The Effect of Income on Anaphylaxis Preparation and Management Plans in Toronto Primary Schools

Abstract

Outcomes of serious allergic reactions are worse at school than at home. Prompt administration of epinephrine is the first-line treatment for anaphylactic reactions, and the EpiPen device is not subsidized by Ontario public health insurance. This study examines the relationship between the proportion of low-income households in Toronto neighbourhoods and the adequacy of anaphylaxis management plans in primary schools. A survey was administered to principals of primary schools. It addressed the areas of: prevalence of food allergy, the presence of EpiPen at school and staff training in its use, and exposure prevention policy. The results were correlated to 2001 Canadian Census data for percentage of low-income households in each school's area. Children with reported severe food allergy attending schools in areas with greater than 20% low-income households were less likely to have medication at school than those in neighbourhoods with less than 20% (relative risk 2.2, 95% confidence interval 1.1-4.4). Other aspects of the anaphylaxis action plan, including staff EpiPen training and parental provision of information to the school, showed no significant correlation to income. Overall, about 50% of schools have their entire teaching staff trained to administer the EpiPen. The lack of medication at school for anaphylaxis is a limiting factor in optimal anaphylaxis management in the school setting. Government support in the purchase of EpiPen in low-income households may be indicated.