Epinephrine Auto-Injectors for Anaphylaxis Treatment in the School Setting: A Discussion Paper

Impact of School Nurses on Children with Food Allergies: A Comprehensive Review

BACKGROUND

Food allergies (FAs) are a significant public health concern, affecting 6-8% of children worldwide, with a growing prevalence. Schools are high-risk environments for allergic reactions, including anaphylaxis, which can be life-threatening. Alarmingly, up to 16-18% of children with FAs experience allergic reactions at school, often due to accidental exposure. Additionally, up to 25% of anaphylactic reactions in schools occur in children with no prior diagnosis of FA, emphasizing the critical need for school-wide preparedness and robust emergency action plans. School nurses play a pivotal role in managing FAs through individualized health plans, emergency preparedness, staff training, and psychosocial support. This review aims to evaluate the multifaceted role of school nurses in ensuring the safety, health, and psychosocial well-being of children with FAs. It also seeks to identify systemic challenges and gaps in allergy management to inform targeted interventions and future research.

METHODS

This comprehensive review synthesizes evidence on the role of school nurses in FA management. A systematic literature search was conducted across PubMed, CINAHL, Scopus, and Cochrane, targeting studies published between 2014 and 2024. The search identified 6313 articles, of which 5490 remained after duplicate removal. After title and abstract screening, 60 articles were selected for full-text evaluation, with 59 included in the final review. Thematic analysis identified six domains: preventive measures, emergency preparedness, communication, health outcomes, psychosocial support, and systemic challenges.

RESULTS

The review highlights the critical contributions of school nurses to FA management. They improve safety by implementing Individualized Health Plans (IHPs) and Emergency Action Plans (EAPs), ensuring timely administration of epinephrine and reducing delays during emergencies. Preventive strategies, such as allergen-free zones and comprehensive training for staff, minimize exposure risks. Psychosocial interventions led by nurses alleviate stigma, bullying, and anxiety, enhancing the quality of life for children with FAs. Despite these benefits, barriers persist, including insufficient nurse-to-student ratios, limited access to emergency resources like stock epinephrine, and disparities in allergy management across socioeconomic and geographic contexts.

CONCLUSIONS

School nurses are integral to managing FAs, ensuring safety, fostering inclusion, and addressing psychosocial needs. Addressing systemic barriers and ensuring equitable resource distribution are essential to optimize their impact. Future research should focus on the long-term outcomes of nurse-led interventions, strategies to reduce disparities, and the potential role of digital tools in improving allergy management.

Investigating awareness and implementation of adrenaline auto-injectors (AAI) via the 'Spare Pens in Schools' scheme in Wales: a cross-sectional pilot study

OBJECTIVE

To investigate awareness and implementation of the Spare Pens (ie, adrenaline auto-injectors (AAIs)) scheme in primary and secondary schools in two regions in Wales.

DESIGN

A cross-sectional pilot study employing a mixed research methods approach was carried out.

SETTING AND PARTICIPANTS

State primary and secondary schools within Swansea and Pembrokeshire regional authorities were invited to take part. For geographical context, Swansea is the second largest city in Wales and is situated in the southwest of the country. Pembrokeshire is located in West Wales, with a large rural population outside of its main towns.

MAIN OUTCOME MEASURES

Awareness and implementation of the Spare Pens in Schools scheme. Additionally, compliance with national guidance was measured by administering a questionnaire capturing data on registers, procedures, storage and training in the use of AAIs.

RESULTS

35 schools (30 primary, 5 secondary) participated, with 11% and 6% reporting awareness and implementation of the scheme, respectively. No significant differences in awareness or implementation of the scheme were revealed for school type or region. Secondary schools reportedly stored more AAI devices compared with primary schools. The location of stored AAIs varied by school type, with 46.7% of primary schools storing AAIs in the classroom while 80% of secondary schools stored AAIs in the school office. Procedures for accessing AAI training differed, with 83% of primary schools receiving training by school nurses and 60% of secondary schools accessing training via an allergy team.

CONCLUSIONS

The overall poor awareness of the Spare Pens in Schools scheme has resulted in a worrying lack of implementation of generic AAI devices. An urgent review of information dissemination regarding the scheme is required.

A National Review of State Laws for Stock Epinephrine in Schools

BACKGROUND

Anaphylaxis is a life-threatening allergic reaction with significant risk for children with allergies. Access to potentially life-saving medication is critical for these children. This review aims to describe state laws and policies guiding stock epinephrine in schools for allergic or anaphylactic events and detail recommendations for best practices.

METHODS

This paper is a comprehensive review of the 50 states and the District of Columbia's (DC) laws and policies for stock epinephrine at schools for children in pre-kindergarten through 12th grade.

RESULTS

All 50 states and DC allow undesignated epinephrine in schools to use for allergic or anaphylactic reactions. A key difference arises in whether states allow (N = 37) or mandate (N = 14) that schools stock epinephrine. States exhibit differences in the body responsible for developing stock epinephrine policy (N = 48), along with stakeholders responsible for developing procedures (N = 30) and implementing them (N = 19). Differences also exist in state epinephrine procurement, administration, training, and liability.

CONCLUSIONS

This review of stock epinephrine laws and policies highlights the significant variation in state legislation despite widespread adoption. Only one-quarter of states mandate that schools have stock epinephrine available for emergency use, underscoring need for a more unified approach with consistent guidelines, comprehensive training, and possible funding for implementation.

Protocols for Managing Food Allergies in Elementary and Secondary Schools

The prevalence of food allergies is on the rise; nearly 8% of children worldwide are affected. The most common allergens-milk, eggs, peanuts, tree nuts, shellfish, fish, and wheat-account for 90% of serious allergic reactions. A literature review of online databases in CINAHL, PubMed Central, Education Resources Information Center (ERIC), Google Scholar, Health Resource Center Academic, and archival searching was performed to identify evidenced-based practices for managing food allergies in schools. There is no cure for food allergies. The current management standard is to avoid the allergen, treat a mild reaction with antihistamine and observation, and treat anaphylaxis with an intramuscular injection of epinephrine. Due to COVID-19 social distancing recommendations, food consumption in schools has moved from cafeterias and lunchrooms into classrooms and other spaces. This in turn necessitates strict adherence to hand washing and disinfecting all surfaces that come in contact with food. Managing food allergies in schools requires cooperation among school administrators, nurses, teachers, staff, families, and health care providers. Resources for managing food allergies in schools are presented offering information for parents, school administrators, nurses, teachers, and staff for planning and implementing strategies for preventing and reducing allergic reactions and treating life-threatening food allergy reactions.