• Article

Occurrence of anaphylaxis by school grade level and staff training Findings from the EpiPen4Schools survey

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

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.

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.

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.


Hogue, S., Bennett, ME., Goss, D., Hollis, K., Millar, K., Silvia, E., ... White, MV. (2015). Occurrence of anaphylaxis by school grade level and staff training: Findings from the EpiPen4Schools survey. Journal of Allergy and Clinical Immunology, 135(2, Suppl), AB212. https://doi.org/10.1016/j.jaci.2014.12.1628