Helping Families and Schools Manage Anaphylaxis

The rate of students at risk for anaphylaxis is rising, and up to 6% of students self-report a food allergy, according to a presentation at the ACAAI annual meeting. Although the rate of epinephrine use in schools is also rising, it is administered in only 64% of cases of anaphylaxis that occur in schools, according to the EPIPEN4SCHOOLS® program, and only 59% of schools cite epinephrine as their standard first-line therapy for anaphylaxis.

Furthermore, research shows that adolescents in particular are not consistently self-carrying their epinephrine auto-injectors. Therefore, Julie Wang, MD, of the Icahn School of Medicine at Mount Sinai in New York City, urged participants to implement best practices for anaphylaxis management in schools.”

Wang stressed that management of anaphylaxis in schools depends on “successful implementation of proactive plans for allergen avoidance, preparedness for reactions, and ready access to epinephrine.” Allergists play a key role in achieving those objectives, she said.

The speaker provided detailed examples of ways to prepare schools. Families have indicated that they would like schools to stock epinephrine, provide lunch menus that contain allergen information, put ingredient labels on food items, and implement food allergy education for students. Other practices encouraged by school nurses include anaphylaxis training for staff, designated lunch areas, and food guidelines for classrooms. Financial, temporal, and attitudinal barriers sometimes prevent implementation.

Wang encouraged allergists and other doctors in the audience to play a larger role in communicating the diagnoses to schools and pointing out the risks. Specifically, they should provide written allergy and anaphylaxis emergency plans (templates are available from the American Academy of Pediatrics), she noted. Allergists also should provide prescriptions for epinephrine auto-injectors and help schools create plans for effective allergen avoidance. Physicians also can encourage parents and caregivers to provide their children’s schools with medical information and medications—and to update it as necessary.

Importantly, she said, doctors should educate and remind all involved that anaphylaxis is potentially life-threatening. Therefore, when in doubt, people should administer epinephrine. In fact, some have advocated that patients with any history of severe reactions to stings or food allergens should receive epinephrine before symptoms even begin.

Training the school staff increases their knowledge, attitudes, and confidence. Such education should be based on evidence-based recommendations and should include all staff, not just school nurses. Wang referred the audience to resources including programs from their own states and school districts, the Centers for Disease Control and Prevention, the National Association of School Nurses, AllergyHome, and Food Allergy Research & Education®.

Finally, she reminded attendees to have frequent discussions with patients and families, encouraging students to take responsibility for self-care that is developmentally appropriate.