INTRODUCTION: The EPIPEN4SCHOOLS® program was launched in 2012 to provide EpiPen® Auto-Injectors free of charge to qualifying public and private kindergarten, elementary, middle, and high schools in the United States.
METHODS: This exploratory, cross-sectional, web-based survey examined the characteristics and treatment of anaphylactic events in US schools participating in the EpiPen4Schools program.
RESULTS: A total of 919 anaphylactic events were reported by 11% of schools that responded to questions on the occurrence of anaphylaxis (607/5683). Most anaphylactic events occurred in students (89%, 757/852), and 22% (187/852) occurred in individuals with no known allergies. Triggers were reported for 92% of anaphylactic events (847/919). The most common triggers were food (62%, 529/847) and insect stings (10%, 81/847); however, triggers could not be identified in 20% of events (172/847). Epinephrine auto-injectors (EAIs) were used in 75% of events with data on treatment administration (636/851). Most of the remaining events were treated with antihistamines (18%, 157/851). Of the events treated with EAIs, the school's stock EpiPen Auto-Injector or the individual's personal EpiPen Auto-Injector was used to treat 49% (310/636) and 45% of events (289/636), respectively; 6% of events (37/636) were treated with other types of EAIs or EAIs of unknown source.
CONCLUSIONS: In the EpiPen4Schools survey, high proportions of observed anaphylactic events had unknown triggers or were experienced by individuals with no known allergies. Nearly 25% of events were not treated with epinephrine, the first-line therapy for anaphylaxis. These data demonstrate the unpredictable nature of anaphylaxis and the importance of preparedness training in schools.
