A majority of school nurses report being trained to handle severe food allergy reactions, and most have stock (or unassigned) epinephrine available as a tool.
Underscoring the importance of those factors, a national survey of school nurses reveals that one-third of the nurses had to deal with at least one severe reaction in the past year.
For their study, published in the Annals of Allergy, Asthma and Immunology in March, Northwestern University pediatrician Dr. Ruchi Gupta and her colleagues got responses from 242 school nurses across the United States. They found that 96 percent of participants received anaphylaxis training, 81 percent said their school had stock epinephrine auto-injectors and 61 percent said their classrooms had strict policies for bringing food in the classroom.
The researchers say the findings show progress in education about anaphylaxis prevention and preparedness, but also some key gaps.
For instance, Gupta notes the availability in schools of stock epinephrine auto-injectors, which can be administered to anyone in a severe reaction, is a “significant improvement over the last decade.” Yet her co-author identifies that there is still further need in this area.
“School stock epinephrine was much less likely to be available for after-school activities or for travel with student groups outside of school,” Anne Russell, a food allergy specialty nurse and director at Food Allergy and Anaphylaxis Michigan Association, told Allergic Living. “This is a concern since up to 19 percent of anaphylactic reactions during the school day may occur outside of the school building or on field trips.”
Russell suggests schools consider extending the availability of stock epinephrine auto-injectors. Most U.S. states have legislation that requires every school to have at least one device and at least one staff member trained to use them properly in case of emergency. That may not apply to extra-curricular activities or field trips.
The survey shows that school nurses see the need for improvement in allergen labeling of cafeteria menu items, and that a majority stress the importance of clear lunchroom cleaning protocols and anaphylaxis training of school staff.
The research also highlights the importance of having a school nurse. Russell notes they saw “higher rates of stock epinephrine availability in schools with full-time nurse coverage.”
“The role of the school nurse in leading, implementing and evaluating individualized student health plans, school policies, and staff education on management of chronic health conditions such as food allergy is vital to student health and safety,” says Russell.
“State legislation supporting availability of stock epinephrine has also assisted in promoting anaphylaxis preparedness in schools,” says Russell. She additionally credits evidence-based resources from the Centers for Disease Control and Prevention and the National Association of School Nurses for helping schools to manage food allergies.
“School food allergy management policies are important to promote student safety.” says Russell. “Our study findings emphasize the need to continue working together on developing and refining useful policies.”