Conference Coverage

Unassigned school epinephrine used more than assigned injectors


Key clinical point: Unassigned epinephrine was used more often in a Texas school district than assigned epinephrine.

Major finding: Over 2 years, 31 epinephrine injections were administered, and in 68% of the cases, it was the unassigned stock that was used.

Study details: A review of nursing records for the Austin Independent School District.

Disclosures: Dr. Kathryn Neupert had no relevant financial disclosures.

Source: Neupert K et al. Abstract 465.



At schools in a Texas district, unassigned epinephrine injectors were used more often than assigned ones were, according to results of an analysis.

In the 2015-2016 and 2016-2017 school years, epinephrine was administered to students 31 times at schools in the Austin Independent School District, which began to stock unassigned epinephrine in its schools after state legislators approved a law in 2015 allowing, but not requiring, school districts to do so. In 21 of those cases, or 68% of the time, it was the unassigned stockpile that was used, Kathryn Neupert, MD, said at the joint congress of the American Academy of Allergy, Asthma, and Immunology and the World Asthma Organization.

Dr. Kathryn Neupert, a resident at the University of Texas, Austin Thomas R. Collins/Frontline Medical News

Dr. Kathryn Neupert

Dr. Neupert and her associates said the findings underscore the public health value of stocking unassigned epinephrine in schools. According to the Food Allergy Research and Education organization, all states but Hawaii had laws at least allowing unassigned epinephrine injectors to be stocked in schools as of 2016, with 12 states requiring it.

She drew attention to the finding that 22% of the time in the study, the epinephrine use involved the unassigned stock for children with no history of anaphylaxis or allergy.

“It kind of argues that, for those people that we don’t know have anaphylaxis to anything, it’s definitely important to have it available to them,” reported Dr. Neupert, a resident at the University of Texas, Austin.

In 45% of the cases, epinephrine was administered to children who had a known history of allergic reactions but, for whatever reason, did not have an epinephrine injector assigned to them.

Food was the most common trigger for use of epinephrine, accounting for 48% of the injections, with fragrance at 16%, insect stings at 10%, and exercise and overheating at 7%.

Dr. Neupert and her associates said the frequency with which epinephrine was administered after exposure to a fragrance – seen in about the same amount for unassigned and assigned epinephrine – might signal a need for greater education.

Carla Davis, MD, a pediatrician at Baylor College of Medicine, Houston, said she hopes more school districts adopt the stock epinephrine policy, despite barriers of cost and education. “I do think that it’s important for these schools to have these, because 20% of children will have their first episode of food allergic reaction – and in some of those cases it will be anaphylaxis – in schools.”

Dr. Neupert had no relevant financial disclosures.

SOURCE: AAAAI/WAO Joint Congress Abstract 465.

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