Published online November 1, 2005
PEDIATRICS Vol. 116 No. 5 November 2005, pp. 1134-1140 (doi:10.1542/peds.2004-1475)
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Administration of Epinephrine for Life-Threatening Allergic Reactions in School Settings

C. Lynne McIntyre, RN, PhD*, Anne H. Sheetz, RN, MPH{dagger}, Constance R. Carroll, RN, MPH§ and Michael C. Young, MD||

* Division of Applied Statistics, Evaluation, and Technical Services
{dagger} School Health Unit, Division of Primary Care and Health Access
§ Division of Perinatal, Early Childhood and Special Health Needs, Massachusetts Department of Public Health, Boston, Massachusetts
|| Department of Pediatrics, Harvard Medical School, and Department of Medicine, Children’s Hospital Boston, Boston, Massachusetts

Objective. Although the potential for life-threatening allergic reactions in children is a significant health concern for schools, there is little information about the circumstances surrounding anaphylactic events that occur in schools. The objectives of this study were to determine the incidence of anaphylaxis in schools, describe the circumstances around anaphylactic events, assess practices that are used to manage students with life-threatening allergies, and identify opportunities for improvement.

Methods. A total of 109 school districts in Massachusetts completed an Epinephrine Administration Form whenever epinephrine was administered at school. Data were collected from September 2001 to August 2003.

Results. Forty-eight school districts reported a total of 115 administrations of epinephrine during the 2-year reporting period. In 24% of the cases, the individual was not known to have a life-threatening allergy. Almost one third (31%) of the students who received epinephrine had allergies to multiple substances, and one quarter (25%) had an allergy to peanuts or tree nuts only. Twenty-two (19%) cases occurred outside the school building on the playground, traveling to and from school, or on field trips. The administration of epinephrine most often occurred in the health office by a registered nurse. The average time from onset of symptoms to administration of epinephrine was 10 minutes. In 92% of the cases, the student was transported to a medical facility via the emergency medical system.

Conclusions. Anaphylactic reactions in schools, although not frequent, are not uncommon events. A systematic review of anaphylactic events that required epinephrine administration identified opportunities for improvement in the treatment of students with life-threatening allergies.

Key Words: allergy • public health • school

Abbreviations: MDPH, Massachusetts Department of Public Health • ESHS, Essential School Health Services • EMS, Emergency Medical System • LTA, life-threatening allergy

Accepted Feb 4, 2005.


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