Occurrence of anaphylaxis by school grade level and staff training

Abstract

Rationale
To conduct an exploratory study of anaphylaxis and epinephrine auto-injector (EAI) use in US schools during the 2013-2014 school year.

Methods
This exploratory, cross-sectional, web-based survey of schools participating in the EpiPen4Schools program captured characteristics of anaphylactic events and EAI use in children and adults enrolled or working in schools.

Results
Thirty-six percent of responding schools (n=2146) were grade schools (pre-K to grade 5), 12% (n=703) were middle schools (grades 6-8), and 18% (n=1064) were high schools (grades 9-12); the remaining 34% (n=2088) were other grade combinations. Nearly 50% of students (n=355) who experienced anaphylaxis were in high school, 32% (n=234) were in grade school, and 19% (n=135) were in middle school. Although frequency of food-related triggers was consistent across grade levels, 22% of high school students (n=79) experienced an event with an unknown trigger, compared with 14% (n=33) and 15% (n=20) of grade school and middle school students, respectively. Approximately 36% of schools (n=2022) trained only the school nurse and select staff to recognize anaphylaxis, whereas 29% (n=1621) and 31% (n=1730) trained most staff or all staff, respectively. A majority of schools, 54% (n=3024), permitted only the school nurse and select staff to administer epinephrine; 16% (n=879) and 22% (n=1218) permitted most staff or all staff, respectively, to administer epinephrine.

Conclusions
Adolescence may be a particularly high-risk developmental stage for anaphylaxis, and some students encounter staff members who are untrained in anaphylaxis recognition or treatment. These findings suggest a need for continued anaphylaxis training for protection of all students, staff, and visitors.