A Collaborative Initiative to Improve Anaphylaxis Management in Utah Schools

Food allergies are a significant public health concern in the United States. Fatality from food-induced anaphylaxis is associated with delayed administration of epinephrine. Utah children were at increased risk for school-related anaphylaxis due to a lack of school nurses, adequately trained staff, and a standardized approach to food allergy emergency management. In collaboration with the Utah School Nurses Association, the Utah Food Allergy Network, and the Utah Department of Health & Human Services, among other contributors, we aimed to accomplish the following goals: (1) develop and implement a web-based curriculum to train school staff to recognize and respond to anaphylaxis in school settings; (2) educate school officials on existing legal protections for layperson first responders; and (3) facilitate acquisition of unassigned epinephrine for use in schools through existing charitable pharmaceutical programs. From 2012 to 2023, our training program was completed 5759 times by individuals representing 421 Utah schools. The course was most frequently completed by teachers (n = 3006, 52.2%), office staff (n = 1480, 25.7%), and principals (n = 276, 4.8%). Since 2015, we have maintained an average year-to-year retention rate of greater than 68%. We observed a 245% increase in the number of schools with unassigned epinephrine. Due to this intervention, many Utah schools now prepare employees to administer epinephrine in the case of anaphylactic emergencies. Although school nurses play a significant role, their coverage is inadequate to meet the needs of all students at risk for anaphylaxis. Training volunteers to recognize and respond to anaphylaxis in school settings is needed to reduce delays in treatment and improve outcomes.