12-year-old Kennedy Pelletier is no stranger to food allergies having discovered she was allergic to fish and shellfish after suffering a reaction at Disney years ago. She had a subsequent reaction at a restaurant in 2018 despite avoiding her allergens when her dish was likely contaminated due to cross-contact.
The seventh-grader decided it was time for action to protect others who might suffer reactions while dining. She contacted State Senator Jim Welch, urging him to sponsor a bill that would allow restaurants to carry stock epinephrine. Epinephrine is the only drug that can halt the progression of anaphylaxis, a severe, life-threatening allergic reaction. Stock refers to doses of the drug that are not prescribed to any individual and may be administered in an emergency.
Kennedy’s class traveled to the Massachusettes statehouse Tuesday to testify before the Joint Committee on Public Health on Welch’s bill, S.1355. The bill would allow an individual suffering an allergic reaction, a family member, or healthcare provider to administer the restaurant’s supply of the drug in an emergency while shielding the restaurant and participants from liability.
“We share her concern that many people who have life-threatening allergies don’t know they have life-threatening allergies before they have a severe reaction,” said Kennedy’s mother, Michelle Regnier-Pelletier.
Though the legislation does not require restaurants to carry stock epinephrine, Sen Welch intimated his goal is to eventually mandate that all restaurants carry.
“I think a restaurant can bear the cost of one EpiPen for the safety of all their customers,” Welch said.
A stock epinephrine and mandatory food allergy education program for the hospitality industry in the City of Toronto is the right thing to do. It has huge benefits for the safety of the general public and increases public awareness of food allergies.
This week I had the honour of providing a public deputation for Toronto City Council alongside Food Allergy Canada in support of Councillor James Pasternak’s motion to investigate mandatory stock epinephrine at Toronto restaurants. The summary of the motion states:
Given that the City of Toronto is home to over 8,000 restaurants and hundreds other public facilities, it is worthwhile to investigate if the mandatory provision for epinephrine auto-injectors in restaurants and public facilities would enhance the safety of residents and visitors to our City.
Going into it, I knew we were facing an uphill battle with the idea of mandatory epinephrine, but the motion was to investigate the issue. My optimism (and naivete) led me to believe that the investigation could lead to discussions with various stakeholders across the city, and whether or not the mandatory stock epinephrine motion would be eventually tabled, food allergies would be discussed as a growing public health concern.
I am utterly disappointed that the Licensing and Standards Committee voted to “defer indefinitely” the motion to investigate mandatory epinephrine in Toronto eateries and other public facilities. The conversation ended before it even begun.
The councillors seemed to be making advance judgement based on personal bias on the appetite for mandatory stock epinephrine in Toronto restaurants, and not interested in undergoing at true investigation. Unfortunately, the supporting document for the motion was a simple one-pager that did not contain many supporting facts to help push this forward. Despite the huge outpouring of public support letters in favour of the motion, there were two very strongly opposed positions coming from the hospitality industry, which councillors seemed to give more weight to. It’s obvious that if a motion like this has any chance to move forward in the future, there needs to be a champion from the industry backing it and explaining why it makes sense operationally.
The most important takeaway from this experience is that, as a community, we haven’t even scratched the surface when it comes to educating the public about food allergies and epinephrine. The city councillor comments and the information they used to come to their final decision were based on assumptions, miseducated testimony and untruths. I am compelled to set the record straight.
Untruth #1: Epinephrine is not the only appropriate drug to use in an allergic reaction
Councilor Jim Karygiannis stated, “I have severe allergies. I choose not to use an EpiPen and I choose to use Atarax. Atarax might not have the same effect immediately, but it’s a slower process, because I choose not to go to the hospital if I shoot myself with an EpiPen in 20 minutes, because I might not be able to get there.”
Antihistamines like Benadryl or Atarax are commonly used for treating hives or other skin symptoms, but they do not treat the life‑threatening symptoms of anaphylaxis. “Epinephrine is the only drug that can reverse symptoms of anaphylaxis. Canadian allergists advise that an epinephrine auto-injector is the first line of treatment for anaphylaxis and should be used first, before asthma puffers or any other medications,” according to Food Allergy Canada.
An EpiPen is actually much easier to use than some may realize.
Epinephrine acts on a number of receptors in the body to exert its effects. It causes constriction, or tightening, of the blood vessels, which decreases swelling and also helps to increase blood pressure. It also increases the heart’s contraction and heart rate, which can help to prevent or reverse cardiovascular collapse. Epinephrine relaxes the muscles around the airways in the lungs, helping the airways to open up. Finally, it prevents the release of additional allergic chemicals, which aids in stopping further progression of the reaction. No other medicine acts on so many body systems, which is why epinephrine is the drug of choice for anaphylaxis.
