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Background Anaphylaxis is a serious and growing concern in the school setting as the prevalence of food allergies and food-induced severe allergic reactions continues to increase. Methods A cross-sectional, web-based survey was conducted regarding anaphylactic events that occurred during the 2014-2015 school year. Eligible schools were enrolled in the EPIPEN4SCHOOLS® program (Mylan Specialty L.P., Canonsburg, PA), which provides free epinephrine auto-injectors to qualifying US schools. Participating schools completed a 29-item survey on anaphylactic event occurrence and treatment, epinephrine stock, school policies regarding anaphylaxis, school staff training, and school nursing coverage. Results Responses were provided by 12,275 schools. Epinephrine was administered on school property for 63.7% of reported anaphylactic events (1272/1998). In 38.5% (235/610) of events for which epinephrine was not used, antihistamines were cited as the reason. Only 59.4% of schools cited epinephrine as their standard first-line therapy for anaphylaxis. School nurses were most likely to be trained in anaphylaxis recognition and permitted to administer epinephrine; however, just 53.6% of schools had a full-time nurse on staff. Conclusions Process-related barriers to the appropriate use of epinephrine go beyond access to medication. Widespread staff training and review of school policies are needed to ensure that anaphylaxis is appropriately managed in schools.

A pilot survey described the characteristics of anaphylactic events occurring in an initial set of participating U.S. schools during the 2013-2014 school year. This survey was subsequently readministered to large school districts, which were underrepresented in initial results. A cross-sectional survey was administered to the U.S. schools that were participating in the EPIPEN4SCHOOLS® program (Mylan Specialty L.P., Canonsburg, PA) to assess characteristics of anaphylactic events. Data from large school districts were added to initial findings in this comprehensive combined analysis. A total of 1,140 anaphylactic events were reported among 6,574 responding schools. Of 1,063 anaphylactic events with data on who experienced the event, it was observed that it occurred mostly in students (89.5%, 951/1,063). For students, anaphylactic events were reported across all grades, with 44.9% (400/891) occurring in high school students, 18.9% (168/891) in middle school students, and 32.5% (290/891) in elementary school students. Food was identified as the most common trigger (60.1%, 622/1,035). A majority of schools (55.0%, 3,332/6,053) permitted only the school nurse and select staff to administer epinephrine to treat anaphylaxis. The unpredictability of anaphylaxis is emphasized by its high occurrence in individuals with no known allergies (25.0%). A majority of schools permitted only the school nurse and select staff to treat anaphylaxis. Thus, individuals experiencing an anaphylactic event may frequently encounter staff members not being permitted to administer potentially life-saving epinephrine. Epinephrine auto-injectors provided by the EPIPEN4SCHOOLS program were used to treat 38.0% of events. Anaphylaxis can occur in children with no previously known allergies, illustrating the importance of public access to epinephrine.

BACKGROUND Although epinephrine is the treatment of choice for anaphylaxis, it remains underused. OBJECTIVE This study was designed to describe anaphylactic events and epinephrine autoinjector (EAI) use in U.S. schools enrolled in the EpiPen4Schools program. METHODS This exploratory, cross-sectional, Web-based survey of 6019 schools that participated in the EpiPen4Schools program assessed anaphylactic events and EAI use at responding schools during the 2013-2014 school year. RESULTS A total of 919 anaphylactic events were reported in 607 schools. Of the 852 anaphylactic events with data on those who experienced an event, most 88.8% (n = 757) occurred in students, and 21.9% of events (n = 187) occurred in individuals with no known allergies. Of the 851 events with data on EAI use, 74.7% (n = 636) were treated with EAIs and 8.5% (n = 54) received a second epinephrine injection. Of the 204 individuals not treated with an EAI, 77.0% (n = 157) received antihistamines, 12.7% (n = 26) received another treatment, and 8.3% (n = 17) received no treatment. Of the 850 events with data on hospital transport, 79.6% of individuals (n = 677) were transported to the hospital. Common triggers varied seasonally, with food listed most frequently overall (62.5%). CONCLUSION More than one in ten schools that participated in the EpiPen4Schools survey reported an anaphylactic event. Approximately 25% of individuals with anaphylactic events were not treated with EAIs, and 20.4% of patients were not taken to the hospital after an anaphylactic event. Analysis of these data supports the value of stocking EAIs and of providing continuing education regarding the recognition and proper treatment of anaphylaxis for school personnel.

