Majority of School EpiPens Used for First-Time Reactions

Yael Waknine

October 31, 2014

Emergency access to stock epinephrine auto-injectors (EAIs) is crucial for students, according to a report published online October 20 by Lilliana DeSantiago-Cardenas, MSW, from the Office of Student Health and Wellness, Chicago Public Schools, Illinois, and colleagues in the American Journal of Preventive Medicine.

Following national and local legislation, Chicago Public Schools was the first large, urban US school district to begin stocking undesignated EAIs for the treatment of acute allergic reactions. Undesignated EAIs are those which are not prescribed for specific students but are kept by schools for use in emergencies. During the inaugural 2012 to 2013 academic year, 38 doses were issued, primarily (92.1%) to students, 63.2% of whom were in elementary schools and 36.8% in high school. School nurses administered most of the shots (76.3%), and 911 was called in 81.6% of cases.

Surprisingly, the rate of first-time EAI use was 55.0%, which is more than double the previously published estimates of life-threatening allergic reactions and anaphylaxis among schoolchildren with no prior history.

"Prior research indicates that 20%–25% of children experience their first allergic reaction in school, potentially because it is their first exposure to the food-allergen trigger," the authors write, pointing out that timely EAI administration is a child's first and primary line of defense to such an event.

“Of children with a known food allergy, only 25% to 28% have access to their EAI at school. Additionally, 30% of school nurses have reported using one student’s prescribed medication to rescue another student in distress,” the authors write.

The majority of reactions were food-related (55.3%), primarily peanuts (18.4%) and fin fish (13.2%). Other causes included insect venom (5.3%), animals (2.6%), and grass (2.6%). However, more than one third of cases (34.2%) lacked an identifiable trigger.

The authors also point out that 26.3% of EAIs were administered to students on Chicago's Far South Side, which was associated with a significantly lower rate of physician-documented food allergy compared with the North-Northwest side (8% vs 47%).

"This underscores the need for access to district-issued EAIs citywide, as children on the Far South Side may not have access to [prior] food-allergy diagnosis and could experience their first allergic reaction at school," they write.

The study is limited by inconsistencies in case detail level that resulted when detailed written forms were abandoned in favor of free-form electronic entry midway through the school year.

The authors have disclosed no relevant financial relationships.

Am J Prev Med. Published online October 22, 2014. Full text

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