• Article

Prevalence and triggers of anaphylactic events in schools

BACKGROUND: Prevention and management of anaphylaxis in schools is an area of active interest as allergy and asthma rates in children continue to increase. A greater understanding of the prevalence and characteristics of anaphylaxis can help guide preventive and management strategies both within and outside of the school setting, with the goal of reducing morbidity and mortality.

OBJECTIVE: This study was performed to elucidate the epidemiology of and management strategies for anaphylaxis in the school setting.

METHODS: A cross-sectional, web-based survey was administered to schools participating in the EPIPEN4SCHOOLS® program (Mylan Specialty L.P., Canonsburg, PA), an initiative that provides stock epinephrine auto-injectors (EAIs) to qualifying US schools. Representatives from participating schools completed a questionnaire regarding anaphylactic reactions that occurred during the 2014-2015 school year. Weighted analyses were performed to account for differential responses between schools that completed the survey and those that did not.

RESULTS: A total of 12,275 of the 45,819 invited schools responded to the survey. Occurrence of 1 or more anaphylactic events was reported by 1358 schools. Most events (89.8%; 1803/2008) occurred in students. High school students accounted for the largest proportion of anaphylactic reactions among students (40.1%; 723/1802). Food was the most commonly identified anaphylaxis trigger across grade levels, seasons, and geographic regions. The trigger was unknown to the individual experiencing anaphylaxis in 21.8% of events (436/1998). No known history of allergy or asthma was present in 24.5% (491/2001) and 51.3% (1026/2000) of affected individuals, respectively. Transportation to the hospital or clinic for further treatment/management was reported for 72.6% of anaphylactic events (1450/1997). Results from the weighted analyses were similar to those of the unweighted analyses.

CONCLUSION: Anaphylaxis occurs across grade levels and in individuals with or without known risk factors, reinforcing the need for school preparedness in both management of anaphylaxis and stocking of EAIs.


White, M. V., Silvia, S., Muniz, R., Herrem, C., & Hogue, S. L. (2017). Prevalence and triggers of anaphylactic events in schools. Allergy and Asthma Proceedings, 38(4), 286-293. https://doi.org/10.2500/aap.2017.38.4066

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