The legislation is named for Elijah-Alavi Silvera, a 3-year-old with a severe dairy allergy who died in 2017 after being fed a grilled cheese sandwich at his New York City day care. His parents, Thomas Silvera and Dina Hawthorne, founded the Elijah-Alavi Foundation to advocate for food allergy awareness and similar laws nationwide. Pennsylvania joins seven other states and several cities that have adopted versions of Elijah's Law.

About 8% of children and teens in the United States have a food allergy, according to national estimates, putting them at risk of anaphylaxis—a sudden, life-threatening reaction that can close the airway. Symptoms can begin within minutes or up to an hour after eating and include hives, facial swelling, vomiting, wheezing, and a dangerous drop in blood pressure. Epinephrine auto-injectors, such as EpiPens, can quickly reverse those complications, but only if the medication is available and someone knows how to use it.

Previously, stocking epinephrine was voluntary for Pennsylvania child care providers. The new law requires facilities to have the medication on hand, with doses supplied through state agencies. The requirement is contingent on the state securing federal funding to help purchase and cover the costs of epinephrine, which can run as high as $700 out of pocket for a two-dose pack and may need annual replacement.

State Rep. Kristin Marcell, a Bucks County Republican and co-sponsor of the bill, said the law is personal for her. "As a mother of a child with a food allergy, I know how quickly an ordinary situation could become a medical emergency," Marcell said. "To know that we now have created a program in our state that can help children and parents to have those protections and to help them in that way, it makes me feel so relieved."

Marcell also praised the Silvera family for turning their grief into advocacy. "Hearing the pain that they have gone through, but them turning it into positivity by advocating for this legislation across many states, it makes me very happy to see that we could get it done in Pennsylvania," she said.

The law also mandates dedicated training for staff on recognizing early signs of an allergic reaction, administering rescue medication, and identifying emergency support services. Kimberly Early, senior director of public policy and advocacy at the Pennsylvania Association for the Education of Young Children, said the training component is critical. "You can't just provide the tool without providing the education," Early said. "I think the training piece is really important, making sure that those in the classrooms know how to use the systems and know the signs."

Early noted that many child care centers operate on thin margins and might struggle to absorb the cost of the medication without state help. "Obviously, they want to see children healthy and safe, but don't always have the funding to cover all of those extra costs," she said. The association was an early supporter of the bill, which was sponsored by Marcell and state Rep. Bridget Kosierowski, a Lackawanna County Democrat.

For parents, Marcell said she hopes the law brings reassurance. "That first of all, EpiPens are available, but that there's also training at that facility so that if they recognize any type of food allergy symptoms, that it can be handled," she said. "Because when seconds matter, you want the people in that facility to be able to take care of any child, whether it's someone who has an identified allergy … or if it's a child that maybe they didn't realize had food allergies until that particular incident."