reaction that can kill within min-
utes. 
(9) Food-allergic reactions are the leading cause 
of anaphylaxis outside the hospital setting, account-
ing 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 adminis-
tered 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 one of the children who sur-
vived received epinephrine within 30 minutes. 
(11) The importance of managing life-threat-
ening 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, and 
the American College of Allergy, Asthma and Immu-
nology.
(12) There are no Federal guidelines con-
cerning the management of life-threatening food al-
lergies in the school setting. 
(13) Three-quarters of the elementary school 
nurses surveyed reported developing their own train-
ing guidelines. 
(14) Relatively few schools actually employ a 
full-time school nurse. Many are forced to cover 
more than one school, and are often in charge of 
hundreds if not thousands of children. 
(15) Parents of children with severe food aller-
gies often face entirely different food allergy man-
agement approaches when their children 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 emer-
gency medications, and an inability to administer ep-
inephrine. 
SEC. 3. ESTABLISHMENT OF FOOD ALLERGY AND ANAPHY-
LAXIS MANAGEMENT POLICY. 
(a) ESTABLISHMENT.—Not later than 1 year after 
the date of the enactment of this Act, the Secretary of 
Health and Human Services shall—
(1) develop a policy to be used on a voluntary 
basis to manage the risk of food allergy and anaphy-
laxis in schools; and 
(2) make such policy available to local edu-
cational agencies and other interested individuals 
and entities. 
(b) CONTENTS.—The policy developed by the Sec-
retary under subsection (a) shall address each of the fol-
lowing: 
(1) Parental obligation to provide the school, 
prior to the start of every school year, with docu-
mentation from the student’s physician or nurse— 
(A) supporting a diagnosis of food allergy 
and anaphylaxis; 
(B) identifying any food to which the stu-
dent is allergic; 
(C) describing, if appropriate, any prior 
history of anaphylaxis; 
(D) listing any medication prescribed for 
the child for the treatment of anaphylaxis; 
(E) detailing emergency treatment proce-
dures in the event of a reaction; 
(F) listing the signs and symptoms of a re-
action;
(G) assessing the student’s readiness for 
self-administration of prescription medication; 
and 
(H) providing a list of substitute meals 
that may be offered by school food service per-
sonnel. 
(2) The maintenance of a file by the school 
nurse or principal for each student at risk for ana-
phylaxis. 
(3) Communication strategies between indi-
vidual schools and local providers of emergency med-
ical 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 the cafeteria. 
(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 stu-
dents with life-threatening food allergies. 
(7) The authorization of school personnel to ad-
minister 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-aca-
demic outings and field trips, before- and after- 
school programs, and school-sponsored programs 
held on weekends. 
(10) The creation of an individual health care 
plan tailored to the needs of each individual child at 
risk for anaphylaxis, including any procedures for 
the self-administration of medication by such chil-
dren in instances where— 
(A) the children are capable of self-admin-
istering medication; and 
(B) such administration is not prohibited 
by State law. 
(11) 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 anaphy-
laxis may self-administer medication. 
(d) DEFINITIONS.—In this Act:
(1) The term ‘‘school’’ includes kindergartens, 
elementary schools, and secondary schools. 
(2) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
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