More than 900 episodes of anaphylaxis occurred across 5,700 U.S. schools in the last academic year, according to a newly released nationwide survey. That’s a rate of more than one severe reaction a year in every 10 schools.
Findings from the EpiPen4Schools survey, revealed at the American Academy of Allergy, Asthma and Immunology (AAAAI) annual meeting in Houston, show that 852 individuals (mostly students but also staff) experienced anaphylaxis, with some individuals suffering multiple reactions during the school year. Seventy-five percent of them were treated with an epinephrine auto-injector and – in 49 percent of the cases – it was a school-supplied “stock” epinephrine auto-injector that was used. The survey was sponsored by Mylan Specialty, which markets the EpiPen.
Dr. Martha White, a Maryland allergist and an EpiPen4Schools study author, says these findings speak to the importance of school-owned or “stock” auto-injectors – which schools in most states now keep available for emergency use. The data support stock epinephrine as an important “safety net” for students having their first reactions, she notes.
The survey includes data from 5,683 public and private kindergarten, elementary, middle and high schools across America which participated in the EpiPen4Schools¬Æ stock auto-injector program, an initiative of Mylan Specialty, the marketer of the EpiPen. The results were gathered over the course of the 2013-2014 academic year.
The results were contained in four abstracts at the AAAAI annual meeting. Here are the key findings:
- 919 anaphylactic events were reported from the 5,683 schools surveyed.
- 11% (607) schools reported at least one anaphylactic episode.
- 757 (89%) of those having severe reactions were students; 22% of whom had no known allergies.
- Food allergies were the most common triggers.
- 310 (49%) of severe reactions were treated with school-owned stock epinephrine auto-injectors.
- 75% of severe reactions were treated with epinephrine, considered the first-line treatment for anaphylaxis.
- 25% of cases reported other treatment (usually antihistamines).
“Anaphylaxis is a serious and often unpredictable health problem in the U.S., particularly among children and adolescents,” said Roger Graham, president of Mylan Specialty. “There have been too many tragedies reinforcing that when anaphylaxis occurs, every minute matters, and immediate access to epinephrine and emergency medical care is crucial.”
The unpredictability of anaphylaxis applies to students with diagnosed allergies as well as those with no known allergies, adds White.
“There’s always a first time [for a reaction]; that could be at home, it can be in school, it can be in a restaurant, it can be on the soccer field where they got stung,” White told Allergic Living. “But the bottom line was that, at least in this survey, and there have been other studies that have given similar data, 22 percent of the students that had an anaphylactic event in school had no prior history of anaphylaxis. So they were undiagnosed and would not have had medication at home or at school.”
Dr. Ruchi Gupta, associate professor of pediatrics at Northwestern University Feinberg School of Medicine, conducted an earlier, 2012-13 study of stock epinephrine use in Chicago schools, finding that 38 schools in that city used the school-supplied devices in one year.
Commenting on the need for stock epinephrine, she said at the time: “Because of the amount of time kids spend in school, and given the fact that many first-time allergic reactions occur on school grounds, it is imperative for school districts across the country to provide access to emergency epinephrine to students who may not otherwise have access to the potentially life-saving medication.”
In November 2013, President Barack Obama signed the School Access to Emergency Epinephrine Act, which provides financial incentives for states to adopt laws allowing schools to stock auto-injectors. Most states now allow schools to stock epinephrine, and emergency auto-injectors are required in California, Nevada, Michigan, North Carolina, Nebraska, Virginia, Maryland, and Delaware schools.
New Hampshire, Hawaii, and Iowa are the only states that currently have no epinephrine laws or regulations in place.
While the data presented at AAAAI demonstrates the use of stock epinephrine auto-injectors in schools, White emphasizes it does not replace the need for students with known allergies to have their own epinephrine auto-injectors.