Barriers and Facilitators to Timely Epinephrine Administration for Anaphylaxis in Schools: A Systematic Review

Saturday, 29 July 2017

Emily Christensen, BA1
Susi Miller, MLIS2
Victoria von Sadovszky, PhD1
(1)Department of Nursing Research, Nationwide Children's Hospital, Columbus, OH, USA
(2)Grant Morrow III, MD Library at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, OH, USA


Anaphylaxis affects 2% of the United States population and the incidence is increasing the US, UK, and Australia (Koplin, Marcin, & Allen, 2011; Lieberman et al, 2006). Rates of anaphylaxis are highest in children between the ages of 0 and 19 years, with between 10%-18% cases of all pediatric anaphylaxis occurring in schools (Song, Worm, & Lieberman, 2014). In children not previously diagnosed with anaphylaxis, 24% of first time anaphylaxis occurred at school (Dinakar, 2012). In 32 cases of fatal anaphylaxis in the school setting, 28% of those were due do a delay in the administration of epinephrine (Sicherer &Mahr, 2010). At present there is some research examining issues with availability and use of epinephrine in the United States population (Song, 2014) and no research examining systems that expedite administration. The purpose of this systematic review is to examine the scientific literature for research on epinephrine administration in the American school system.


Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, 2015), two reviewers performed independent literature searches in PubMed, CINAHL, Psychinfo, OVID and ERIC. The Keywords searched were “anaphylaxis”, “school” and “epinephrine” with additional searches on “barriers” and “facilitators”. Limits for the search included: 1) peer-reviewed publications, systematic reviews and meta-analyses; 2) published within the past 10 years; 3) pediatric population. Seventy-eight abstracts were selected and two researchers are evaluating the associated articles for inclusion in the systematic review and agreement on abstracts will provide interrater reliability. Articles will then be reviewed by the study authors. Articles will be analyzed for epidemiology, demographics, and epinephrine use in schools.


 This review is currently in progress and we anticipate the findings to be completed by March2017.


Anaphylaxis is a severe and unpredictable life-threatening allergic reaction that is fairly common in developed nations (Koplin, 2011; Lieberman, 2006). Anaphylaxis frequently occurs in the school setting, however there is scant research regarding facilitators and barriers of rapid epinephrine administration. A systematic review is needed to direct future research as well as current practice regarding epinephrine administration at school.