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

Introduction The 2020 Protection of Students with Life-Threatening Allergies Act, obligates schools 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 Herein, we assessed the effectiveness of this policy by comparing pre-hospital EAI use before and after implementation of the act. Methods The Cross-Canada Anaphylaxis Registry (C-CARE) enrolls patients presenting to a participating emergency department with anaphylaxis defined as the involvement of ≥2 systems and/or hypotension. Specific to this project, we extracted data on pediatric patients recruited from the Stollery Children’s Hospital in Edmonton, Alberta from 2016-2024. 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 EAI use for cases occurring at school before versus after the enactment of the Act on January 1, 2020. Evaluating pre-hospital EAI use in Quebec and Ontario and antihistamine use pre versus post act in Alberta were used as negative controls. Result Of the 59 cases of in-school anaphylaxis identified over the study period, 52.5% occurred post-Act. The median age was 13.0 years (IQR=9.5-15.8) and 40.7% were male. EAI use in schools was greater post-act versus pre-act (64.5% versus 35.7%, aOR=3.82, 95%CI=1.24-11.7). There was no difference in pre-hospital EAI use pre versus post 2020 in Quebec and Ontario, that did not use the act (aOR=0.72, 95%CI=0.31-1.70). There was no difference in pre-hospital antihistamine use pre versus post act (aOR=0.31, 95%CI=0.07-1.41). Conclusion Implementation of the provincial policy 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.