White MV, Silvia S, Hollis K, Wooddell M, Hogue S. Differences in anaphylaxis-related risks by school grade level: findings from the EpiPen4Schools® survey. Poster presented at the 2015 ASCIA Conference; September 2015. Adelaide, Australia. [abstract] Intern Med J. 2015 Sep 3; 45(Suppl 4):3. doi: 10.1111/imj.12869.

BACKGROUND: In 2012, the EPIPEN4SCHOOLS® program (Mylan Specialty L.P., Canonsburg, PA) began providing EpiPen® Auto-Injectors to qualifying US schools, inclusive of all grade levels from pre-kindergarten through 12th grade.

METHOD: A web-based, exploratory, cross-sectional pilot survey was distributed to schools participating in the EpiPen4Schools program during the 2013–2014 school year; results were summarized using descriptive statistics.

RESULTS: Of the 724 anaphylactic events experienced by students with known grade level, the highest proportion was experienced by students in high school (49%, 355/724), followed by those in elementary school (32%, 234/724) and middle school (19%, 135/724). Students in high school were also most likely to experience an anaphylactic event with an unknown trigger (22%, 79/354) compared with those in middle school (15%, 20/133) and elementary school (14%, 33/234). High schools were least likely to permit most or all staff to treat anaphylactic events with an epinephrine auto-injector (EAI) (31%, 310/989) compared with middle schools (37%, 234/639) and elementary schools (38%, 759/1980). Frequency of EAI use varied considerably by grade level; the lowest frequency of EAI treatment occurred in students in pre-kindergarten (58%, 21/36), and the highest frequency occurred in students in 10th grade (88%, 100/113). Of the treatments administered in lieu of EAIs, antihistamines were most common; use of antihistamines instead of EAIs was higher among elementary school students (29%, 69/234) than middle school students (23.0%, 31/135) and high school students (12.1%, 43/355).

CONCLUSION: Results demonstrate that the nature of anaphylaxis-associated risks varies by grade level. Marked differences were observed across school grade levels in the frequency of anaphylactic events with an unknown trigger, proportion of staff permitted to treat life-threatening reactions, and management of anaphylactic events using EAIs. Together, these data highlight a need for consistent preparedness training for both students and school staff across all grade levels.

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