Although the pens open airways, which can keep the allergic child breathing, that sharp point on the syringe can cause safety concerns.
"Some schools would not allow that in the gym, or for the children to carry it in the classroom," said Tringale. "Some schools would require asthma inhalers and [an] epinephrine syringe to be locked in the nurse's office and the nurse only comes in three days a week."
But Washington has statewide policies to ensure those students can carry their asthma inhalers or get to their epinephrine when they need it.
With most of the state's population living in thin air at 6,000 feet above sea level, it's no wonder the government paid attention to breathing.
New Mexico fell just below the AAFA's Honor Roll, but the Land of Enchantment deserves an honorable mention. It made 14 of the 18 gold standard requirements.
"Most of what we saw, we were pleased with [in all states]," said Collins, who took extra care to draft the requirements for the Honor Roll. Collins helped put together a panel of active parents, school administrators, asthma educators, school nurses, doctors and social workers to come up with the criteria.
"It's important to have policy to have uniform standards based on not just the loudest mother, but best practice," said Tringale.
"We tried to not just make it a bunch of clinicians and medical types," said Collins, but people who were on the ground working in the schools.
Only three other states met 14 of the 18 gold standard requirements.
New York, neighbor to most of the Honor Roll states, fell just slightly below the Honor Roll rankings. But it came close, with 14 points on the 18-point scale.
Children in New York have all the tobacco bans, the indoor air quality standards and the rights to carry their medications. But New York administrators might have less paperwork to file.
New York didn't meet the AAFA standards in reporting asthma incidents or mandated asthma awareness programs. Still, the Empire State made a good showing for policies in place, and Tringale thinks that's essential.
"Definitely, there must be a policy," said Tringale, who added parents would not want their child's education standard to change from school to school, or district to district. "We think the same thing about health," he said.
Two hundred miles south of New York lies Maryland, yet another leader in setting the standard for allergy care.
Maryland scored the same as New York -- 14 points out of 18 -- but missed out in different areas. Maryland was more likely to lag on policies for tobacco bans at school functions and indoor air quality control.
That's no moot point for Principal Riddile. "Air quality in schools should be a definite priority, and it is among the school systems I know," he said.
The move from an old building into a new one changed more than the air quality for his school.
"Our attendance went up, we had fewer sick days," said Riddile. "I noticed a difference with [my] allergies."
While Maryland lacked on indoor air quality control policies, West Virginia, which tied Maryland for an honorable mention, did gangbusters.
Though the state is close to Tobacco Country, West Virginia led the way in terms of banning tobacco on school grounds. The state was also strong in terms of letting children have access to their medicine, and indoor air quality.