001537 - Effectiveness of a Provincial Policy to Improve Epinephrine Use for Anaphylaxis in Schools in Alberta, Canada: A Pre-Post Study

Protection of Students with Life-Threatening Allergies Act, enacted in 2020, obligates every school board across Alberta, Canada to hold a common use stock of at least one epinephrine autoinjector (EAI) and to maintain a protocol for the prevention and management of anaphylaxis. The effectiveness of this policy remains unclear. Herein, we aimed to evaluate whether pre-hospital EAI use increased following the implementation of the Act.

As part of the Cross-Canada Anaphylaxis (C-CARE), which includes a site in Edmonton, Alberta. Pediatric cases of anaphylaxis, defined as the involvement of ≥2 systems and/or hypotension, that occurred at school and presented to the Stollery Children’s Hospital’s Emergency Department in Edmonton, Alberta from 2016-2023 were retrospectively identified. Data were collected on demographics, comorbidities, symptomatology, pre- and intra-hospital management, and outcome of anaphylaxis by standardized chart review. Multivariable logistic regression was used to assess pre-hospital anaphylaxis management before versus after the enactment of the Act on January 1, 2020. Adjusted for age at reaction, previously known food allergy, sex, known asthma and reported as adjusted odds ratios (aOR) and 95 percent confidence intervals (95%CI). Pediatric cases of anaphylaxis from Ontario and Quebec were combined and compared to examine if pre-hospital EAI use changed in provinces where this policy was not enacted. This study was approved by the McGill University Research Ethics Board.

Of the 52 cases of anaphylaxis in school identified over the study period, 46.2% occurred post-Act. The median age was 13.4 (interquartile range=9.5-15.7) and 59.6% were female. There was no difference in pre-hospital antihistamine use pre versus post Act (aOR=0.99, 95%CI=0.29-3.38). However, there was greater post- act use of pre-hospital EAI in schools versus pre-act (62.5% versus 35.7%, aOR=3.31, 95%CI=1.01-10.8). There was no difference in pre-hospital EAI use pre versus post Act in the provinces of Ontario and Quebec (aOR=1.14, 95%CI=0.72-1.80). No reactions resulted in hospital admittance.

Implementation of the Act was associated with an increase in pre-hospital EAI use in cases of pediatric anaphylaxis occurring at school. These preliminary results support the effectiveness of policy interventions for anaphylaxis management.