Epinephrine in schools

Approximately 1 in 13 children are affected by food allergies1— and children at risk for anaphylaxis may be present in almost every classroom.1,2 An estimated 13% to 23% of children with food allergies experience reactions at school.3

As a school nurse, you know that readily accessible epinephrine auto-injectors are integral to the emergency treatment of children with food allergies.4 Epinephrine is the only first-line therapy for anaphylaxis, according to The National Institute of Allergy and Infectious Diseases guidelines.5 But not all children at risk for anaphylaxis have received an epinephrine prescription or always carry their auto-injectors with them.6,7

That’s where the EpiPen4Schools® program can help. EpiPen4Schools® is offered by Viatris Inc., the marketer and distributor of EpiPen® (epinephrine injection, USP) and EpiPen Jr® (epinephrine injection, USP) Auto-Injectors, to help improve access to epinephrine in the school setting.

How EpiPen4Schools® works

The EpiPen4Schools® program provides up to four free EpiPen® (epinephrine injection, USP) or EpiPen Jr® (epinephrine injection, USP) Auto-Injectors in the form of two EpiPen 2-Pak® cartons, two EpiPen Jr 2-Pak® cartons or one 2-Pak of each kind along with EpiPen® Trainers and a detailed training video, to qualifying public and private kindergarten, elementary, middle and high schools in the US. Schools may receive the authorized generic versions of EpiPen and EpiPen Jr.

To participate in EpiPen4Schools®, a school nurse or other authorized school representative must visit www.EpiPen4Schools.com to download the order and certification form, and then fax or email the form with a valid prescription to 1-973-718-4328 or info@bioridgepharma.com. Alternatively, school representatives can call 1-973-845-7600 to speak with a live representative. There is no requirement for a school to purchase additional EpiPen® Auto-Injectors or any other Viatris Inc. product.

Patient Training Video

How to Use EpiPen® (epinephrine injection, USP) Auto-Injector
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Anaphylaxis action plans

Consider keeping an anaphylaxis action plan on file for students with potentially life-threatening allergies.

American Academy of Allergy, Asthma & Immunology (AAAAI) anaphylaxis emergency action plan >.

According to voluntary guidelines established by the US Centers for Disease Control and Prevention, school officials should have a policy in place for managing food allergies, avoiding allergic triggers and taking appropriate emergency action should anaphylaxis occur.

When parents request a 504 Plan

Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 (ADA) are major pieces of federal legislation designed to protect the civil rights of individuals with disabilities.9-11 They define a disability as “an impairment that limits a major life activity.”11-13 In food allergies, three major life activities—eating, breathing, and caring for self—could be affected.11-13

Parents of children with potentially life-threatening allergies have the right to request a 504 Plan for their child’s school to document how teachers and other staff will address trigger avoidance and anaphylaxis treatment.9,10

Developed by the school in collaboration with the parent and child, a 504 Plan details the child’s medical needs and the precautions that must be taken to help manage his/her severe allergies. It may also address the way snacks should be served and stored, how often the child should wash his/her hands, how the classroom should be cleaned and other issues.9,12

The school nurse’s vital role

School nurses are essential advocates for anaphylaxis management. According to the National Association of School Nurses (NASN), “the registered professional school nurse…is the leader in a comprehensive management approach which includes planning and coordination of care, educating staff ...and ensuring prompt emergency response should exposure to a life-threatening allergen occur."14

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There’s only one recommended first line treatment for anaphylaxis.

More Important Safety Information (the following information applies to both Epipen and its Authorized Generic)

EpiPen® (epinephrine injection, USP) 0.3 mg and EpiPen Jr® (epinephrine injection, USP) 0.15 mg Auto-Injectors are intended for immediate administration as emergency supportive therapy only and are not intended as a substitute for immediate medical or hospital care. In conjunction with the administration of epinephrine, the patient should seek immediate medical or hospital care. More than two sequential doses of epinephrine should only be administered under direct medical supervision.

