Anaphylaxis in Schools: Results of the EPIPEN4SCHOOLS Survey Combined Analysis

Abstract

A pilot survey described the characteristics of anaphylactic events occurring in an initial set of participating U.S. schools during the 2013–2014 school year. This survey was subsequently readministered to large school districts, which were underrepresented in initial results. A cross-sectional survey was administered to the U.S. schools that were participating in the EPIPEN4SCHOOLS® program (Mylan Specialty L.P., Canonsburg, PA) to assess characteristics of anaphylactic events. Data from large school districts were added to initial findings in this comprehensive combined analysis. A total of 1,140 anaphylactic events were reported among 6,574 responding schools. Of 1,063 anaphylactic events with data on who experienced the event, it was observed that it occurred mostly in students (89.5%, 951/1,063). For students, anaphylactic events were reported across all grades, with 44.9% (400/891) occurring in high school students, 18.9% (168/891) in middle school students, and 32.5% (290/891) in elementary school students. Food was identified as the most common trigger (60.1%, 622/1,035). A majority of schools (55.0%, 3,332/6,053) permitted only the school nurse and select staff to administer epinephrine to treat anaphylaxis. The unpredictability of anaphylaxis is emphasized by its high occurrence in individuals with no known allergies (25.0%). A majority of schools permitted only the school nurse and select staff to treat anaphylaxis. Thus, individuals experiencing an anaphylactic event may frequently encounter staff members not being permitted to administer potentially life-saving epinephrine. Epinephrine auto-injectors provided by the EPIPEN4SCHOOLS program were used to treat 38.0% of events. Anaphylaxis can occur in children with no previously known allergies, illustrating the importance of public access to epinephrine.

Exploring School Nurse Interventions and Health and Education Outcomes: An Integrative Review

“…Other studies included education for school nurses about food allergies (Chokshi, Patel, & Davis, 2015), adolescent relationship abuse and how to integrate discussions of healthy/unhealthy relationships in each student encounter (Raible et al, 2017), school preparedness for biological events (Rebmann, Elliott, Artman, VanNatta, & Wakefield, 2016), how to support students as they return to the classroom (i.e., return to learn) after concussions (Wing, Amanullah, Jacobs, Clark, & Merritt, 2015), recognizing children at risk for maltreatment (Jordan, MacKay, & Woods, 2017), and improving communication with families on weight-related health issues through a web-based tutorial (Steele, Wu, Cushing, & Jensen, 2013). School nurses also assisted with creating an education module about food allergies for school staff (White et al, 2016) and provided recommendations for education on collaboration with interdisciplinary staff as well as conducting mandated screenings to provide care for students with disabilities (Singer, 2013).…”

The global burden of illness of peanut allergy: A comprehensive literature review

“…Multiple studies in various countries have examined potential strategies for schools to address the risks of food allergies, such as becoming ‘peanut‐free’ and making adrenaline available to school staff, with some controversy 115,116,119–127 . A survey of school nurses in Massachusetts found that 10.3% of schools do not permit peanuts to be sent in from home, 91.1% had peanut‐free tables, and 65.6% had peanut‐free classrooms 128 .…”

Gaps in the management of food‐induced anaphylaxis reactions at school

“…In the United States (US), 115 anaphylaxis reactions requiring adrenaline at school (2001)(2002)(2003) have been reported, and the Epipen4schools ® program provided data on allergic reactions that occurred in the 6574 responding schools (2013-2014). 4,5 In France, prevention measures to improve the acceptance of children with allergic disease and reduce the risk of anaphylaxis at school through individual healthcare plans (IHP) were introduced into law in 2003.…”