Risk of Anaphylaxis Risk In Schools – A Systematic Review
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Derek K Chu, MD, PhD, Heather Cruickshank, Jan Brozek, MD, PhD, Susan Waserman, MD MSc FAAAAI
RATIONALE: Anaphylaxis is a rapid-onset systematic allergic reaction that may cause death. We sought to systematically evaluate the risk of anaphylaxis in schools.

METHODS: Following established guidelines, we completed a comprehensive search of multiple databases. Eligibility criteria included any observational study reporting on the incidence of anaphylaxis, allergic reaction, or epinephrine use in schools.

RESULTS: Incidence of anaphylaxis in schools was estimated to be 23 per 100,000 person-years (mandatory registry). Incidence of anaphylaxis in preschools was estimated to be 2 per 1000 children (survey of parents). 11% of schools report at least 1 anaphylactic reaction per year. Between 1% and 20% of all anaphylactic reactions in children happen in school. Of all studies that investigated mortality from anaphylaxis, there were 12 cases of fatal reactions. The incidence of epinephrine use in schools ranges from 6 to 22 per 100,000 person-years. Epinephrine has been given to persons without known food allergy in 15–27%. Assuming the highest incidence rate of 22 per 100,000 person-years and that 27% would be individuals without known allergy, then the incidence rate in those individuals would be 6 per 100,000 person-years. Assuming an average 350 students per school it would mean that epinephrine would be used in a person without known allergy once per 48 schools per year.

CONCLUSIONS: The risk of anaphylaxis in schools is primarily informed by surveys. Data are sparse on the risk of fatal anaphylaxis in schools, or outcomes after epinephrine administration to patients with and without a history of food allergy.