Niti Y. Chokshi|Dipika Patel|Carla M. Davis
Long-term increase in epinephrine availability associated with school nurse training in food allergy
Texas Children's Hospital|Baylor College of Medicine|Texas Children's Hospital|Baylor College of Medicine|Texas Children's Hospital|Baylor College of Medicine
clinical implicationsa single food allergy education session targeting school nurses increased availability epinephrine children food allergies effect sustained 2 years study details feasible model increase nationwide school availability lifesaving treatment single food allergy education session targeting school nurses increased availability epinephrine children food allergies effect sustained 2 years study details feasible model increase nationwide school availability lifesaving treatment food allergy serious disease affects 5 us children1boyce ja assaad burks aw jones sm sampson ha wood ra et alguidelines diagnosis management food allergy united states summary niaidsponsored expert panel reportj diet assoc 2011 111 1727abstract full text full text pdf pubmed scopus 26 google scholar approximately 18 23 children food allergies experience reactions school setting accounts 28 anaphylaxis fatalities2sicherer sh mahr american academy pediatrics section allergy immunology management food allergy school settingpediatrics 2010 126 12321239crossref pubmed scopus 101 google scholar 3versluis knulst ac kruizinga ag michelsen houben gf baumert jl et alfrequency severity causes unexpected allergic reactions food systematic literature reviewclin exp allergy 2014 httpsdoiorg101111cea12328crossref pubmed scopus 72 google scholar one critical risk factor death anaphylaxis delay epinephrine administration4simons kj simons fe epinephrine use anaphylaxis current issuescurr opin allergy clin immunol 2010 10 354361crossref pubmed scopus 155 google scholar readily accessible injectable epinephrine devices integral safety children food allergies5shah ss parker cl smith eo davis cm disparity availability injectable epinephrine large diverse us school districtj allergy clin immunol 2014 2 288293abstract full text full text pdf scopus 29 google scholar addition lower socioeconomic schools shown fewer injectable epinephrine devices nonlow socioeconomic schools5shah ss parker cl smith eo davis cm disparity availability injectable epinephrine large diverse us school districtj allergy clin immunol 2014 2 288293abstract full text full text pdf scopus 29 google scholar recently president obama signed law school access emergency epinephrine act provides incentives states require schools stock epinephrine6gregory n president obama signs school access emergency epinephrine act food allergy research education november 13 2013 available httpwwwfoodallergyorg accessed january 16 2014google scholar training school personnel essential component epinephrine device placement schools texas studentspecific epinephrine allowed every child food allergy must onsite prescribed epinephrine receive anaphylaxis treatment hypothesized single didactic session targeting houston independent school district nurses would increase identification children food allergies decrease allergic reactions increase availability studentspecific injectable epinephrine devices low nonlow socioeconomic schools evaluation number children food allergies allergic reactions injectable epinephrine devices 2 years 2011 didactic session school nurses performed education addressed allergic reaction symptoms treatment case studies handson injectable epinephrine device practice table number children food allergies injectable epinephrine devices obtained 2 control school districts school socioeconomic status based national school lunch program low socioeconomic schools defined 70 student participation national school lunch program nonlow socioeconomic schools 70 participation wilcoxon signed ranked test utilized compare number children food allergies allergic reactions injectable epinephrine devicestable ischool education workshop contentsessionscomponents1 didactic lecture entitled food allergy 101recognition management food allergyeducation parents children2 group discussion handouts including food allergyassess type reaction mild vs life threateningassess suitability response benadryl vs epinephrine3 practice sessiondetermination benadryl dose 1 teaspoon10 kgepinephrine trainer groups 234 didactic lecture entitled school management food allergiesschool avoidance strategiescomponents school policy management students lifethreatening allergies5 development individualized school policy open table new tab sixtytwo nurses representing approximately 61000 students per year responded surveys 39 responding study years 2010 2013 2010 2012 84 schools low socioeconomic schools although significantly injectable epinephrine devices per school nonlow low socioeconomic schools pre posteducation experienced statistically significant increase injectable epinephrine devices posteducation table ii significant increase seen total number responding