EPIPEN4SCHOOLS® Program Pilot Survey: Characteristics and Treatment of Anaphylactic Events in a US School Setting

Background: The EPIPEN4SCHOOLS^® program (Mylan Specialty L.P., Canonsburg, PA), launched in 2012, provides EpiPen^® (epinephrine injection) Auto-Injectors to qualifying public and private kindergarten, elementary, middle, and high schools in the US to help improve access to epinephrine in the event of life-threatening anaphylactic reactions.

Methods: This exploratory, cross-sectional, web-based pilot survey examined the characteristics and treatment of anaphylactic events in US schools enrolled in the EpiPen4Schools^® program during the 2013-2014 school year.

Results: A total of 919 anaphylactic events were reported by 607 schools (11%, 607/5683). Anaphylactic events occurred in students (89%, 757/852), and 22% (187/852) occurred in individuals with no known allergies. Commonly reported triggers included food (62%, 529/847) and insect stings (10%, 81/847); however, triggers were not identified in 20% of events (172/847). Epinephrine auto-injectors (EAIs) were used in 75% of anaphylactic events (636/851). Most of the remaining events were treated with antihistamines (18%, 157/851). Of the events treated with EAIs, the school’s stock EpiPen^® Auto-Injector was used to treat 49% of events (310/636), and the individual’s personal EpiPen^® Auto-Injector was used to treat 45% of events (289/636). Thirty-six percent of schools (2022/5613) trained only the school nurse and select staff to recognize anaphylaxis, whereas 29% (1621/5613) and 31% (1730/5613) trained most staff or all staff, respectively. In the majority of schools (54%, 3024/5578), only the school nurse and select staff were permitted to administer epinephrine.

Conclusions: Results from the EpiPen4Schools^® survey reported that a high proportion of observed anaphylactic events were experienced by individuals with no known allergies and that many events lacked an identifiable trigger. These data highlight the unpredictable nature of anaphylaxis and the importance of preparedness training. The results also reported variation in the levels of staff training in participating schools, with a high proportion of schools focusing training only on the school nurse. Finally, treatments other than epinephrine were administered in nearly 25% of observed anaphylactic events; however, such treatments (eg, antihistamines) are not approved as first-line treatment for these life-threatening, severe events. These data highlight a continued need for training to properly identify and treat anaphylactic events in US schools.