Background: Allergy guidelines recommend intramuscular injection of epinephrine as a first-line therapy to treat anaphylaxis. In the community, epinephrine can be promptly administered with an epinephrine auto-injector (EAI). In the Unites States, the EPIPEN4SCHOOLS® program (Mylan Specialty L.P., Canonsburg, PA) provides EpiPen® (epinephrine injection) Auto-Injectors to qualifying public and private schools. An initial pilot survey was used to assess characteristics of anaphylactic events occurring in a set of participating schools during the 2013-2014 school year. However, large school districts (≥50 schools per district) …

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 that participated in an initiative that provides stock epinephrine autoinjectors (EAIs) to qualifying U.S. 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. The occurrence of one 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 who experienced anaphylaxis in 21.8% of the 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 and/or management was reported for 72.6% of the individuals with anaphylactic events (1450/1997). Results from the weighted analyses were similar to those of the unweighted analyses. CONCLUSION Anaphylaxis occurred across grade levels and in individuals with or without known risk factors, which reinforced the need for school preparedness in both management of anaphylaxis and stocking of EAIs.

Susan L Hogue,1 Diana Goss,1 Kelly Hollis,1 Suyapa Silvia,2 Martha V White3 1Health Solutions, RTI International, Research Triangle Park, NC, 2Education and Workforce Development, RTI International, Research Triangle Park, NC, 3Institute for Asthma and Allergy, Wheaton, MD, USA Background: Anaphylaxis is a serious, potentially life-threatening condition. Adequate preparation for anaphylaxis management is imperative for school personnel. This descriptive pilot study assessed preparedness of US schools to manage anaphylactic reactions. Methods: An exploratory, cross-sectional, web-based, pilot survey assessed the occurrence and characteristics of anaphylactic events, as well as training provided to school personnel for the recognition and treatment of anaphylaxis. Eligible US schools were participants in the EpiPen4Schools® program during the 2013–2014 school year. EpiPen4Schools provides EpiPen® (epinephrine injection) Auto-Injectors and training materials to qualifying US schools. Survey data were parsed by US Census Bureau region and state and were evaluated using descriptive statistics. Results: Schools from all 50 states and the District of Columbia participated in the survey (N=6,019). Among schools that provided information on anaphylactic events, 11% (607/5,683) reported the occurrence of one or more events, with significant variability in incidence across census regions and among states. A total of 5,613 schools provided information regarding which staff members were trained to recognize the signs and symptoms of anaphylaxis. Thirty-six percent of schools (2,022/5,613) indicated that only the school nurse and select staff were trained in anaphylaxis recognition. The proportion of schools in which most or all school staff received such training differed by region/state (range, 13%–100%). A total of 5,578 schools provided information on which staff were permitted to administer epinephrine. The majority of schools (54%; 3,024/5,578) permitted only the school nurse and select staff to administer epinephrine, although percentages varied by region/state (range, 4%–100%). Conclusion: Schools differed substantially in their preparedness to manage anaphylaxis, with significant disparities in staff training and permission to treat. Given the ramifications of delayed treatment, removing barriers to the recognition and treatment of anaphylactic events in schools is an important public health goal. Keywords: anaphylaxis, epinephrine, epinephrine auto-injector, preparedness, school nurse, school staff training

M O N D A Y 684 EpiPen4Schools Survey: Characteristics of Anaphylaxis and Common Triggers Martha V. White, MD, FAAAAI, Diana Goss, Kelly Hollis, K. Millar, Suyapa Silvia, Peter Siegel, Mary Elizabeth Bennett, Ray A. Wolf, PharmD, Margaret Wooddell, Susan Hogue; Institute for Asthma and Allergy, RTI International, Clarity Consulting LLC, Mylan Specialty L.P., PA, Mylan Specialty. RATIONALE: The purpose of this study was to describe the characteristics of anaphylactic events and EAI use in children and adults in US schools. METHODS: This exploratory, cross-sectional, web-based survey of schools participating in the EpiPen4Schools program captured characteristics of anaphylactic events and EAI use during the 2013-2014 school year. RESULTS: A total of 5683 schools responded to questions on the occurrence of anaphylactic events. A total of 919 anaphylactic events were reported by 11%of schools (607/5683).Most schools (89%, n55076) reported no anaphylactic events, and 10% (n5543) reported 1 to 2 anaphylactic events. Most anaphylactic events occurred in students, 89% (n5757), 22% (n5187) of which occurred in those with no known allergies. In 9% (n575), allergy status was unknown. Of the 919 events, triggers were reported for 847 events (92%); most triggers, 62% (n5529), were listed as food, 10% (n581) were listed as insect stings, 7% (n556) as environmental/medication/health-related factors, and 1% (n59) as latex. Approximately 20% of events (n5172) had an unknown trigger. Although food allergy triggers were predominant throughout the year, prevalence of certain triggers varied seasonally. Insect stingswere relatively less frequent during winter, 4% (n55/143), vs fall, 13% (n531/243), and spring, 10% (n526/268) months, whereas unknown triggers reached a high of nearly 27% (n571/268) during spring. CONCLUSIONS: More than 1 in 10 schools reported an anaphylactic event in a single school year, many of whichwere associated with unknown triggers. These data indicate the unpredictable nature of anaphylaxis and the importance of anaphylaxis training for staff.