Medication and Treatment

1. State requires schools to have medication administration policies for school personnel to give prescription medication to students.
2. State policy ensures students’ right to self-carry and self-administer prescribed asthma medication.
3. State policy ensures students’ right to self-carry and self-administer prescribed anaphylaxis medication.
4. State policy protects school personnel from liability for unintended injuries related to medication administration.
5. State requires anaphylaxis medicine (epinephrine) stocking and authority to administer in schools.
6. State allows and/or requires asthma quick-relief medicine stocking and authority to administer in schools.
7. State requires schools to update and maintain records/health histories for identified students with chronic conditions including asthma and anaphylaxis.
8. State requires schools to maintain asthma/allergy incident reports for reactions, attacks and medications administered.
9. State requires schools to have emergency protocols for asthma.
10. State requires schools to have emergency protocols for anaphylaxis.
11. State has adopted policy that each school will have at least 1 full-time nurse.
12. State has adopted policies that address the development of comprehensive, school-based health services.

Extra Credit

1. State has or is preparing an explicit asthma program with policies, procedures, and resources for schools to manage students with asthma.
2. State has or is preparing an explicit anaphylaxis program with policies, procedures, and resources for schools to manage students with allergies.
3. State recommends each school stock at least 2 doses of easily administered epinephrine. 
4. State provides funding for stock medications.

Awareness

13. State sponsors or provides funding for staff training in asthma awareness covering school asthma program/policy and procedures.
14. State sponsors or provides funding for staff training for the prevention, recognition, and treatment of allergic reactions to food.

School Environment

15. State requires schools to have indoor air quality (IAQ) management policies.
16. State makes funding or other resources, such as training, available for technical IAQ assistance to schools.
17. State requires schools to inspect and maintain heating, ventilation, and air conditioning (HVAC) systems.
18. State requires schools to develop a plan to identify sources of mold and, if necessary, a plan to clean and remediate mold and mold sources in public school buildings.
19. State recommends standards and programs to promote IAQ for school construction and renovation. 
20. State requires schools to develop a cleaning program that promotes healthy IAQ. 
21. State requires schools to use Integrated Pest Management (IPM) techniques, including limiting use of pesticides inside schools and on school campuses. 
22. If pesticide use is necessary, state requires schools to notify parents of upcoming pesticide applications.
23. State limits school bus idling time and/or establishes proximity restrictions.
24. State has implemented zero-emission school bus transition incentives or mandates.
25. State prohibits all smoking and vaping in school buildings and on school grounds.
26. State prohibits all smoking and vaping on school buses and at school-related functions.
27. State requires tobacco-use and vaping prevention in health education curriculum.

Extra credit:

5. State requires school facility design and operation standards that address IAQ.
6. State requires districts or schools to provide tobacco-use-cessation and e-cigarette-use-cessation services and resources to students.

1. Expand emergency medication stocking in schools. States should adopt policies that mandate emergency medication availability in all schools. The policies should address appropriately training school personnel, liability concerns for people who use the medicine in good faith, and resources for acquiring the medications.
2. Ensure full-time school nurses in every school. States should adopt policies that require at least 1 full-time nurse in every school. States should also prioritize funding for school nurse programs and explore partnerships with local health departments to expand access to nursing services.
3. Adopt comprehensive IAQ management plans. States should require schools to adopt comprehensive IAQ management plans that include regular HVAC inspections and maintenance, green cleaning practices, IPM, and mold prevention. These plans should also incorporate ongoing monitoring to identify and address IAQ concerns promptly.
4. Strengthen tobacco and vaping policies in schools. States should adopt and enforce policies that ban all tobacco and vaping product use in schools, on school grounds, on school buses, and at school-sponsored events. States should also require schools to provide tobacco and vaping prevention education and school-based tobacco-use and e-cigarette-use cessation services and resources.
5. Mandate or incentivize school bus electrification. States should adopt policies that mandate or incentivize school bus electrification and prioritize equitable access to funding and resources.

1. The 2025 State Honor Roll Report is an independent research project of the Asthma and Allergy Foundation of America and made possible by support from Amgen, DBV, Kaléo, Pfizer, PhRMA, Sanofi, Regeneron, and Viatris.

AAFA State Honor Roll Expert Workgroup

The following individuals served as expert stakeholders to advise on updating the policy standards for this report. These experts contributed valuable insights through roundtable discussions, helping to ensure the standards reflect current best practices and needs of K-12 students with asthma, food allergies, anaphylaxis, and related diseases.

Mary Ellen Conley, RN
AAFA Board Member, Retired School Nurse

Jeffrey Demain, MD
AAFA Medical Scientific Council Member; Allergy, Asthma and Immunology Center of Alaska

Caryn Durham
Kaléo

Evalyn Grant, MD
AAFA Board Member, Vertex Pharmaceuticals

Jason Hartke
International WELL Building Institute*

Katie Horton
GW Milken Institute School of Public Health

Carol Johnson
Centers for Disease Control and Prevention

Piper Largent
National Association of School Nurses

Emmanuel Mahlis, MD
AAFA Board Member, MTF Biologics

Steve Marmaras
Amgen

Tiah McKinney
The McKinney Foundation

Tracey Mitchell
Environmental Protection Agency

Mike Pistiner, MD, MMSc
AAFA Medical Scientific Council Member; Food Allergy Center, Massachusetts General Hospital

Gary Riddle
Kaléo

Naomi Seiler
GW Milken Institute School of Public Health

Thomas Silvera
Elijah-Alavi Foundation

Paige Welch
Centers for Disease Control and Prevention

Jennifer Whelan
Allergy Standards Ltd.*

Larry Zarker
Building Performance Institute

The views and opinions expressed in this report are those of the AAFA authors and do not necessarily reflect the policies or positions of other individuals, organizations, or companies.

*Affiliation at time of participation.

2025 Report Authors and Contributors

External Contributors

Natasha Frost, Lead Legal Researcher
Attorney, Seed 2 Roots

Adriana Del Principe
Attorney

Asthma and Allergy Foundation of America

Melanie Carver
Chief Mission Officer

Maggie Corson
Policy, Advocacy, and Development Intern

Sanaz Eftekhari
Chief Business Development Officer; Vice President, Research

Nicole Gaghan
Creative Director

Kimm Rafferty
Marketing and Communications Production Director

Jenna Riemenschneider
Vice President of Advocacy and Policy

Andy Spears
Public Affairs Manager