SPOKANE, Wash. — While bee stings from ’90’s movies like “My Girl” once symbolized deadly allergic reactions, most cases of anaphylaxis are caused by food allergies.
One in 13 children, or about two per classroom, have food allergies according to the CDC. The nine leading causes of food allergies identified in the U.S. are milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, soybeans, and sesame. These allergens create daily challenges for school nutrition programs. The number of students with mild to life-threatening food allergies continues to climb across the country.
31,000 meals are served daily in Spokane Public Schools, where nutrition staff work around the clock to keep children safe while serving more meals than any other district in Washington state.
“Just yesterday I was working on the student that had allergies to like 5 or 6 different things,” said Ellen Ramus, nutrition services supervisor for Spokane Public Schools.
Every year, students with life-threatening food allergies must submit safety plans reviewed by healthcare providers, complete with new epinephrine prescriptions. The number of families required to complete these plans continues to grow. The increase coincides with Washington state legislation and the Community Eligibility Provision (CEP) that provides free meals to all students in the Spokane School District.
“This year especially, I’m like, oh my gosh, so many more kids have these diets. But I think part of it might be because they’re eating at school now and maybe before they weren’t,” Ramus said.
The district has implemented comprehensive safety protocols to protect students with allergies. Every menu item appears on the district website with complete ingredient lists and allergen information.
Even high school students who can select their own meals receive protection through the district’s alert system. When students with known allergies enter their identification codes in the cafeteria, kitchen staff receive immediate notifications about their dietary restrictions.
Despite these safeguards, accidental exposures still occur, making emergency response plans critical for student safety.
Becky Doughty, a registered nurse and executive director of school support services, leads nearly 50 nurses across the district. She emphasizes the importance of immediate epinephrine administration when allergic reactions occur.
“If a student has a life-threatening food allergy, I think the most important thing for me to share with families and with providers is that we administer the EpiPen first if there is a suspected or known exposure,” Doughty said.
However, some parents resist immediate epinephrine use, hoping to avoid traumatic experiences for their children at school.
Doughty said she often hears from parents asking for a phone call or a dose of Benadryl before an EpiPen is used.
“Our goal is to keep the child safe and alive while they’re at school,” Doughty explained.
A new needle-free nasal spray emergency epinephrine recently received FDA approval, offering an alternative for students who fear needles. Some Spokane students are already using the new option this school year.
“If insurance allows, that is obviously a great option for families because it is a nasal spray. And, that is much less frightening to a child than a needle,” Doughty said.
The nasal spray costs approximately $700, and not all insurance companies currently provide coverage. This cost barrier may limit access for some families, despite the potential benefits.
Spokane Public Schools remains prepared to administer any medication prescribed by healthcare providers, making consultation with family doctors worthwhile for parents considering the new option.
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