How will EpiPen price hikes affect school operators?

From peanuts to shellfish, diners and foodservice directors alike are diligent when it comes to allergen awareness and alternatives. An ever-increasing number of operations feature allergy-free stations and zones; Kent State University this fall even unveiled the first all gluten-free dining hall on a college campus.

But the prevalence of diners with a food allergy is only increasing. The number of children in the U.S. who have a food allergy rose by nearly 50 percent from 1997 to 2011, according to a 2013 study by the Centers for Disease Control and Prevention. The survey showed 5.1 percent of children age 17 and younger had a food allergy in 2011.

If those children do experience an allergic reaction, their lives may depend on EpiPens—the auto-injectable epinephrine devices used to treat anaphylactic reactions to allergies. But a recent 400% price increase (the wholesale price for a two-pack of the devices, which expire after 12-18 months, is now $600) has some parents hesitant or unable to purchase a fresh supply. The price hikes then heighten the importance of EpiPens’ availability in schools, as well as ensuring every foodservice employee knows their role in the allergy-management plan.

There’s a huge variety in foodservice directors’ level of responsibility when it comes to allergies and emergency management—some create the policies, others follow guidelines set by nurses and school boards—but the EpiPen price increase, “has a direct impact, because parents may be hesitant to repurchase them,” says Kevin Sauer, associate professor of dietetics at Kansas State University, who co-authored a 2014 survey on K-12 allergy management conducted by the Center of Excellence for Food Safety Research in Child Nutrition Programs.

Though foodservice operators FSD spoke with said that, in their districts, the nursing staff was in charge of purchasing and monitoring the EpiPen supply, they emphasized the important of the relationship between the two departments. “That’s one of the first things [foodservice staffers] do when they come back to school, is to visit with the nurse to see if there’s anything jumping out about a particular student,” says Gail Koutroubas, school nutrition director at Andover Public Schools in Andover, Mass. Students in her district are flagged for allergens in the POS system—they punch in an ID number, their allergies appear on a screen, and a foodservice employee scans their plate for problems. All foodservice employees also are trained in using EpiPens, Koutroubas adds.

Laws or guidelines on administering epinephrine are decided on a state level, and, as of July, 39 states had no official policy on the books requiring schools to stock it, according to nonprofit group Food Allergy Research & Education. But when schools do carry those EpiPens, they’re being used, the Chicago Tribune reports. In the 2014-1025 school year, 17 districts in Illinois reported administering epinephrine 65 times, an Illinois State Board of Education survey found.

But the 2014 Child Nutrition Programs survey also showed just 38 percent of K-12 foodservice operators had attended allergy training in the past year. And while neither Sauer nor Emily Patten, an assistant professor at Brigham Young University who co-authored the report, has yet heard of any specific reactions where EpiPens haven't been available at a school, Patten says the conversation, “becomes a real opportunity to highlight what foodservice directors have already put in place to manage allergies.”

“If they’ve already done staff training, reiterate with managers and nutrition professionals how important it is to avoid cross-contact, to check changes in products, and to communicate with students about food allergies and what to do if there is an issue,” she says.

Sauer also sees the opportunity for FSDs to ramp up communication with parents and students about allergen-friendly options. “I always like to say, the foodservice director is in a great position to provide food safety leadership,” he says. “Whether they feel direct to the cause or not, this is maybe a great time for FSDs to regather and review the processes in their schools, from emergency plans to say, ‘Is that all intact?’ to the, ‘What ifs; what if we do start to see fewer pens brought to school?’”