Feature Story

Improving Asthma and Food Allergy Care in Detroit Public Schools

These AAAAI members are working with schools and school nurses to ensure students receive timely care

Very soon, students will be going back to school. Thanks to the efforts of four American Academy of Allergy, Asthma & Immunology (AAAAI) members working out of Central Michigan University, many school nurses and some administrators and teachers are feeling more confident in welcoming back students with asthma and food allergy to Detroit’s public schools.

“We were concerned about access to asthma/anaphylaxis emergency care in local schools where a lot of students have asthma and food allergy. Parents would often express frustration about the safety of their children in school. Our goal was to connect with local schools to learn of current needs, knowledge and to educate the nursing staff or administrative staff who takes responsibility of care in a school setting.”

- Milind V. Pansare, MD, FAAAAI

Marwa El-Bohy, MD

Marwa El-Bohy, MD, explained further that the schools they wanted to serve are located in downtown Detroit, and so these are the patients they see coming to their clinic. “We wanted our community and patients to feel safe and comfortable in school,” she said. “Our goal is to be a partner so we can work collectively with patients, their families and schools. Our hope is for a long-term partnership with schools, so if they need more resources we can help provide them.”

It was challenging to schedule meetings with administration due to the hectic school calendar to provide an in-person session. “One of the schools had expressed an interest on education in asthma and anaphylaxis for their staff. This particular school didn’t have a school nurse on campus, so administration and teachers needed to be first responders,” said Devika Pillay, DO, who worked on the project before she graduated from her training program. “We went to the school and presented a session. First, we assessed their baseline comfort level then did a verbal and visual presentation on asthma and anaphylaxis; specifically, how to recognize it and treat it. We then had hands-on teaching using autoinjectors on a dummy and albuterol MDI and spacers.”

Approximately 40 staff attended and were able to practice techniques with devices/equipment. While many of the attendees had expressed discomfort with the material and hands-on applications, by the end of the session they were much more comfortable with the subject and the techniques they practiced.

The same physician group from Central Michigan University also attended the Michigan Association of School Nurses Annual Meeting, where they presented a similar session. “Of course, as school nurses they had a higher baseline knowledge than the school administration and teachers we’d previously met with,” said Dr. Pillay. “Our session focused on reinforcing the A/I training they already get in their schools and helping them get more comfortable using the proper techniques.”

Devika Pillay, DO, presenting to school nurses at the Michigan Association of School Nurses Annual Meeting.

The entire project has been a reality check when it comes to what is available in the school setting, according to Divya Seth, MD, FAAAAI. “We saw there were many obstacles for the schools to access resources, even when following the proper channels.”

Milind V. Pansare, MD, FAAAAI, expanded on this. “Many inner-city public schools don’t have access to autoinjectors; they have to apply to receive them. These schools have access in theory, but in practice there are hoops to jump through for schools to actually get some of these resources. I know of one school that went through the process correctly, but never did get the stock epinephrine. Now they need to start the process again for the coming school year.”

Divya Seth, MD, FAAAAI

Despite these hurdles, simply providing in-person education seemed to make a huge difference, “From just one session with hands-on demonstration, we watched school nurses and school staff going from being afraid to take actions beyond calling 911 to being confident enough to provide necessary treatment,” Dr. Seth said.

All four of them agreed that this experience highlighted the importance of in-person connection, and how sessions like this can be incredibly helpful in a way virtual education can’t. They hope to approach more schools, especially those identified as needing more A/I education.

The education provided by these four AAAAI members was based off The School-Based Allergy, Asthma and Anaphylaxis Management Program® (SA³MPRO^TM) and Michigan’s specific school tools, which local school nurses are familiar with. They made some adjustments to materials as needed, depending on if the audience was school nurses or administrators and teachers. SA³MPRO^TM is a helpful resource for any allergist/immunologist looking to do work with their local schools.