EpiPen® and EpiPen Jr® should only be injected into the anterolateral aspect of the thigh. Do not inject intravenously, into buttock, or into digits, hands, or feet. Instruct caregivers to hold the leg of young children firmly in place and limit movement prior to and during injection to minimize risk of injection-related injury.

Rare cases of serious skin and soft tissue infections have been reported following epinephrine injection. Advise patients to seek medical care if they develop symptoms of infection such as persistent redness, warmth, swelling, or tenderness at the injection site.

Epinephrine should be used with caution in patients with heart disease, and in patients who are on drugs that may sensitize the heart to arrhythmias, because it may precipitate or aggravate angina pectoris and produce ventricular arrhythmias. Arrhythmias, including fatal ventricular fibrillation, have been reported, particularly in patients with underlying cardiac disease or taking cardiac glycosides, diuretics, or anti-arrhythmics.

Patients with certain medical conditions or who take certain medications for allergies, depression, thyroid disorders, diabetes, and hypertension, may be at greater risk for adverse reactions. Common adverse reactions to epinephrine include anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and/or respiratory difficulties.

Indications (the following information applies to both Epipen and its Authorized Generic)

EpiPen® and EpiPen Jr® Auto-Injectors are indicated in the emergency treatment of Type I allergic reactions, including anaphylaxis, to allergens, idiopathic and exercise-induced anaphylaxis, and in patients with a history or increased risk of anaphylactic reactions. Selection of the appropriate dosage strength is determined according to body weight.

Click here for Full Prescribing Information for EpiPen.
Click here for Full Prescribing Information for the Authorized Generic for EpiPen


  1. Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128(1):e9-e17.
  2. National Center for Education Statistics. Digest of education statistics. http://nces.ed.gov/programs/digest/d13/tables/dt13_209.30.asp. Accessed December 15, 2014.
  3. Versluis A, Knulst AC, Kruizinga AG, et al. Frequency, severity and causes of unexpected allergic reactions to food: a systematic literature review. Clin Exp Allergy. 2015;45(2):347-367.
  4. Shah SS, Parker CL, O’Brian Smith E, Davis CM. Disparity in the availability of injectable epinephrine in a large, diverse US school district. J Allergy Clin Immunol Pract. 2014;2(3):288-293.
  5. Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6)(suppl):S1-S58.
  6. Simons FE, Ardusso LR, Bilò MB, et al; World Allergy Organization. World Allergy Organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011;4(2):13-37.
  7. Simons FE. Anaphylaxis: recent advances in assessment and treatment. J Allergy Clin Immunol. 2009;124(4):625-636.
  8. Centers for Disease Control and Prevention. Voluntary Guidelines for Managing Food Allergies in Schools and Early Care And Education Programs. Washington, DC: US Department of Health and Human Services; 2013.
  9. Mudd K, Wood RA. Managing food allergies in schools and camps. Pediatr Clin North Am. 2011;58(2):471-480.
  10. Sicherer SH, Mahr T; American Academy of Pediatrics Section on Allergy and Immunology. Management of food allergy in the school setting. Pediatrics. 2010;126(6):1232-1239.
  11. US Department of Justice. A Guide to Disability Rights Laws. Washington, DC: US Department of Justice; 2009 (updated April 2012).
  12. Moses M, Gilchrest C, Schwab NC. Section 504 of the Rehabilitation Act: determining eligibility and implications for school districts. J Sch Nurs. 2005;21(1):48-58.
  13. US Department of Agriculture. Accommodating Children with Special Dietary Needs in the School Nutrition Programs: Guidance for School Food Service Staff. Washington, DC: USDA, Food and Nutrition Service; 2001.
  14. National Association of School Nurses. Allergy/anaphylaxis management in the school setting: position statement. Position Statements, Issue Briefs, Resolutions and Consensus Statements. Silver Spring, MD: National Association of School Nurses; 2013 (revised January 2015).
EpiPen® & EpiPen Jr® (epinephrine injection, USP) Auto-Injectors 0.3/0.15mg

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