Untruth #2: EpiPens could cause fatal harm
Councillor Jim Karygiannis asked, “So, this could have a reverse effect that somebody thinks they’re having an allergic reaction, hits somebody, and that might cause them fatal harm?” Commander Bikram Chawla with Toronto Paramedic Services responded, “Theoretically, there is that potential.”
Common side-effects of epinephrine include fast, irregular or “pounding” heartbeat, sweating, nausea or vomiting, breathing problems, paleness, dizziness, weakness, shakiness, headache, feelings of over excitement, nervousness or anxiety. These side-effects usually go away quickly if you lie down and rest.
The minimum lethal human dose by subcutaneous injection is estimated at 4mg. EpiPens come in two standard doses of 0.15mg and 0.3mg of epinephrine, which is significantly lower than a dangerous dose. To put things into perspective, you would need 26 simultaneous shots from an EpiPen Jr. to receive a dangerous dose.
Untruth #3: Food allergy and auto-injector training is too difficult
Councilor Frances Nunziata shared, “I do have an EpiPen. I have allergies. I’ve had to use mine many times. But I would not feel comfortable being in a restaurant or any establishment and having someone stab me with an EpiPen not knowing how long they’ve had that EpiPen… So to have establishments and restaurants like Tim Horton’s and McDonald’s be trained, I think we’re in really muddy waters.”
An EpiPen is actually much easier to use than some may realize. The instructions are illustrated on the device in three simple steps. Practice EpiPens also help make training easier and more effective.
It has huge benefits for the safety of the general public and increases public awareness of food allergies.
Assumptions that every single staff member in the restaurant would need to be educated like a paramedic so they could recognize symptoms of allergic reactions and administer EpiPens made this motion difficult for council to support. They did not recognize that like AEDs that are available at public places, EpiPens would be available as life-saving devices to the people who need them and know how to use them.
A stock epinephrine and mandatory food allergy education program for the hospitality industry in the City of Toronto is the right thing to do. It has huge benefits for the safety of the general public and increases public awareness of food allergies. Restaurant staff are currently trained at different capacities on how to keep customers safe by minimizing risks of bacterial food poisoning, and it is equally as important that they are trained on food allergies and how to minimize cross-contamination risks.
There is still a lot of work to be done. As a food allergy advocate and someone invested in the City of Toronto, I’m grateful to Councillor Pasternak for bringing the motion forward and to the Licensing and Standards Committee for discussing the possibility. As a community we will move onwards and upwards from this and continue to educate others and correct untruths.
ANNAPOLIS — A bill allowing certain food-service operations to administer auto-injectable epinephrine, or EpiPens, in an emergency breezed through the General Assembly this week as the abbreviated session expired.
After a tragedy last October that claimed the life of a popular local man and business owner, some questioned if the outcome could have been different if restaurants and other food-service operations were allowed to obtain, store and utilize EpiPens and had certain staff trained and available to utilize them in the case of an emergency. Maryland is currently one of just 14 states that does not allow most food-service operations to obtain, store and utilize EpiPens.
Urged by resort officials, State Senator Mary Beth Carozza introduced Senate Bill 477, which would “authorize food service facilities to store and make available for administration auto-injectable epinephrine for a certain purpose under the program, authorize participating food service facilities, except under certain circumstances, to obtain a certain prescription for and supply of auto-injectable epinephrine, and require participating food service facilities to store a supply of auto-injectable epinephrine in a certain manner.”
Over in the House, Delegate Wayne Hartman (R-38C), along with other state delegates, introduced sister legislation House Bill 1462. Both bills passed unanimously in their respective chambers and crossed over where they were returned passed by both the Senate and the House.
The full Senate passed the legislation with a 47-0 vote on Monday and the full House followed suit with a 130-0 vote on Wednesday as the General Assembly session abbreviated by concerns over the ongoing coronavirus pandemic neared its close. The legislation is now headed to Gov. Larry Hogan’s desk for signing and will become effective on Oct. 1.
The bill requires eligible food service institutions to obtain a certificate allowing it to obtain, store and administer auto-injectable epinephrine in an emergency situation. The certificate holder would designate certain eligible agents certified in administering the EpiPens. For example, the agents would have to be at least 18 years of age and would have to successfully complete an educational training program.
Under the legislation, the participating facilities will designate the employees who are certificate holders who will be responsible for the storage, maintenance and control of the supply or auto-injectable epinephrine.
A participating facility would not be able obtain or store auto-injectable epinephrine unless it has at least two employees or designated affiliated individuals who are certificate holders. Participation in the epi-pen program would be strictly voluntary. In addition, provisions in the bill would provide immunity from liability under the state’s Good Samaritan laws.
In late October, local resident and pillar of the community Chris Trimper suffered an extreme allergic reaction during a reception at a local food service facility and did not survive. In the wake of the tragedy, local elected officials and resort business leaders called on their delegation in Annapolis to introduce legislation that would allow certain food service operations under certain specified conditions to store and administer epinephrine in the event of an emergency.
