April 12, 2022
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School-based strategies may reduce disparities in anaphylaxis caused by food allergies

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Programs that increase access to epinephrine autoinjectors to treat anaphylaxis caused by food allergies, along with training in using them, need to be expanded, according to a review published in Annals of Allergy, Asthma & Immunology.

Expanding access and training would minimize the disparities in care experienced by underrepresented groups and by those who come from a lower socioeconomic background, Ellen W. Daily Stephen, MD, a first year allergy and immunology fellow in the department of internal medicine at Rush University Medical Center in Chicago, and colleagues wrote in the review.

Obstacles to care for anaphylaxis due to food allergy include lack of access to personal epinephrine autoinjectors, inadequate education in recognizing and managing anaphylaxis, and lack of access to allergist care for diagnosis and management of food allergy.
Data were derived from Daily Stephen E, et al. Ann Allergy Asthma Immunol. 2022;doi:10.1016/j.anai.2022.03.027.

For example, 17.5% of children in private schools in New York City had been diagnosed by a physician with a food allergy, compared with 7.4% of children in public schools, the researchers said.

A lack of diagnosis makes it difficult to recognize children who experience severe food reactions, the researchers wrote. Children who have not been diagnosed also do not have food allergy action plans, nor do they carry epinephrine autoinjectors.

Through their District-Issued Emergency Epinephrine Initiative, the Chicago Public Schools have stocked their facilities with undesignated epinephrine autoinjectors. These devices were used 38 times in a 1-year span between 2012 and 2013, including 21 cases involving food reactions. Also, 55% of these injections were given to children who did not have a diagnosed allergy.

Schools need to train everyone on their staff in recognizing anaphylaxis and in using epinephrine autoinjectors as well, the researchers wrote. Only 31% of schools provide such training for all their staff, the researchers continued, and only 3% allow students and staff to administer epinephrine via autoinjector.

Laws regarding epinephrine administration vary from state to state, with individual schools and districts developing their own policies. Addressing these laws and policies would improve response to food-induced anaphylaxis, the researchers wrote.

In a call to action, the researchers spotlighted strategies that could remedy these disparities.

To address the lack of access to personal epinephrine autoinjectors, the researchers called for the provision of open access to these devices, especially in school settings. They also suggested exploring options to reduce or eliminate the cost of epinephrine autoinjectors for low-income patients.

Citing inadequate education in recognizing and managing anaphylaxis, the researchers recommended standardized education for all school staff and expanded public outreach to improve awareness of the symptoms of food-induced anaphylaxis.

Finally, because there is a lack of access to allergist care for the diagnosis and management of food allergy, the researchers said providers should collaborate with school medical staff for referral to allergy specialty care when there are concerns about food allergies. Primary care providers should receive education about food allergies as well.