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Ann Allergy Asthma Immunol. 2018 Aug;121(2):174-178. doi: 10.1016/j.anai.2018.04.015. Epub 2018 Apr 21.

Current trends in food allergy-induced anaphylaxis management at school.

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Children's Hospital Colorado, University of Colorado School of Medicine, Section of Allergy and Immunology, Aurora, Colorado. Electronic address:
Nova Southeastern University School of Medicine, Fort Lauderdale, Florida.
Family Allergy and Asthma, Louisville, Kentucky.
National Association of School Nurses, Silver Spring, Maryland.
Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
Institute for Asthma and Allergy, Wheaton, Maryland.
College of Psychology, Nova Southeastern University, Davie, Florida.
Allergy & Asthma Network, Tysons Corner, Virginia.
Ann & Robert H. Lurie Children's Hospital of Chicago, Institute for Public Health and Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois.
Section of Pediatric Allergy and Immunology, MassGeneral Hospital for Children, Harvard University School of Medicine, Boston, Massachusetts.



To review the evidence and current policies regarding the use of epinephrine at schools and child care centers DATA SOURCES AND STUDY SELECTIONS: A narrative review was performed based on the result of conference proceedings of a group of interprofessional stakeholders who attended the USAnaphylaxis Summit 2017 presented by Allergy & Asthma Network.


Anaphylaxis is a well-recognized medical emergency that requires prompt treatment with intramuscular epinephrine. Anaphylaxis can be associated with poor quality of life. There is renewed recent focus on anaphylaxis management in schools. This interest has been spurred by an increase in the number of children with food allergy who are attending school, data that support up to 25% of first-time anaphylactic events occurring on school grounds, and a well-publicized fatality that helped to initiate a movement for stock, undesignated, non-student-specific epinephrine. Stock epinephrine is now available in 49 states, with an increasing number of states instituting mandatory reporting for use of such devices. Nursing efforts are paramount to support and implement stock epinephrine programs. Many states do not have clarity on delegation of authority for who can administer stock epinephrine, and there is evidence of variability in storage of stock devices. Few states have outcomes data that support successful implementation of stock epinephrine programs.


Additional data are needed to demonstrate successful implementations of stock epinephrine programs and their outcomes. Such programs should include support for school nursing and clearer delineation of authority for medication administration as well as standards for where and how devices are stored.

[Indexed for MEDLINE]

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