Epinephrine administration for cases of anaphylaxis in a US school setting
Results from the EpiPen4Schools survey
Wooddell, M., Goss, D., Hollis, K., Millar, K., Silvia, E., Siegel, P., Bennett, ME., Wolf, RA., Hogue, S., & White, MV. (2015). Epinephrine administration for cases of anaphylaxis in a US school setting: Results from the EpiPen4Schools survey. Journal of Allergy and Clinical Immunology, 135(2, Suppl), Article AB212. https://doi.org/10.1016/j.jaci.2014.12.1627
Rationale This study was designed to describe anaphylactic events and epinephrine auto-injector (EAI) use in US schools.
Methods This exploratory, cross-sectional, web-based survey of schools participating in the EpiPen4Schools program captured details of all reported occurrences of anaphylactic events and treatment(s) administered at each responding school during the 2013-2014 school year.
Results A total of 919 anaphylactic events were reported in 607 schools (11%, n=5683 responding schools). Of the 851 events with data on the use of EAIs, 75% (n=636) were treated with auto-injectors. Of the events treated by EAI, 49% (n=310) were treated using the EpiPen4Schools’ program stock EpiPen® EAI, and 46% (n=289) were treated using the individual’s EpiPen EAI. Other EAIs accounted for approximately 4% of EAI treatments. Fifty-four (9%) received a second epinephrine injection. Of those individuals not treated with an EAI, 77% (n=157) received antihistamines, 13% (n=26) received another treatment, and 8% (n=17) received no treatment. Of the 850 events with data on hospital transport, 80% of individuals (n=677) were transported to the hospital.
Conclusions Over 10% of schools participating in the EpPen4Schools survey reported an anaphylactic event. Approximately 25% of anaphylactic events were not treated with epinephrine, most receiving antihistamines. Furthermore, 20% of patients were not taken to the hospital after an anaphylactic event. Considering the potential for biphasic reactions, close medical supervision is imperative after an anaphylactic attack. Thus, these data suggest the value of stocking EAIs and providing continuing education for school personnel and family members.