Characteristics and Treatment of Anaphylactic Events in a US School Setting: Results from the EPIPEN4SCHOOLSŪ Program Survey
The EPIPEN4SCHOOLS® program (Mylan Specialty L.P., Canonsburg, PA), launched in 2012, was developed to help improve access to epinephrine in the event of life-threatening anaphylactic reactions in schools. The program provides EpiPen® Auto-Injectors to qualifying public and private kindergarten, elementary, middle, and high schools in the United States. A survey of participating schools was subsequently developed and implemented for the 2013-2014 school year to better understand the characteristics of anaphylactic events, how they were treated, and the level of staff training to recognize and treat anaphylaxis.
This exploratory cross-sectional survey of schools participating in the EpiPen4Schools® program assessed anaphylactic events, treatments administered, and staff training at each responding school. More than 32,000 schools were contacted to complete the survey, and 6019 schools provided a response within the designated time frame for completion. A total of 919 anaphylactic events were reported by 607 schools (11%, 607/5683). Most anaphylactic events occurred in students (89%, 757/852), and 22% (187/852) occurred in individuals with no known allergies. The most commonly reported triggers included food (62%, 529/847) and insect stings (10%, 81/847); however, triggers could not be identified in 20% of events (172/847). In schools with data on treatment administered, epinephrine auto-injectors (EAIs) were used in only 75% of anaphylactic events (636/851). Most of the remaining events were treated with antihistamines (18%, 157/851). Of the events treated with EAIs, the school’s stock EpiPen® Auto-Injector was used to treat 49% of events (310/636), whereas the individual’s personal EpiPen® Auto-Injector was used to treat 45% of events (289/636). Approximately 36% of schools (2022/5613) trained only the school nurse and select staff to recognize anaphylaxis, whereas 29% (1621/5613) and 31% (1730/5613) trained most staff or all staff, respectively. A majority of schools (54%, 3024/5578) permitted only the school nurse and select staff to administer epinephrine; 16% (879/5578) and 22% (1218/5578) permitted most staff or all staff, respectively, to administer epinephrine.
In the EpiPen4Schools® survey, a high proportion of observed anaphylactic events were experienced by individuals with no known allergies, and many anaphylactic events had no identifiable trigger. These data highlight the unpredictable nature of anaphylaxis and the importance of training staff and caregivers to recognize and treat such events. Unfortunately, the data also reveal considerable variation in the levels of staff training in participating schools, with a high proportion of schools focusing training only on the school nurse. Finally, epinephrine, the first-line therapy for anaphylaxis, was not used in nearly 25% of anaphylactic events; using treatments other than epinephrine puts students at risk of poorer outcomes. Together, these data demonstrate that there continues to be a need for comprehensive training to properly identify and treat anaphylactic events in US schools.