Today, 49 states either require, or allow schools to stock epinephrine for treating food allergy emergencies.
To learn more about the use of epinephrine in schools, researchers surveyed more than 1,200 school nurses about using the drug to treat anaphylaxis during the 2014-15 school year. Elementary and high school nurses from urban, suburban, and rural areas were surveyed.
Recently, the study’s lead author, Dr. Michael Pistiner, director of Food Allergy Advocacy, Education and Prevention at Mass General Hospital for Children, shared the study outcomes with FARE (Food Allergy Research & Education); in summary:
- Unknown Allergy. Thirty percent of the epinephrine administered went to students whose allergy was unknown to the school. This is very close to the 25 percent statistic often cited for school emergencies involving an unknown allergy, suggesting the 25 percent figure is reasonable.
Nurse Coverage. Of the nurses surveyed, 30 percent covered more than one school building, and above 20 percent covered three or more buildings. This highlights the issue of who administers epinephrine to kids with first-time reactions when the nurse is not there.
The nurses recalled 482 epinephrine administrations during the 2014-15 school year, and of those, six percent were given by non-nurses to children not known to have an allergy. This further emphasizes the importance of having non-nurse personnel at the school adequately trained to recognize anaphylaxis, and administer epinephrine.
Designee Challenge. Students with a known allergy have delegates at the school. Delegates are non-nurse personnel trained to follow a child’s emergency care plan and administer epinephrine when the nurse is absent. For kids with an unknown allergy, staff trained to administer epinephrine are called designees. The challenge is to have designee training protocols specific enough to make anaphylaxis recognizable, yet to differentiate it from other conditions (e.g. gastroenteritis, exercise-induced asthma).
Second Dose Question. Surprisingly, 10 percent of the students needing epinephrine required more than one dose. Continued data analysis may find this occurs more often in rural schools since the children are a greater distance from hospitals. A second dose might also be a reassurance measure taken by some school nurses.
Since laws governing stock epinephrine in schools vary from state to state, as do available resources for implementation, studies such as this one reveal the necessity of having clear policies in place.
“Our message is that these findings show the importance of having policies, protocols and trained personnel to be able to recognize anaphylaxis in the school building, as well as having available epinephrine for both folks who have known allergy as well as for people whose allergy is unknown to the school,” says Dr. Pistiner.