News Release

Study highlights need for epinephrine in schools -- and staff trained to administer it

Study abstract being presented at American Academy of Pediatrics 2017 National Conference & Exhibition finds epinephrine often administered by nonmedical staff, and sometimes to students with no known allergy

Peer-Reviewed Publication

American Academy of Pediatrics

CHICAGO -With school nurses often covering multiple buildings, nearly one in five students who experience severe allergic reactions are given potentially life-saving epinephrine injections from unlicensed staff or students.

The study abstract, "National School Nurse Survey of Epinephrine Use in Schools," will be presented on Sunday, Sept. 17, at the American Academy of Pediatrics 2017 National Conference & Exhibition in Chicago.

For the study, more than 1,200 school nurses completed an electronic survey about the use of epinephrine in schools as emergency treatment for anaphylaxis, a severe allergic reaction, during the 2014-15. Nearly one-quarter (23.9 percent) of participants reported epinephrine being administered in their school during the past year.

In total, out of the 482 administrations of epinephrine reported, 16.2 percent were by unlicensed staff or students. In addition, researchers said, 33.6 percent of administrations were to students who did not have an allergy known to the school. The survey also found that 10.8 percent of students having a severe allergic reaction required more than one dose of epinephrine before emergency medical responders arrived.

"The findings highlight the importance of having a supply of epinephrine available in schools, and people trained to administer it during an allergy emergency," said Michael Pistiner, MD, MMSc, FAAP, and author of the abstract and Director of Food Allergy Advocacy, Education and Prevention at MassGeneral Hospital for Children (MGHfC) in Boston.

Prior research suggests as many as one in five children with food allergy have had an allergic reaction at school or child care, Pistiner said. Considering that more than one-third (34 percent) of the nurses responding to the survey said they staff more than one building, Pistiner said, his research team wasn't surprised that epinephrine shots frequently were being administered by nonmedical staff.

"Despite the potential severity of food allergy reactions, there are many schools where the nurse may not be onsite at all times," said Julie Wang, MD, FAAP, a co-author of the abstract and an associate professor of pediatrics and allergy and immunology at Icahn School of Medicine at Mount Sinai. "Training other school workers may be beneficial," she said, "and it would extend the school nurses' ability to manage students with food allergies in schools."


Dr. Pistiner will present the abstract, available below, between 1:30 p.m. and 3:30 p.m. in McCormick Place West room S103 D.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.

The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit

Abstract Title: National School Nurse Survey of Epinephrine Use in Schools

Background: Food allergy prevalence is estimated to be approximate 8% in children and rising. Prior studies have shown that 16-18% of children have had an allergic reaction at school or daycare. Since allergic reactions and anaphylaxis occur at school, schools must have systems in place for the recognition and prompt treatment of anaphylaxis. Close to 25% of epinephrine administrations in MA schools have been to individuals whose allergies were unknown to the schools. New regulations addressing epinephrine in school are now widespread throughout the U.S.: Objective: To conduct a national survey of school nurses to help further our understanding of current practices in schools concerning epinephrine practices and the management of anaphylaxis. Methods: An anonymous electronic survey was distributed via the email list serve for the National Association of State School Nurse Consultants. The State School Nurse Consultants had the option to share with school nurses in the states that they represent. Results: 1486 responders started the survey, 1,285 (86%) completed all survey questions. The majority represented 9 states (>20 participants from each), but other states were also represented. 41.4 % reported having ever administered epinephrine. For the 2015-2016 (2014-2015) school year 15% (24%) of participants reported that at least one dose of epinephrine was administered in their school(s) by anyone, themselves included. 2.7% (4.3%) reported that epinephrine was administered by unlicensed staff. Epinephrine was administered by a licensed school nurse to someone without a known prior allergy in 4.8% (8%); unlicensed staff administered epinephrine to someone without a known history in 0.98 % (1.6%). 1.7% (2.9%) reported >1 dose of epinephrine was needed for a single event of anaphylaxis before EMS arrival. Conclusion: Epinephrine use in schools is significant, and is being given by both licensed and unlicensed school staff for individuals with known and unknown histories of allergies. Although epinephrine use by unlicensed staff is less frequent than by licensed school nurses, these results support the importance of staff training.

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