Stock Epinephrine Research Articles

How to Stock Epinephrine in Schools: Creation of a National Toolkit

How to Stock Epinephrine in Schools: Creation of a National Toolkit

The Implementation and Evaluation of a Stock Epinephrine for Schools Program in Maricopa County, Arizona.

The increasing rate of food allergies in children, combined with the role of food as an integral part of the school day has led to the emergence of anaphylaxis as a daily threat to students, regardless of prior allergy diagnosis. Stock epinephrine-non-patient specific epinephrine auto-injectors that may be used during emergencies-is a means for schools to prepare for anaphylactic events and protect children with allergies. The Maricopa County Department of Public Health initiated the School Surveillance and Medication Program (SSMP), a data capture program, to facilitate the process of stocking epinephrine in schools. Spearheaded by the implementation efforts of the Kyah Rayne Foundation, program enrollment increased 146% between the 2020-2021 and 2021-2022 school years. The increased proportion of schools enrolled in the SSMP and the number of school personnel trained to administer epinephrine demonstrates the feasibility of school-centered stock epinephrine programs and validates strategies for increasing program uptake.

Stock Epinephrine Laws Pertaining to Early Childcare Centers are Heterogenous Across the United States

Young children in early childcare centers (ECCs) are uniquely vulnerable to anaphylaxis and other effects of food allergy. Despite epinephrine being widely available in the US and it being the treatment for anaphylaxis, not all ECCs have the needed legislative protections to have stock epinephrine. We sought to examine the state of legislation pertaining to stock epinephrine in ECCs.

The Need for Required Stock Epinephrine in All Schools: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee

Epinephrine is the first line of treatment for anaphylaxis which can occur outside a medical setting in community environments like schools. Patients with diagnosed IgE-mediated food allergy at risk of anaphylaxis are prescribed self-injectable epinephrine and given an individualized anaphylaxis action plan. As students, such patients/families provide their school with completed medication forms, a copy of their anaphylaxis plan, and additional student-specific epinephrine. However, students approved to self-carry prescribed self-injectable epinephrine may forget to do so or have other reasons for lacking prescribed epinephrine such as familial inability to fill the prescription due to cost or other access barriers. Undiagnosed students lacking prescribed epinephrine may also experience anaphylaxis at school. The presence of non-student specific school stock epinephrine allows school nurses and other staff the ability to treat anaphylaxis on-site while awaiting emergency medical services. Notably, not all states legally mandate K-12 schools to stock epinephrine. In states with laws only voluntarily allowing schools to stock epinephrine, it provides the ability to opt-out. Herein, we present a comprehensive review of barriers to school stock epinephrine, related improvement strategies, and workgroup recommendations supporting the need for mandated stock epinephrine in all schools in every state. Proposed solutions include ensuring legal immunity from liability for prescribers; advocacy for legislation to stabilize cost of self-injectable epinephrine; educational initiatives to schools promoting merits and safety of epinephrine and related anaphylaxis training; and partnerships between patient advocacy groups, medical and nursing organizations, public health departments and other health professionals to promote laws and district policies addressing need for stock epinephrine and school nurses to train and supervise school staff.

THE LEARN EARLY PROJECT: LEARNING EDUCATORS ANAPHYLAXIS RESPONSE NEEDS

<h3>Introduction</h3> With the Incidence of food allergies on the rise, and more studies demonstrating the disproportionate impact on Black and Hispanic children, it is crucial that allergists investigate and begin to address these disparities. A significant gap in this area is the role that daycares and preschools may play in helping to prevent anaphylaxis and death. <h3>Method</h3> The LEARN Early Project partnered with 17 Head-Start centers to investigate barriers they face in managing food allergies. Individual needs assessments were performed as well as food allergy knowledge tests. The results of these were then discussed in focus groups to identify potential areas for improvement as well as solutions. <h3>Results</h3> Significant variability exists in the structure of each Head Start center which presents implementation dilemmas. Additionally, there is no standardization of epinephrine training or food allergy training. In general, educators tended to over-estimate their food allergy knowledge as well as their capability of managing food allergy emergencies in comparison to that of center directors. Finally, despite some legislation appearing to support policies surrounding food allergy, such as stock epinephrine, early childcare centers are sometimes considered exceptions to these policies. <h3>Conclusion</h3> Identifying barriers that early learning centers face in providing for children with food allergies is critical in ensuring equitable, and safe care. These barriers are likely distinct for each center, but general themes were identified. It is likely that these needs will continue to evolve, and it is important to continue to reassess these needs to ensure we are implementing appropriate solutions.

