Emergency Epinephrine in Washington State Schools

On April 16, ESB 5104 passed unanimously in the House of Representatives.

On April 23, the bill passed unanimously in the Senate.

On May 16, 2013, Governor Inslee signed the bill into law during a ceremony at his office in Olympia.


Here is a re-cap of the bill’s history:

On January 16, 2013, Senator Mark Mullet of Issaquah introduced ESB 5104 in the Washington State Senate.  If approved, this bipartisan bill would allow physicians to write standing prescriptions directly to schools for “stock” epinephrine auto-injectors (e.g. EpiPen®, Auvi-Q™).  School nurses could then administer the school’s stock epinephrine to any student experiencing anaphylaxis.  SB 5104 would also provide legal protection for physicians, pharmacists, school employees, and schools themselves.

On February 1, there was a public hearing in the Senate Committee on Early Learning & K-12 Education in Olympia.  Testimony was offered for and against the bill (click here to watch the hearing).

On February 4, SB 5104 received a unanimous vote from the Early Learning and K-12 Education Committee, and advanced to the Senate Committee on Rules.

On February 8, SB 5104 was passed on the Senate floor with a unanimous vote.

House Bill 1578, a companion bill, is still pending in the House of Representatives.

Senator Mullet and the School Nurses of Washington (SNOW) recently reached a comprise on the bill.  There was concern about non-medical school employees having to make a diagnosis of food allergy.  An updated version of the bill is in the works.  A school employee may use stock epinephrine only if a student already has a prior allergy diagnosis.  If a student is reacting for the first time, only a school nurse can make the decision whether or not to use stock epinephrine. See this article in the Seattle Times from March 3, 2013.

On March 14 at 8:00am, there was a public hearing in the House Education Committee.  The committee ultimately voted to pass the bill to a vote on the House floor.


Please read below for details, or contact your state legislator to ask him or her to support this important legislation.

Click here for a news story about this proposed new law.




  • Ammaria Johnson, a 7-year-old Virginia girl, recently died of a food-allergic reaction at school.  She had a known food allergy, but did not have her own epinephrine auto-injector available.  At the time, it was illegal for the school to give her another student’s epinephrine.  This tragic loss underscores the importance of recognizing the increasing prevalence and severity of food allergies, as well as being better prepared in the event of a food allergy emergency.
  • According to a recent study in Pediatrics, 1 in 13 U.S. children – roughly 2 in every classroom – has a food allergy, and that number is on the rise.1
  • Up to 40% of food-allergic children may be at risk for anaphylaxis, a potentially life-threatening reaction.1
  • Currently, there is NO cure for food allergies.  The best approach is strict food avoidance and being prepared in the event of an emergency.
  • Food allergies account for over 300,000 hospital visits by children every year.  25% of first-time anaphylactic reactions among children occur in a school setting (e.g. at school, on a school bus, on a field trip).2
  • Teenagers and children with asthma are at higher risk for fatal anaphylaxis due to food allergy.3
  • From the onset of the reaction, there may only be minutes to administer epinephrine to save a life.  Delayed used of epinephrine (or children without ready access to epinephrine at school) increases the risk of fatal anaphylaxis for food-allergic children.3,4
  • Allergy experts agree that emergency epinephrine’s potential benefits far outweigh the risks of unnecessary dosing.3
  • Anaphylaxis can also occur due to severe bee allergy, drug allergy, and other causes.
  • It is critical that schools be prepared to manage potentially life-threatening allergic reactions, even if a child does not already have a prescription for an epinephrine auto-injector.
  • Several states have already enacted emergency epinephrine laws, including Illinois, California, Georgia, Kansas, Maryland, Missouri, Nebraska, Texas, and Virginia.


  • On January 16, 2013, Senate Bill 5104 was introduced in the Washington State Legislature.  If approved, this bipartisan bill would allow physicians to write standing prescriptions directly to schools (both public and nonpublic) for “stock” epinephrine auto-injectors (e.g. EpiPen®, Auvi-Q™).
  • A companion bill is being prepared for the Washington State House of Representatives.
  • During an emergency, school nurses (or designated school employees) would be allowed to administer the school’s stock epinephrine to a known-allergic student having an anaphylactic reaction.  If a student has a first-time allergic reaction while at school (not previously diagnosed with an allergy), only a school nurse can make the decision whether or not to give epinephrine.
  • The proposed law would apply to public and private schools alike.  It would apply in most school settings:  school grounds, school buses, and school-sponsored field trips.
  • To protect physicians, pharmacists, school personnel, and schools themselves, the bill will also provide legal protection in the event of harm due to emergency epinephrine administration.
  • Several community and professional organizations are in support of this new legislation, including FARE, the Washington Chapter of the American Academy of Pediatrics, and the Washington State Society of Allergy Asthma and Immunology.


1. Gupta et al., “The Prevalence, Severity and Distribution of Food Allergy in the United States,” Pediatrics, June 20, 2011.

2. Sicherer et al., “Clinical report – Management of Food Allergy in the School Setting,” Pediatrics, December 1, 2010.

3.  Boyce et al., “Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel”.  Journal of Allergy and Clinical Immunology, December 2010.

4.  Ben-Shoshan et al., “Availability of the Epinephrine Autoinjector at School in Children with Peanut Allergy.  Annals of Allergy Asthma and Immunolgy, June 2008.

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