Emergency epinephrine use for food allergy reactions in Chicago Public Schools.

BACKGROUND: Given the increase in childhood food allergy, national and local policies have been developed to encourage schools to stock undesignated epinephrine auto-injectors in case of an anaphylactic emergency. PURPOSE: To describe the use of epinephrine auto-injectors in Chicago Public Schools during the 2012-2013 school year, specifically for food-induced allergic reactions. METHODS: District-issued epinephrine auto-injectors were distributed to all public and charter schools in Chicago prior to the start of the 2012-2013 school year. Data on their use were collected, and frequencies were computed in the autumn of 2013. RESULTS: Thirty-eight district-issued epinephrine auto-injectors were administered during the inaugural year of the Chicago Public Schools initiative. Epinephrine auto-injectors were administered to students (92.1%) and school staff (7.9%). Most district-issued epinephrine auto-injectors were administered in elementary schools (63.2%) and on Chicago's North-Northwest Side (36.8%). More than half (55.0%) of all district-issued epinephrine auto-injectors were administered for first-time anaphylactic events. Food-induced reactions accounted for more than half (55.3%) of all reactions requiring epinephrine auto-injector use, whereas the trigger of more than one third (34.2%) of all reactions requiring the use of an epinephrine auto-injector remained unknown. CONCLUSIONS: Chicago Public Schools is the first large, urban school district in the U.S. to develop and implement the District-Issued Emergency Epinephrine Initiative, which helped 38 students and staff avoid potential morbidity and mortality. The impact of this initiative during its first year underscores the need for stocking undesignated epinephrine in schools across the country.

Asthma and food allergy management in Chicago Public Schools.

OBJECTIVES: This study aimed to characterize asthma and food allergy reporting and management in Chicago Public Schools. METHODS: Demographic and health data for students who have asthma and food allergy were extracted from the Chicago Public Schools database. Demographic and geographic variability and the existence of school health management plans were analyzed, and multiple logistic regression models were computed. Home addresses were geocoded to create maps of case counts per community area. RESULTS: Approximately 18,000 asthmatic and 4000 food allergic students were identified. Of asthmatic students, 9.3% had a food allergy; of food allergic students, 40.1% had asthma. Asthma odds were significantly higher among black and Hispanic students (odds ratio [OR] = 2.3 and 1.3, respectively), whereas food allergy odds were significantly higher among black students (OR = 1.1; 95% confidence interval [CI], 1.0-1.3) and significantly lower among Hispanic students (OR = 0.8; 95% CI, 0.7-0.9). Only 24.3% of students who had asthma and 50.9% of students who had food allergy had a school health management plan on file. Odds of having a school health management plan were significantly higher among students with both conditions, but the likelihood of having a plan on file was significantly lower among racial/ethnic minority and low-income students, regardless of medical condition. CONCLUSIONS: Only 1 in 4 students who have asthma and half of food allergic students have health management plans in schools, with lower numbers among minority and low-income students. Improving chronic disease reporting and access to school health management plans is critical.

The development and implementation of the Chicago public schools emergency EpiPen® policy.

BACKGROUND: Food allergy affects 1 in 13 children, or 2 children per classroom. Food allergies are the leading cause of anaphylaxis, a severe allergic reaction that can result in death. In fact, 25% of first-time anaphylactic reactions among children occur in school. To address this, the Chicago Public Schools (CPS) Office of Student Health and Wellness amended the Administration of Medication Policy in 2012. METHODS: The CPS Administration of Medication Policy was reviewed and analyzed. RESULTS: The policy allows all CPS district schools to be stocked with EpiPens and authorizes school nurses to administer them to students that the nurse in good faith professionally believes is having a first-time anaphylactic reaction. Although the policy has proven effective, CPS faces challenges during implementation. CPS school nurse coverage is low, and therefore, there are times when no nurse is onsite to administer EpiPen treatment to a student experiencing a first-time reaction. CONCLUSIONS: This landmark policy provides quick and easy access to lifesaving treatment and protects nurses from liability in the event of an anaphylactic emergency. A challenge to this policy's utilization includes the lack of funding for daily nurse coverage in each school.