schools compared table iia schools measured years analyzed table iib statistically significant difference amount increase injectable epinephrine devices based socioeconomic status p 07table iinumber schools epinephrine devices student number 2010 2012number schoolsmean epinephrine devices per schoolsdp value effect sesp value effect timemean number students food allergysda total number responding schools 2010001nonlow ses12583341171592low ses76092110618725 2012001nonlow ses217576190278919652low ses1161681940001192247b schools data 2010 2012 2010001nonlow ses1061371761751low ses51104122625785 2012001nonlow ses1089630278107665low ses512220000128631sd standard deviation ses socioeconomic schools open table new tab sd standard deviation ses socioeconomic schools notably 2010 2012 allergic reactions decreased 15 children food allergies reacting 2010 0 2012 p 014 number studentspecific injectable epinephrine devices increased p 001 effect sustained 2013 without continued education 2010 2012 correlation injectable epinephrine devices children food allergies increased figure 1 2012 2013 intervention district posteducation ratio epinephrine device child food allergy 077 compared control district 0185 addition smaller texas control school district demonstrated significant increase ratio epinephrine device child food allergy 008 01 2010 2013 targeted nursing education significantly affected school preparedness allergic reactions food increased number studentspecific injectable epinephrine devices per child food allergy decreased allergic reactions one educational session eliminated allergic reactions food 2012 hypothesize one mechanisms improvement reviewing school food avoidance techniques education effective methods prevent accidental exposures school setting prevention effective strategy protecting children food allergies drastic reduction allergic reactions food argues importance school education regarding food allergies nursing staff reported educational intervention facilitated identification symptoms associated allergic reactions food particularly clarifying difference asthma exacerbations allergic reactions food example wheezing postexposure food allergens often treated asthma medications rather epinephrine indicated anaphylaxis previous studies shown school personnel poor understanding anaphylaxis signs symptoms use injectable epinephrine devices7muraro agache clark sheikh roberts g akdis ca et aleaaci food allergy anaphylaxis guidelines managing patients food allergy communityallergy 2014 69 10461057crossref pubmed scopus 108 google scholar prompt recognition symptoms food allergy imperative early administration lifesaving epinephrine per nursing staff educational session increased awareness need subsequent availability physiciancomposed food allergy action plans suggest mechanism increase epinephrine availability food allergy action plans document patients food allergies well treatments indicated specific symptoms recommended children food allergies2sicherer sh mahr american academy pediatrics section allergy immunology management food allergy school settingpediatrics 2010 126 12321239crossref pubmed scopus 101 google scholar action plans intervention schools emphasize importance epinephrine administration reactions may one mechanism injectable epinephrine devices increased schools two control school districts texas without food allergy educational intervention showed number epinephrine devices number children food allergies ratios similar houston independent school district preeducation thus increased community awareness alone could account increase number epinephrine devices posteducation houston school district evaluate whether educational session could effective setting limited resources compared low nonlow socioeconomic schools patients lower socioeconomic status experience many factors limit access medical care including lower health literacy8national center education statisticsthe health literacy americas adults results 2003 national assessment adult literacy us department education washington dc2006google scholar poorer understanding signs symptoms food allergy despite factors single school nurse educational intervention equally effective low nonlow socioeconomic schools longer term studies needed assess intervention effectively bridge gap number epinephrine devices low nonlow socioeconomic schools single educational session made dramatic sustainable impact availability lifesaving epinephrine large urban school district although school access emergency epinephrine act increase availability nonassigned injectable epinephrine devices education food allergy indications epinephrine device use increased availability assigned epinephrine devices still needed single intervention provides model feasible nationwide school food allergy education plan enhance safety children food allergies sincerely thank danielle guffey ms charles minard phd dan l duncan institute clinical translational research baylor college medicine help statistical analysis