Implementation of Stock Epinephrine in Chartered Versus Unchartered Public-School Districts.

ABSTRACTBACKGROUNDAccess to unassigned epinephrine is critical for schools to treat anaphylaxis. Low socioeconomic status is associated with decreased access to epinephrine in the school setting. In and around New Orleans, physicians partner with schools to assist with stocking unassigned epinephrine autoinjectors (EAIs). New Orleans' decentralized public charter school district makes widespread adoption challenging.METHODSPhysicians partnered with New Orleans decentralized public charter schools, as well as neighboring centralized public school districts, to perform training on recognizing and treating anaphylaxis, assist with the adoption of school policy for stock epinephrine, and aid with obtaining stock EIAs free‐of‐cost through the EpiPen4Schools® program. We used publicly available school enrollment data and our own calendar records to calculate how many children we covered with stock epinephrine per hour of physician or administrator time.RESULTSFor centralized school districts, we cover approximately 4000 children with stock epinephrine per hour of time. For the decentralized district of New Orleans, we estimate covering only 400 children with stock epinephrine per hour of time.CONCLUSIONDecentralized school districts reduce educational disparities, but require more time and energy to get EAIs in place than centralized school districts do.

Food Allergic Reactions In U.S. Schools

Allergic reactions to food occur in schools, with some reactions leading to hospitalization. However, schools are not required to stock epinephrine auto-injectors or have protocols for when an allergic reaction occurs. Though there is CDC guidance on how to manage children with food allergies in schools, allergic reactions to foods continue to occur.

The Economic Burden of Food Allergy: What We Know and What We Need to Learn.

Purpose of ReviewFood allergy management and treatment require dietary modification, are associated with significant burdens, and affect food choices and behaviours. Emerging therapies, such as oral immunotherapy (OIT), provide a glimmer of hope for those living with the condition. Some burdens have received substantial focus, whereas many knowledge gaps on the significance of other impacts, including economic burden, remain.Recent FindingsEvidence from many countries, but disproportionately from the United States, supports that food allergy carries significant healthcare and societal costs. Early introduction for the prevention of food allergies is theoretically cost-effective, but remains largely undescribed. Unique considerations, such as those to cow’s milk protein allergy, which affects a substantial proportion of infants, and adrenaline autoinjectors, which have a high cost-per-use, require a balance between cost-effectiveness to the healthcare system and adverse outcomes. Household costs have largely been explored in two countries, but owing to different healthcare structures and costs of living, comparisons are difficult, as are generalisations to other countries. Stock epinephrine in schools may present a cost-effective strategy, particularly in economically disadvantaged areas. Costs relating to OIT must be examined within both immediate benefits, such as protection from anaphylaxis, and long-term benefits, such as sustained unresponsiveness.SummaryAlthough the absolute costs differ by region/country and type of food allergy, a consistent pattern persists: food allergy is a costly condition, to those who live with it, and the multiple stakeholders with which they interact.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40521-022-00306-5.

A National Review of State Laws for Stock Epinephrine in Schools.

