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 1.0) 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.