Availability of the epinephrine autoinjector at school in children with peanut allergy

Background Peanut allergy accounts for most severe food-related allergic reactions, and accidental exposures are frequent. Delayed administration of epinephrine and the allergic individual's failure to personally carry epinephrine contribute to fatal outcomes. Objectives To describe epinephrine autoinjector availability at school and to determine factors that might affect autoinjector availability in children allergic to peanut. Methods Two hundred seventy-one children with peanut allergy living in Quebec were queried about their autoinjector. Logistic regression models were used to select factors associated with device availability. Results Four of 271 children diagnosed as having peanut allergy were not prescribed autoinjectors. Forty-eight percent of the children did not carry the autoinjector with them at school. In 78.0% of those, the autoinjector was located in the nurse's or another school office, which was staffed by a full-time nurse only in 18.5%. Of all the respondents, those administered epinephrine for a previous reaction (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.3–5.7), older children (OR, 1.1; 95% CI, 1.0–1.2), and those living only with their mother (OR, 3.4; 95% CI, 1.0–11.0) were more likely to carry the autoinjector with them at school. Of children 7 years or older, those who experienced a severe reaction were more likely to carry their autoinjector (OR, 3.3; 95% CI, 1.4–8.1). Conclusions Almost 50% of children allergic to peanut might experience a delay in anaphylaxis treatment due to limited access to their device. More education is required regarding the importance of a readily available autoinjector.