Children experiencing an anaphylactic event at school may frequently encounter staff members who are not permitted to administer potentially life-saving epinephrine, according to recent survey study.

Of 6,574 surveys submitted by schools, there were 1,140 anaphylactic events reported in 736 schools.

A total of 6,088 schools provided data on staff training for recognizing anaphylaxis recognition: 30% provided training for all staff, 28% for most staff, 37% for the school nurse and select staff, and 2% for just the school nurse. Of 6,053 schools providing data on who is permitted to administer epinephrine to treat anaphylaxis, 22% permitted all staff, 16% permitted most staff, 55% permitted the school nurse and select trained staff, and 3% permitted the school nurse only, reported Martha V. White, MD , Institute for Asthma and Allergy, Wheaton, Md., and her associates (Pediatr Allerg Immunol Pulmonol. 2016. doi: 10.1089/ped.2016.0675 ).

These findings “suggest that there may be an opportunity to improve school staff training programs. Only 58.6% of schools surveyed trained all or most staff members to recognize the signs and symptoms of anaphylaxis. Similarly,only 37% of responding schools permitted all or most staff to administer epinephrine. … School policies should be designed to allow for prompt administration of epinephrine during the early stages of an anaphylactic attack,” Dr. White and her associates concluded.

Among students having events for whom grade information was available, 33% occurred in elementary school students, 19% occurred in middle school students, and 45% occurred in high school students. In 1,049 anaphylactic events, the allergy history was known: 68% of events occurred in students with known allergies and 25% were in students with no known allergies.

When triggers were identified (in 78% of cases), food was the most common trigger, occurring in 60%, followed by insect bites or stings in 8%; environmental, medication, or health related triggers in 9%; and latex in 1%.

Data on use of epinephrine autoinjectors (EAIs) was available in 1,059 cases. EAIs were administered in 76% of anaphylactic events, were not administered in 23% cases, and it was unknown whether EAIs were given in the remaining 1%.

This study was supported by Mylan Specialty. Dr. White has served as a consultant for Mylan and Merck, and has received grants, fees, or support from numerous pharmaceutical companies. Christopher Herrem, PhD, is a paid employee of Mylan and may hold stock within the company. The remaining authors reported that they had no conflicts of interest.


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