Anaphylaxis is a life-threatening allergic reaction with significant risk for children with allergies. Access to potentially life-saving medication is critical for these children. This review aims to describe state laws and policies guiding stock epinephrine in schools for allergic or anaphylactic events and detail recommendations for best practices. This paper is a comprehensive review of the 50 states and the District of Columbia's (DC) laws and policies for stock epinephrine at schools for children in pre-kindergarten through 12th grade. All 50 states and DC allow undesignated epinephrine in schools to use for allergic or anaphylactic reactions. A key difference arises in whether states allow (N=37) or mandate (N=14) that schools stock epinephrine. States exhibit differences in the body responsible for developing stock epinephrine policy (N=48), along with stakeholders responsible for developing procedures (N=30) and implementing them (N=19). Differences also exist in state epinephrine procurement, administration, training, and liability. This review of stock epinephrine laws and policies highlights the significant variation in state legislation despite widespread adoption. Only one-quarter of states mandate that schools have stock epinephrine available for emergency use, underscoring need for a more unified approach with consistent guidelines, comprehensive training, and possible funding for implementation.

The Role of Pediatric Health-care Providers in Promoting Students' Asthma Health.

The Role of Pediatric Health-care Providers in Promoting Students' Asthma Health.

Community Use of Epinephrine for the Treatment of Anaphylaxis: A Review and Meta-Analysis

Community use of epinephrine for the treatment of anaphylaxis is low. Knowledge of rates of epinephrine use in the pre-hospital setting along with identification of barriers to its use will contribute to the development of policies and guidelines. A search was conducted on PubMed and Embase in April 2020. Our systematic review focused on 4 domains: (1) epinephrine use in the pre-hospital setting; (2) barriers to epinephrine use in the pre-hospital setting; (3) cost evaluation and cost-effectiveness of epinephrine use; and (4) programs and strategies to improve epinephrine use during anaphylaxis. Two meta-analyses with logit transformation were conducted to: (1) calculate the pooled estimate of the rate of epinephrine use in the pre-hospital setting among cases of anaphylaxis and (2) calculate the pooled estimate of the rate of biphasic reactions among all cases of anaphylaxis. Epinephrine use in the pre-hospital setting was significantly higher for children compared with adults (20.98% [95% confidence interval (CI): 16.38%, 26.46%] vs 7.17% [95% CI: 2.71%, 17.63%], respectively, P= .0027). The pooled estimate of biphasic reactions among all anaphylaxis cases was 3.92% (95% CI: 2.88%, 5.32%). Our main findings indicate that pre-hospital use of epinephrine in anaphylaxis remains suboptimal. Major barriers to the use of epinephrine were identified as low prescription rates of epinephrine autoinjectors and lack of stock epinephrine in schools, which was determined to be cost-effective. Finally, in reviewing programs and strategies, numerous studies have engineered effective methods to promote adequate and timely use of epinephrine. The main findings of our study demonstrated that across the globe, prompt epinephrine use in cases of anaphylaxis remains suboptimal. For practical recommendations, we would suggest considering stock epinephrine in schools and food courts to increase the use of epinephrine in the community. We recommend use of pamphlets in public areas (ie, malls, food courts, etc.) to assist in recognizing anaphylaxis and after that with prompt epinephrine administration, to avoid the rare risk of fatality in anaphylaxis cases.

Food allergy: how expensive are they?

Food allergy remains a disease of global public health significance well known to impact social, emotional, and financial well being. This review aims to summarize the existing literature focused on the direct, indirect, and intangible costs of food allergy at the household and healthcare system levels, and begin to discuss how emerging treatment and prevention strategies may be leveraged to comprehensively care for the food allergic population with the efficient use of health resources. Food allergy imposes significant costs to multiple stakeholders and largely impact families at the household level. Recent studies elucidate the need to balance the household management of food allergy with the efficient use of health resources. Overall, it remains critical that safe foods and medications remain affordable while further exploring the cost-effectiveness of early introduction, emerging food allergy therapies, and the wider use of stock epinephrine to adequately meet the public health needs of the food-allergic community. Better understanding how the cost of food allergy impacts populations will help to inform more progressive policies aimed at lessening socioeconomic disparities and ultimately improve quality of life for children and adults with food allergies.

