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Investigators estimate that replacing individually prescribed school-based devices with spare adrenaline autoinjectors could improve access for students.
Less than half of schoolkids at risk of food anaphylaxis in England are prescribed adrenaline autoinjectors (AAIs), a new analysis found. The study also showed that if schools received spare AAIs, this would replace children leaving their own AAIs due to school promises and could save national AAI costs by 25%.1
Investigators, led by Paul J. Turner, from the National Heart & Lung Institute at Imperial College London in the UK, aimed to estimate the costs of supplying emergency adrenaline autoinjectors to individual students on a name-patient basis versus providing spare autoinjectors at schools for use by any student in need. The primary outcome was the proportion of school children with food allergy prescribed AAIs and the cost of providing ≥ 2 AAIs to individual students versus the cost of delivering 4 spare AAIs to every school for the academic year 2023/2024.
“The rationale for requesting pupils to keep additional AAIs in schools (in addition to the two AAIs they should keep on them) is simple: the child/family may forget to bring AAIs to school every day, or they may be out of date. However, in an emergency, school staff can waste critical minutes in trying to find and identify a pupil’s own AAIs…” wrote Helen Blythe, from Benedict Blythe Foundation, and colleagues in an accompanying commentary.2 “In addition, many children with food allergy are not prescribed AAIs, and 30% of school-based reactions happen in children without a prior diagnosis of food allergy.
This retrospective cohort study examined English primary electronic health data from the Clinical Practice Research Datalink (CRPD) and English prescriptions data from the NHS Business Services Authority.1 The study included 28,520 students aged 5 – 18 years with a food allergy diagnosis.
Among the sample, 44% of school-aged children had ≥1 AAI prescription, but only 34% received repeat prescriptions (40% of children aged 5–10 years; 28% of children aged 11–18 years; P <.0001).1 For children who have previously experienced anaphylaxis, 59% had an AAI prescription and 44% had a repeat AAI prescription.
The analysis saw that AAI prescriptions, including ≥ 2 AAIs, were more common in primary school-age children (49% of 5 – 10 years olds) compared with secondary school-age children (40%; 11 – 18 years; P <.0001). A nut allergy and a previous history of anaphylaxis were associated with greater odds of AAI prescription, whereas increasing age and greater IMD were associated with lower odds. Being treated outside of the hospital setting was associated with slightly lower odds of receiving an AAI prescription (odds ratio [OR], 0.87; P =.01) but not for repeat prescription.1
During the 2023–2024 academic year, about 63% of students had ≥ 2 AAI dispensed, with an estimated cost of > £9 million. Moreover, 60% of students received at least 4 devices.1
The estimated cost of providing spare AAIs to every school was £4.5 million. The study estimated that replacing named-patient AAIs left on school premises with spare AAIs could potentially save £4.6 million, representing a 25% reduction in total national AAI expenditure.1
The study observed a monthly spike in AAI prescriptions dispensed in September, the start of the UK academic year. In total, 13% of all AAI prescriptions were issued in September, opposed to an expected monthly average of 8.3%.1
“Children in deprived areas are more likely to attend schools without spare AAIs—and are also less likely to be prescribed AAIs,” Blythe and colleagues wrote.2 “This places the most vulnerable children at greatest risk. When allergy safety is inconsistent, safeguarding is incomplete. Allergy safety is safeguarding—and it’s time we treated it that way.”
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