Comparing school environments with and without legislation for the prevention and management of anaphylaxis

Abstract

Background School personnel in contact with students with life-threatening allergies often lack necessary supports, creating a potentially dangerous situation. Sabrina’s Law, the first legislation in the world designed to protect such children, requires all Ontario public schools to have a plan to protect children at risk. Though it has captured international attention, the differences a legislative approach makes have not been identified. Our study compared the approaches to anaphylaxis prevention and management in schools with and without legislation. Methods Legislated (Ontario) and non-legislated (Alberta, British Columbia, Newfoundland and Labrador, and Quebec) environments were compared. School board anaphylaxis policies were assessed for consistency with Canadian anaphylaxis guidelines. Parents of at-risk children and school personnel were surveyed to determine their perspectives on school practices. School personnel’s EpiPen technique was assessed. Results Consistency of school board policies with anaphylaxis guidelines was significantly better in a legislated environment (p=0.009). Parents in a legislated environment reported more comprehensive anaphylaxis emergency forms (p< 0.001), while school personnel in non-legislated environments reported more comprehensive forms (p=0.004). Despite school personnel in both environments receiving EpiPen training (>80%), suboptimal technique was commonly observed. However, school personnel in the legislated environment had better technique (p < 0.001). Conclusion Our results suggest that school boards in legislated environments have made greater efforts to support students at-risk for anaphylaxis compared to non-legislated environments. However, significant gaps exist in both environments, especially with respect to EpiPen administration, content and distribution of anaphylaxis emergency forms, and awareness of school procedures by school personnel and parents.

Emergency Epinephrine Use for Food Allergy Reactions in Chicago Public Schools

“…With the prevalence of food allergy rapidly on the rise, [14][15][16] school districts must be prepared to administer life-saving medication in an environment where contact with food is unavoidable. 6,17,18 Previous research suggests that the cause of an anaphylactic event often goes unrecognized. 13 Similarly, the trigger in more than one third of all events requiring administration of district-issued EAIs was unidentified.…”

School Board Policies on Prevention and Management of Anaphylaxis in İstanbul: Where Do We Stand?

“…These policies are based on the principles of food allergen avoidance, including the avoidance of food sharing and cross-contact, and preparedness with epinephrine. However, previous studies demonstrated that school personnel often lack the knowledge and skills necessary to recognize and treat anaphylactic reactions (12)(13)(14). Many schools did not provide their staff with education on how to prevent allergic reactions or respond to life-threatening events (4,15).…”

“…It was reported that even in legislated environments, the actual implementation of school anaphylaxis policies has been suboptimal. Meanwhile, school boards in legislated environments have made greater efforts to support students at risk of anaphylaxis compared to non-legislated ones (14). On the other hand, a survey by Wu and Hill (18) found that 53% of schools in Indianapolis had no policy for the management of anaphylaxis and the remaining 47% had a policy that consisted only of calling 911.…”

“…Likewise, Sicherer et al (4) reported that 25% of the children with a peanut allergy experienced their first attack in school. Several countries enacted legislation related to anaphylaxis in schools requiring the establishment of an anaphylaxis policy towards reducing allergen exposure, providing regular management training for school personnel, and establishing individual anaphylaxis emergency management plans (5)(6)(7)(8). This legislative approach potentiated efforts for the implementation of a safer school environment.…”

“…This legislative approach potentiated efforts for the implementation of a safer school environment. Meanwhile, there are significant gaps in the implementation of school anaphylaxis guidelines, even in those legislated states, especially with respect to the administration of epinephrine, usage of anaphylaxis emergency forms, and awareness of school procedures by school personnel (8).…”