Epinephrine Use in Austin Independent School District (AISD) Schools After Implementation of Unassigned Epinephrine
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Kathryn Neupert, MD, Sheeba Kunnel, MD, Sally Freeman, Stephen Pont, MD, Pooja Varshney, MD
RATIONALE: Due to the increasing prevalence of food allergy and awareness of the importance of epinephrine in treating allergic reactions, legislation has been passed allowing schools to stock unassigned epinephrine. The study of epinephrine use in the school setting provides an opportunity to inform future policy decisions.

METHODS: Retrospective chart review of nursing records for assigned and unassigned epinephrine administrations (EA) in a large urban school district for the 2015-2016 and 2016-2017 school years.

RESULTS: Thirty-one EA were recorded in AISD elementary, middle, and high schools. Unassigned epinephrine accounted for 68% of epinephrine use. Twenty-two percent of EA occurred in persons with no history of allergy. Fifty-eight percent of EA occurred in students with known allergy who did not have assigned epinephrine. Sixty-eight percent of EA was in students aged 12-19. Adolescents also represented the largest group with a history of allergy but no assigned epinephrine. Food was the trigger for nearly 50% of reactions requiring epinephrine.

CONCLUSIONS: In the first two years of a stock epinephrine program, unassigned epinephrine was used more frequently than assigned epinephrine. Unassigned epinephrine was utilized in students with no history of allergy and those with a history of allergy but without assigned epinephrine. Adolescents, a group known to be at high-risk for fatal food anaphylaxis, comprised the largest group without assigned epinephrine despite a known allergy. This data highlights areas for improvement in the management of patients with food allergy and the importance of having unassigned epinephrine available in schools.