Each academic year, one in every six U.S. schools will have a student or staff member experience anaphylaxis, according to a nationwide survey that further supports the need for stock epinephrine auto-injectors in schools, and training for staff on when and how to use them.
The latest results from the EpiPen4Schools Survey were presented at AAAAI’s annual meeting in March. Billed as the first nationwide survey to evaluate the prevalence of anaphylaxis and the use of epinephrine auto-injectors in U.S. schools, the survey’s initial findings were revealed in February 2015. This year, the data were expanded to include larger districts, looking at more than 6,500 elementary, middle and high schools during the 2013 to 2014 academic year.
The survey revealed that not only are anaphylactic events a relatively common occurrence in schools, but also that the risk extends beyond those with diagnosed allergies. A quarter of the individuals who experienced anaphylaxis in a school setting had no known allergies.
“That means that 25 percent of people having reactions in schools would have no reason to carry epinephrine auto-injectors, which underlines the importance of stock epinephrine injectors,” explains Dr. Martha White, a Maryland allergist and one of the study authors. According to the survey, stock epinephrine was used to treat 38 percent of the anaphylactic events.
However, White highlights that stock epinephrine does not replace the need for those with known allergies to have their own epinephrine auto-injectors at school. “The safety net is really there for people who don’t know that they have an allergy or for whatever reason, don’t have their own epinephrine auto-injector,” she says.
Outside of stocking emergency medication at school, White also emphasizes the need for anaphylaxis training. Only one in three schools surveyed had taught their entire staff to recognize the signs and symptoms of a severe reaction.
“If you don’t recognize that a child is having a reaction, they might collapse by the time you think to get the nurse,” says White. “The faster you’re able to recognize that a child is in need of help, the faster that help is then given – and allergic reactions progress quickly, so you want to stop them early.”
This training, and giving staff the ability to administer epinephrine auto-injectors, is particularly important since not all reactions happen on school property. Nearly half of the schools surveyed only permitted the school nurse and select staff to administer epinephrine in an emergency.
“Kids on school buses, playing out in the playground, or on school trips may be at risk because they’re probably with people who don’t know how to recognize an allergic reaction unless they have personal experience,” says White. “We need to improve that.”
White encourages parents to teach their children to recognize when they’re having a severe reaction, and to immediately speak up and tell an adult.
The results were split into two presentations at the AAAAI annual meeting. Here are the key findings:
- 1,140 episodes of anaphylaxis occurred across 6,574 U.S. schools.
- Most (89.5 percent) incidents involved students, but not all.
- More reactions were seen in high school students, and researchers say this makes sense given that they generally tend to take more risks.
- Food was the trigger for a majority (60 percent) of the reactions. Other triggers include environmental, medication, and insect stings or bites.
- 22 percent of severe reactions were from unknown triggers.
- Epinephrine auto-injectors (both stock and personal) were used to treat 77 percent of anaphylactic events reported.
In 2013, President Obama signed the “School Access to Emergency Epinephrine Act,” which encouraged but did not require all states to adopt stock epinephrine regulations for schools. According to FARE, nearly all states now have guidelines allowing stock epinephrine but only 11 require it.
Overall, White says that the EpiPen4Schools survey – which was sponsored by Mylan Specialty, which markets the EpiPen – shows that there is still much to be done when it comes to making U.S. schools safe for those with known or unknown allergies.