Study highlights need for epinephrine in schools—and staff trained to administer it

With school nurses often covering multiple buildings, nearly one in five students who experience severe allergic reactions are given potentially life-saving epinephrine injections from unlicensed staff or students.

The study abstract, "National School Nurse Survey of Epinephrine Use in Schools," will be presented on Sunday, Sept. 17, at the American Academy of Pediatrics 2017 National Conference & Exhibition in Chicago.

For the study, more than 1,200 school nurses completed an electronic survey about the use of epinephrine in schools as emergency treatment for anaphylaxis, a severe allergic reaction, during the 2014-15. Nearly one-quarter (23.9 percent) of participants reported epinephrine being administered in their school during the past year.

In total, out of the 482 administrations of epinephrine reported, 16.2 percent were by unlicensed staff or students. In addition, researchers said, 33.6 percent of administrations were to students who did not have an allergy known to the school. The survey also found that 10.8 percent of students having a severe allergic reaction required more than one dose of epinephrine before emergency medical responders arrived.

"The findings highlight the importance of having a supply of epinephrine available in schools, and people trained to administer it during an allergy emergency," said Michael Pistiner, MD, MMSc, FAAP, and author of the abstract and Director of Food Allergy Advocacy, Education and Prevention at MassGeneral Hospital for Children (MGHfC) in Boston.

Prior research suggests as many as one in five children with food allergy have had an allergic reaction at school or child care, Pistiner said. Considering that more than one-third (34 percent) of the nurses responding to the survey said they staff more than one building, Pistiner said, his research team wasn't surprised that epinephrine shots frequently were being administered by nonmedical staff.

"Despite the potential severity of food allergy reactions, there are many schools where the nurse may not be onsite at all times," said Julie Wang, MD, FAAP, a co-author of the abstract and an associate professor of pediatrics and allergy and immunology at Icahn School of Medicine at Mount Sinai. "Training other school workers may be beneficial," she said, "and it would extend the school nurses' ability to manage students with food allergies in schools."