Improving Access To Stock Epinephrine In A De-Centralized School District: The New Orleans Experience

Improving Access To Stock Epinephrine In A De-Centralized School District: The New Orleans Experience

Analysis of Value-Based Costs of Undesignated School Stock Epinephrine Policies for Peanut Anaphylaxis

To determine if laws that allow undesignated school stock epinephrine autoinjectors are cost-effective by defining value and cost of different school strategies.Markov simulations of the Chicago Public Schools system were used over extended time horizons to model 2 school stock epinephrine autoinjector policies that provide access for students at risk for anaphylaxis at school. The dates of the data used in the analysis were September 2017 to June 2018 (the 2017–2018 school year).Researchers in this study compared the following 3 strategies: (1) no school epinephrine supply, in which the only devices available are personal autoinjectors provided by students with an allergic condition; (2) school undesignated supplemental epinephrine supply, in addition to student-supplied devices (supplemental model); and (3) school undesignated universal epinephrine supply, in which school-based devices supplant the need for student-supplied devices (universal model). Computer-based mathematical microsimulations (Markov simulations) were used to evaluate hypothetical cohorts of children with peanut allergy from kindergarten through high school graduation, with a continued horizon to age 80 years. The base-case model assumed a 10-fold reduced fatality risk with having undesignated stock epinephrine units available versus not having undesignated stock epinephrine units available. Costs of school stock epinephrine units available for acquisition by schools were evaluated from a societal perspective. Quality-adjusted life-years (QALYs) and total epinephrine acquisition expenses were calculated. These models were used because they can account for the annual costs and recurrent risks of peanut exposure and reactions.The cost was $107 816 (95% confidence interval [CI]: $107 382–$108 250) for no school undesignated epinephrine supply compared with $108 160 (95% CI: $107 725–$108 595) for the supplemental model and $100 397 (95% CI: $99 979–$100 815) for the universal model. When comparing supplemental model stock epinephrine to the strategy without undesignated devices, the incremental cost-effectiveness ratio was high at $268 811 per QALY in the base-case simulation. However, the cost of the supplemental model fell to <$100 000 per QALY when the annual undesignated epinephrine acquisition costs did not exceed $338 per school (compared with stock epinephrine unavailability). The universal model dominated all others and was associated with significant cost savings ($7419 per student at risk who would otherwise be prescribed an individual school epinephrine supply).Undesignated school stock epinephrine is cost-effective if device acquisition costs do not exceed $338 per school per year, and a universal model versus a supplemental model is associated with superior health and economic outcomes.Legislation to either permit or mandate school-based stock epinephrine programs has emerged to provide timely access to epinephrine for children, given that up to 8% of US children have food allergies and as many as 25% of first-time anaphylactic reactions occur in school. Currently, schools either have no designated stock epinephrine or supplemental epinephrine, where students are still asked to provide their own epinephrine autoinjectors. The authors argue that a universal model, in which all schools have stock epinephrine and do not require at-risk students to also provide autoinjectors, would achieve the desired health outcomes and is more cost-effective. This may reduce the cost burden on families and decrease the risk of further supply interruptions and shortages from pharmaceutical companies. However, although the universal model is cost-saving, there are important practical advantages to having students also carry their own designated individual epinephrine units because they would be available in close proximity daily, in transit to and from school (eg, on the school bus), on school field trips, and for after-school activities.

