Airline Access to Emergency Epinephrine Act (S. 1972)

Dear Mr. President:

Please turn Airline Access to Emergency Epinephrine Act (S. 1972) bill into a law. We urge your support for S. 1972. We thank you for your attention to this issue and for your consideration.  I am the grieving mother of Joseph DeNicola, I am a constituent of Wisconsin, district 8, Greenbay.  I am not only a voter I am an active voice in keeping America safe. I lost Joseph on Halloween 2014 due to a severe anaphylaxis he never recovered, due to the delay in receiving the only life-saving auto-injector. He had been placed on his nebulizer prior to receiving his auto-injector. Minutes matter when treating life taking Anaphylaxis. Since his death, the community has heard my voice that time was the difference between keeping my son alive.  The first response is giving such immediately, agreed finally now across the community including all in the medical field. They have finally started to advocate such. If he had received his auto-injector in time, he would be alive today. Those at the time of his tragedy did the best they knew how, but that lesson they now are aware. Never do I want another to feel this pain of losing a beautiful child.  I advocate this daily to over 15 Million people in our Great USA and am only now a choice left of my son. I want to keep USA great, by sharing my son’s tragedy. He was only 7 years old.  I am a lifetime advocate of the food allergy and anaphylaxis community, a lifetime member of my child’s honor. After being contacted by a mutual friend about Francine Val son’s (read here) near-death experience    I am doing my part to help.  I have included her son’s story to the end of this letter. Another close call in 2014 read here. I do pray to all of our angels that this reaches you, Mr. President Trump, I thank you in advance and I appreciate you pushing this bill forward and creating law. This bill had been heard twice, but has been sitting without action. It needs to become a law, to keep America safe!

So I see the following loophole that needs correction immediately to save lives “Flight attendants, are trained of medical emergency kits but are  “not required” to using any medications, in said emergency kits. I believe that immunity of good samaritan laws for all staff should be given and  “require” stocking of two epi auto-injectors (fast acting, reduces time to draw vial and dose questions)”. Giving just “Allowance to stock” quick acting auto-injectors does not mean they can be USED.  I would like  “required” TO STOCK AND GOOD Samaritan for all staff in addition to any onboard doctors” .  Then guideline regulation procedures will “require” training and use. I would just suggest “require” annual training of use, to all staff. e.g. flight attendants. They have access to ground control staff medical.” – Julianne Riceputo DeNicola… 

The American Academy of Allergy, Asthma & Immunology is pleased to announce its support of the recently introduced Airline Access to Emergency Epinephrine Act (S. 1972), which would ensure life-saving epinephrine auto-injectors for individuals with allergic/immunologic conditions.

The bipartisan bill, introduced by U.S. Senators Mark Kirk (R-Il) and Jeanne Shaheen (D-NH) with co-sponsors Mark Warner (D-VA) and Ben Cardin (D-Md), is in line with current Federal Aviation Administration (FAA) mandates that facilitate automated external defibrillator access and training. S. 1972 would extend those lifesaving measures and require airlines to maintain a supply of epinephrine auto-injectors on commercial aircrafts and train flight crews on proper administration in the event of a systemic allergic reaction.

With increasing prevalence, approximately 15 million Americans have food allergies. Many others also have acute allergic reactions to stinging insects, medications and other exposures. In the most serious cases, a life-threatening allergic reaction called anaphylaxis can occur. This requires immediate medical treatment, including an injection of epinephrine and a trip to the emergency room. Having life-saving Auto-Injectors available is so important to a veil of such medication.  Dosage is very important. Training is important. I do hope that you can include good samaritan laws for not just doctors but all who attempt to save a life in flight.

Medical emergencies during air travel

In-flight medical emergencies occur in 1 per 11,000 passengers [6] or 1 in every 604 flights [2]. A number of reasons are proposed to explain the incidence of medical and allergic events during air travel, and those are summarized in Table 1. The most common in-flight medical events include syncope, gastrointestinal and cardiac problems [278].

