EpiPen adoption in U.S. schools soars after passage of federal law


Before passage of this legislation, only four states mandated access to epinephrine in schools. Now nearly every state has passed such a law.

Ned MilenkovichIn late 2013, President Barack Obama signed legislation aimed at increasing the nationwide availability of epinephrine in schools. Before passage of this legislation, only four states required schools to stock this medication. Epinephrine helps prevent adverse reactions and even death in children with severe allergies.

The School Access to Emergency Epinephrine Act is structured as an incentive rather than as a mandate; however, states that require schools to maintain a supply of the medication and permit trained school personnel to administer it will receive preference for federal asthma-treatment grants.

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Since the passage of the federal law, nearly every state has passed legislation to address the stocking of non-patient-specific epinephrine. Although proposed legislative bills and laws can differ by state, the intent is to make epinephrine available to individuals during a time of medical emergency. In some cases, only a school nurse can administer the epinephrine to a student with no known history of food allergy. In other instances, multiple designees may administer the medication in an emergency. 

The passage of these laws is helpful and provides for quick access to epinephrine, which is critical in treatment of individuals experiencing life-threatening allergic reactions. According to the “Guidelines for the Diagnosis and Management of Food Allergy in the United States,” delayed administration of epinephrine has been implicated as contributing to fatalities.

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However, the availability is not the only piece of the puzzle. Safe and proper administration is crucial for positive outcomes.

A study performed by the Institute of Asthma & Allergy (IAA) in Wheaton, Md., underscored the need for continued education in proper administration in schools.

Dr. Martha V. White, the director of research at the IAA, presented the study’s findings at the national conference of the American Academy of Pediatrics. The research showed that more than 50% of participating schools allowed only the school nurse or nursing staff to administer the epinephrine, and less than 30% of the schools reported that other staffers were trained in epinephrine administration or recognition of the signs of anaphylactic shock.


During anaphylaxis, allergic symptoms can affect several areas of the body and may threaten breathing and blood circulation. Food allergy is the most common cause of anaphylaxis, although several other allergens - including insect stings, medications, or latex - are potential triggers. Epinephrine works by reversing the most severe symptoms of anaphylaxis.

Currently, every state has pending or passed legislation allowing or mandating epinephrine to be made available in schools. This is critical, in light of the fact that more than six million children in the United States alone suffer from food allergies. In addition to protecting those children whose epinephrine isn’t immediately accessible during a reaction, this legislation will help save the lives of those who experience an anaphylactic reaction and don’t have a prescription for epinephrine available.


Other venues

In addition, 17 states have passed legislation that permits, but does not require, various public venues to stock undesignated epinephrine for emergency use. These entities may include day camps, youth recreation programs, theme parks, daycare centers, restaurants, sports arenas, and college campuses.

A few states have passed laws specific to colleges and/or universities that permit post-secondary education institutions to stock undesignated epinephrine. These laws may outline specific requirements for training personnel, as well as how to obtain, maintain, store, and administer the epinephrine. In some cases, they even stipulate against any civil liability in cases of emergency intervention.

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