The stock epinephrine law: Five years later and counting

The stock epinephrine law: Five years later and counting

Stock epinephrine in schools: A survey of implementation, use, and barriers

Stock epinephrine in schools: A survey of implementation, use, and barriers

Cost-Effectiveness of Stock Epinephrine Autoinjectors on Commercial Aircraft

In-flight food-allergic reactions are rare events, but given increasing reports, grass-root advocates have lobbied to replace aircraft emergency kit epinephrine ampules with autoinjectors. To evaluate the cost-effectiveness of stock epinephrine on commercial aircraft. We conducted a Markov model with microsimulation of food-allergic individuals over an 80-year time horizon to evaluate the cost-effectiveness of supplementing airline medical kits with epinephrine autoinjectors (eg, providing autoinjector twin-packs in addition to the epinephrine ampule in the medical kit), versus not doing so, using a per-plane annual value-based cost ceiling of $338 (the value-based ceiling for school stock epinephrine). We assumed that autoinjector availability reduced fatality risk by 10%. Equipping all commercial aircraft with autoinjectors cost $2,470,422/year ($0.08/passenger-at-risk), from a societal perspective and when distributed over all at-risk travelers. Over the model horizon, the supplemental autoinjector strategy cost $32,329.29 (standard deviation [SD], $4024.32) versus $32,326.70 (SD $4024.29), produced 26.8917 quality-adjusted life-years (QALYs) (SD, 2.9720) versus 26.8915 (SD, 2.9725), with a lower fatality rate (0.00012; SD, 0.01095 vs 0.00015; SD, 0.1225) versus the ampule-only strategy. The incremental cost-effectiveness ratio of supplemental airline epinephrine autoinjectors was $10,766/QALY in the base-case analysis. The supplemental model remained cost-effective at a willingness to pay threshold of $100,000/QALY if it produced a minimum 1.4% annual food allergy fatality risk reduction, and dominated if it lowered diversion risk or event-related medical care costs-per-event by 10%, respectively. Under base-case scenarios, an airline supplemental stock epinephrine model is cost-effective, with a high value-based cost-ceiling and low annual cost per passenger-at-risk of $0.08.

School Personnel Apprehension Related To Stock Epinephrine In Greater Houston Area

School Personnel Apprehension Related To Stock Epinephrine In Greater Houston Area

Undesignated stock epinephrine in schools cost effective

Undesignated stock epinephrine in schools cost effective

Analysis of Value-Based Costs of Undesignated School Stock Epinephrine Policies for Peanut Anaphylaxis

Children experiencing anaphylaxis at school may lack access to a personal epinephrine device, prompting recent legislation permitting undesignated (eg, non-student specific) stock epinephrine autoinjector units at school. However, epinephrine device costs vary, and the cost-effectiveness of undesignated school stock epinephrine is uncharacterized to date. To define value-based strategies for undesignated school stock epinephrine programs. Markov simulations of the Chicago Public Schools system were used over extended time horizons to model 2 school stock epinephrine autoinjector policies to provide access for at-risk students. The dates of the data used in the analysis were September 2017 to June 2018 (the 2017-2018 school year). This study compared the following 3 strategies: no school undesignated epinephrine supply, school undesignated supplemental epinephrine supply (supplemental model), and school undesignated universal epinephrine supply (universal model). The base-case model assumed a 10-fold reduced fatality risk with having undesignated stock epinephrine units available vs not having undesignated stock epinephrine units available. Costs of school stock epinephrine units available for acquisition by schools were evaluated from a societal perspective. Quality-adjusted life-years (QALYs) and total epinephrine acquisition expenses were calculated. Based on Markov simulations of the Chicago Public Schools system (371 382 students), the cost was $107 816 (95% CI, $107 382-$108 250) for no school undesignated epinephrine supply compared with $108 160 (95% CI, $107 725-$108 595) for the supplemental model and $100 397 (95% CI, $99 979-$100 815) for the universal model. Undesignated stock epinephrine improved outcomes, with 26.869 (95% CI, 26.841-26.897) QALYs accrued as the model concluded compared with 26.867 (95% CI, 26.839-26.896) QALYs for the strategy without undesignated stock epinephrine. When comparing supplemental model stock epinephrine to the strategy without undesignated devices, the incremental cost-effectiveness ratio was high at $268 811 per QALY in the base-case simulation. However, the cost of the supplemental model fell below $100 000 per QALY when the annual undesignated epinephrine acquisition costs did not exceed $338 per school (compared with stock epinephrine unavailability). The universal model dominated all others and was associated with significant cost savings ($7419 per student at risk who would otherwise be prescribed an individual school epinephrine supply). Undesignated school stock epinephrine is cost-effective at device acquisition costs not exceeding $338 per school per year, although a universal model vs a supplemental model is associated with superior health and economic outcomes.