Anaphylaxis on the rise, but Adrenaline autoinjector usage in schools remains stable

Published Online: April 14, 2016

In 2008 the Victorian Government was one of the first in the world to legislate anaphylaxis management plans in schools through the Anaphylaxis Management Act. This law required schools to implement an anaphylaxis management policy, which includes actively collecting information on how many enrolled students are at risk of anaphylaxis and development of individualised anaphylaxis management plans for students.

A study by Paxton and colleagues published in The Journal of Allergy and Clinical Immunology (JACI) reported that the prevalence of children at risk of anaphylaxis has increased 41 percent over a six year period in schools across Victoria, Australia. The study analysed Statewide surveys from over 1500 government schools including more than 550,000 students. Students at risk of anaphylaxis were defined as those who had been prescribed an adrenaline auto-injector (AAI) by their health practitioner and had an Allergy Anaphylaxis Management Plan.

The study found that the prevalence of students at risk of anaphylaxis increased from 0.98 per cent in 2009 to 1.38 per cent in 2014. Despite the increase in anaphylaxis risk among the state’s students, researchers reported the number of children using an AAI in the school environment remained stable. The number of AAI’s activated per 1000 students at risk of anaphylaxis ranged from six to eight per year. Secondary school students were far more likely to activate an AAI compared to primary school students.  The study also found that as children transitioned from primary school to secondary school, there was a significant drop in those reporting anaphylaxis risk suggesting a change in parental reporting of anaphylaxis risk among secondary school students. This finding was of concern as it suggests that vigilance around food allergy may be decreasing at this critical age around adolescence.

The stable rates of AAI use for students despite rising rates of anaphylaxis risk may reflect the fact that Victorian schools have adopted strict risk minimisation strategies that have limited accidental exposure and reactions to allergens, or that there is a failure to use such devices when required, or both. Further research into understanding drivers for adrenaline autoinjector prescriptions and usage, particularly in the peri-adolescent period, would be valuable.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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