Current trends in food allergy-induced anaphylaxis management at school

Greenhawt, M.; Wallace, D.; Sublet, W.; Maughan, E.; Tanner, A.; Kelly, K.; Fineman, S.; White, M.; Cash, G.; Anderson, C.; Schoessler, S.; Gupta, R.; Pistiner, M.

Ann Allergy Asthma Immunol. 2018 Apr 24

Abstract

OBJECTIVE: To review the evidence and current policies regarding the use of epinephrine at schools and child care centers Data Sources and Study Selection: A narrative review was performed based on the result of conference proceedings of a group of inter-professional stakeholders who attended the USAnaphylaxis Summit 2017 presented by Allergy & Asthma Network. RESULTS: Anaphylaxis is a well-recognized medical emergency requiring 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 a rise in the number of children with food allergy 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 a growing 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 supporting successful implementation of stock epinephrine programs. CONCLUSIONS: 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.

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