Russell Anne F, Bingemann Theresa A, Cooke Abigail Tarr, Ponda Punita, Pistiner Michael, Jean Tiffany, Nanda Anil, Jobrack Jennifer, Hoyt Alice E W, Young Michael C
School of Nursing and Health Sciences, Spring Arbor University, Spring Arbor, Mich; Food Allergy and Anaphylaxis Michigan Association, Ann Arbor, Mich.
Divisions of Allergy, Immunology and Rheumatology and Pediatric Allergy and Immunology, University of Rochester, Rochester, NY.
J Allergy Clin Immunol Pract. 2023 Apr;11(4):1068-1082.e1. doi: 10.1016/j.jaip.2022.12.047. Epub 2023 Jan 28.
Epinephrine is the first line of treatment for anaphylaxis that can occur outside a medical setting in community environments such as 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 onsite 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.
肾上腺素是治疗过敏性反应的一线药物，过敏性反应可能发生在学校等社区环境的医疗场所之外。被诊断为有过敏性反应风险的IgE介导的食物过敏患者会被开出自用注射型肾上腺素，并得到一份个性化的过敏性反应行动计划。作为学生，这些患者/家庭会向学校提供填好的用药表格、过敏性反应计划副本以及额外的学生专用肾上腺素。然而，被批准自行携带处方自用注射型肾上腺素的学生可能会忘记这样做，或者由于其他原因而没有处方肾上腺素，比如家庭因费用或其他获取障碍而无法配药。未被诊断但缺乏处方肾上腺素的学生在学校也可能发生过敏性反应。学校备有非学生专用的肾上腺素库存，使学校护士和其他工作人员能够在等待紧急医疗服务时在现场治疗过敏性反应。值得注意的是，并非所有州都在法律上强制要求K-12学校储备肾上腺素。在那些仅自愿允许学校储备肾上腺素的州，学校有选择不储备的权利。在此，我们全面综述了学校储备肾上腺素的障碍、相关的改进策略以及工作组的建议，这些建议支持在每个州的所有学校强制储备肾上腺素的必要性。提出的解决方案包括确保开处方者免于法律责任；倡导立法稳定自用注射型肾上腺素的成本；针对学校开展教育活动，宣传肾上腺素的优点和安全性以及相关的过敏性反应培训；以及患者倡导组织、医学和护理组织、公共卫生部门及其他卫生专业人员之间建立伙伴关系，以推动制定解决储备肾上腺素需求的法律和地区政策，并让学校护士培训和监督学校工作人员。