A recommendation from this World Allergy Organization (WAO) expert group for in-flight treatment of a SAR and AE is:

  1. a)

    For AE, inhaled bronchodilator and oxygen. Consider an oral, intramuscular or intravenous corticosteroid for moderate to severe symptoms and intramuscular epinephrine for severe symptoms.

  2. b)

    For mild, moderate, and severe SAR, intramuscular epinephrine 0.01 mg/kg up to 0.5 mg of 1:1000 solution IM in the anterior lateral thigh. Repeat as necessary.



    • Promote the prevention of allergic diseases via passenger education

    • Medical consultation for high-risk passengers before traveling

    • Train and re-train aircrews

    • Promote general preventive measures during the flight: hydration, food allergen avoidance (especially peanuts, tree nuts, other foods, as necessary)

    • Provide an appropriate place for furry pets away from subjects with pet allergy

    • Provide for sufficient quantities of appropriate medications: epinephrine (adrenaline), β2 agonists for inhalation and nebulization, oral and injectable corticosteroids and antihistamines

    • Oxygen

As greater numbers of people fly and the public health concern of the annual increases in this illness, so do first-time reaction percentages, the number of AE and SAR are likely to increase during flights in the future. Therefore, passengers at risk should be aware of the necessary measures to prevent and manage these emergencies. It is also vitally important that airlines are prepared to deal with these diseases by providing the necessary strategies to decrease the incidence of SAR and AE. They also should have the necessary means to treat these reactions when and if they occur. There is a clear opportunity for airlines to work alongside allergists/immunologists to implement evidence-based recommendations to prevent allergic reactions during flight, especially SAR.

AAAAI continues to actively support legislation that facilitates access to epinephrine, having previously supported the 2013 School Access to Emergency Epinephrine Act and several smaller bills at the local and state levels. Go online to read S. 1972 in its entirety or view the AAAAI letter of support. More information on allergies and anaphylaxis is also available at the AAAAI website.

Dr. Andrew Murphy, a Pennsylvania allergist and representative of AAAAI, which also supports the legislation, adds that the training of in-flight staff is a key component of the bill. “I think a lot of people panic with allergic reactions, including physicians sometimes,” says Murphy, chair of AAAAI’s Advocacy Committee. “There is a way of treating these people, and you can treat them successfully as long as you’re aggressive with the use of epinephrine. So the training is important so that people know what to do.”

While there has been some research done in the area of air travel and anaphylaxis, notably University of Michigan researcher Dr. Matthew Greenhawt’s large study that identified eight mitigating factors that can reduce allergy risk factors in flight, Murphy says that a Congressional report would provide much-needed additional details. “It will give us a chance to find out what’s going on,” he says.

Beyond choosing the right airline and knowing more about their allergy policies, Murphy reminds that the primary responsibility for having emergency epinephrine still resides with patients themselves. This new law is about having a “backup” auto-injector to an allergic person’s self-care, he says.

I would like to add that most first time reactions, no available auto-injector would be available on the persons, so having epinephrine who have previously undiagnosed allergies or as a backup for those with known allergies. We advocate always to have two.  As President Obama had passed law for such in schools, I am asking for you to pass such in the skies.

“It would certainly give the flight crew another level of confidence, and then give the patient another level of confidence as well, that there’s another auto-injector available if needed,” he says. “This is a way of adding a level of redundancy. There are AEDs everywhere, but that doesn’t mean we tell people to forget about learning CPR.”

Abbreviation meanings AE: Asthma exacerbation SAR: Systemic allergic reaction WAO:
World Allergy Organization

I thank you in advance

Most respectfully,

Julianne DeNicola

I have emailed this letter to the White House today and supplied my direct contact information. March 17, 2018.  Tomorrow March 18, 2018, would be my son Joseph DeNicola’s 11th Birthday.  I find no better time to ask for this to become law.

Here is Francines Val sons near-death experience  –


MSB drafted the manuscript. All authors contributed to the conception of the review and revising it critically for important intellectual content. All authors read and approved the final manuscript.

AAAAI Announces Support of Senate Bill to Put Lifesaving Medication on Airlines
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