Food Allergy Research

New Findings on Epinephrine Availability and Use in Schools

Epinephrine should be prescribed for all patients at risk of experiencing a severe reaction (anaphylaxis). Epinephrine is the only medication that can reverse the symptoms of anaphylaxis.

Recent findings from poster presentations given at the annual meeting of the American Academy of Allergy, Asthma & Immunology reiterate the importance of having this life-saving medication available and in the hands of all patients at risk of anaphylaxis.

In 2013, President Obama signed the School Access to Emergency Epinephrine Act, championed by FARE and sponsored by U.S. Sens. Richard Durbin (D-IL) and Mark Kirk (R-IL) and U.S. Reps. Phil Roe (R-TN) and Steny Hoyer (D-MD). This law provides a financial incentive for states to enact their own laws requiring schools to keep non-student specific epinephrine auto-injectors in case of an emergency. Nearly every state in the U.S. now either allows or requires stock epinephrine in schools.

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The findings from these abstracts include:

Epinephrine use in New York City Public Schools steadily increasing

Nursing records from the New York City public school district show that epinephrine was administered 38 times in 2008, according to researchers at the Icahn School of Medicine at Mount Sinai. In 2012, the number rose significantly, with epinephrine being used 114 times. This rise may be due to an increase in ability to recognize the signs of anaphylaxis, or a true rise in the number of allergic reactions.

Notably, just 21 percent of epinephrine uses were for students with a medical administration form on file. This study confirms the importance of stocking non-student specific epinephrine in schools and identifying students in the school population at risk for allergic reactions.

Hundreds of students experience anaphylaxis in school

In a survey of 6,574 schools participating in EpiPen4Schools®, a program offered by Mylan Specialty that provides free epinephrine auto-injectors to qualifying schools in the U.S., 1,140 anaphylactic events were reported during the 2013-2014 school year. This survey had been administered as a pilot previously, and now researchers are reporting on a readministered survey which included large school districts that were underrepresented in the initial survey.

Of the 1,140 anaphylactic events, 76.5 percent were treated with epinephrine auto-injectors on school property. Stock epinephrine auto-injectors from the EpiPen4Schools program were used to treat 38 percent of anaphylaxis cases.

45 percent of anaphylactic events occurred in high schools, 19 percent in middle schools and 33 percent in elementary schools. Epinephrine auto-injectors were also needed to treat anaphylaxis in 98 staff members.

More than half of schools reported that the school nurse and select staff were permitted to administer epinephrine. The authors cautioned that this means students may frequently be in settings without personnel trained to treat allergic reactions. With 25 percent of anaphylactic events in this survey occurring in individuals with no known allergies, these findings underscore the need for comprehensive preparedness training in schools.

School nurses spread thin, need for additional staff trained to treat anaphylaxis

It is typical for school nurses to cover multiple school buildings in a district. A study of Colorado nurses authored by researchers in Denver, New York and Boston showed that when one nurse is covering five or more buildings, there is an increase in unlicensed staff being called upon to administer epinephrine. In these schools with high building to nurse ratio, 14 percent of anaphylaxis events were treated by unlicensed staff. The majority of nurses reported that school staff received anaphylaxis training, but felt that more comprehensive training is needed in the form of hands-on training to increase student safety.

Disparities in stock epinephrine implementation in Kansas schools

In 2009, the Kansas legislature authorized schools to stock emergency epinephrine, four years prior to the passage of the federal School Access to Emergency Epinephrine Act by President Obama in 2013. Although Kansas was an early-adopter of stock epinephrine legislation, a new study from researchers at the University of Kansas Medical Center shows that epinephrine is only available in a few Kansas communities.

According to a 2015 survey of Kansas school nurses, only 20 counties out of 59 reporting stocked epinephrine in at least one school. Schools were more likely to stock epinephrine in wealthier counties and in urban cores. Nurses cited cost, legal liability, having a prescribing physician, lack of staff knowledge and lack of administrator support as reasons preventing them from stocking epinephrine. “Further investigation is necessary to resolve this inequality, which disproportionately affects Kansas communities,” the authors concluded.

Children with peanut and/or tree nut allergy are more likely to be prescribed epinephrine

In a study of a general pediatric clinic, over a one-year period children with peanut and/or tree nut allergy were 2.2 times more likely to receive prescriptions for epinephrine, according to researchers from the Icahn School of Medicine at Mount Sinai and the Albert Einstein College of Medicine. Children who had a history of anaphylaxis were also more likely to receive prescriptions. Many food allergens other than peanut or tree nut can cause anaphylaxis. The authors concluded that for pediatricians, further education is needed to ensure their patients are prepared with epinephrine to treat any severe allergic reactions they may face.

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