A national survey shows stock supplies reduce emergency shortages, though most schools still require families to provide personal devices.
RT’s Three Key Takeaways:
- Improved Emergency Safety: Schools that do not maintain stock epinephrine were more than four times more likely to report lacking the medication during an allergic emergency than schools with stock supplies.
- Persistent Dual Requirements: Although 87% of surveyed schools maintain stock epinephrine, 74% continue to require families of students with known allergies to provide personal auto-injectors.
- Unused Medication Burden: With 72% of schools reporting zero epinephrine administrations in the previous year, researchers noted that expanding stock programs could prevent personal devices from expiring unused and lower healthcare expenses for families.
Having stock epinephrine available in school settings significantly improves safety for students experiencing severe allergic reactions, according to survey results presented at ACAAI 2026.
The research revealed that while on-site stock supplies prevent critical lapses during medical emergencies, the majority of schools still mandate that families supply their own devices.
“Our findings show that having stock epinephrine available at school clearly improves student safety, since schools without it were far more likely to end up without a working device in an emergency,” said Mahi Singh, MD, lead study author and ACAAI member. “At the same time, schools also often require students with a known food allergy to bring their own personal epinephrine device each year and leave it with the school nurse. That can be expensive for families and limit accessibility outside school hours compared to backpack storage.”
Epinephrine serves as the sole treatment capable of halting anaphylaxis before it turns fatal, according to the presentation. Currently, only 10 US states require schools to keep stock epinephrine available for any student in an emergency, though schools in other states maintain inventory voluntarily.
Survey Highlights Medication Gaps and Redundancies
To evaluate how schools store and administer the medication, investigators surveyed nearly 1,850 school nurses across the country between August and December 2025, with 349 nurses—each representing an individual school—completing the questionnaire.
According to the survey findings, 87% of schools kept stock epinephrine on site, yet 74% still required students to submit a personal auto-injector. Furthermore, 74% of nurses preferred a dual-coverage model that keeps both stock supplies and personal devices available, whereas 27% indicated that stock supplies alone would be sufficient. Dr Singh noted that this dynamic warrants additional investigation.
The survey also identified low rates of emergency administration in educational settings. A total of 72% of schools reported that no student required epinephrine during the previous year, and 97% had never needed more than two doses in a single day. These findings suggest that many family-provided prescriptions remain unused and expire in storage.
Reducing Financial and Clinical Hurdles
Despite low overall utilization, access gaps still occur in schools that lack unassigned stock supplies. Ten percent of surveyed nurses reported that epinephrine was unavailable when a student experienced a life-threatening allergic emergency, with schools lacking stock medication more than four times as likely to encounter that shortage.
According to the study authors, families frequently bear the financial expense of purchasing auto-injectors annually, only for the units to expire unopened in nurse offices. The researchers stated that their findings support the broader implementation of stock epinephrine initiatives across school districts, which could reduce financial burdens on families, streamline administrative management, and guarantee rapid medication access during acute respiratory and anaphylactic events.
Study Abstract
EPINEPHRINE UTILIZATION AND MANAGEMENT IN SCHOOLS: A NATIONAL SURVEY OF SCHOOL NURSES
D025
M. Singh*, E. Carr, A. Volerman, S. Nyenhuis, C. Ciaccio, Chicago, IL.
Introduction
Many students with a documented food allergy are required to supply personal epinephrine administration devices to school each year, creating both financial and administrative burdens. Transitioning to exclusive stock epinephrine in schools is a more cost-effective alternative; however, the safety, feasibility, and preference for this practice is unclear.
Methods
A cross-sectional survey was distributed to a national database of 1,847 U.S. school nurses between August-December 2025 to assess the current requirements and usage of epinephrine in US schools. Survey analysis included descriptive statistics and chi-square tests.
Results
349 (19%) school nurses completed the questionnaire, each representing one school. Most schools (87%) had stock epinephrine; 74% required students to bring personal epinephrine devices. Approximately one quarter (27%) of nurses preferred stock-only supply; 74% favored a dual coverage supply model.
Encouragingly, 72% reported that there were no epinephrine administrations in the previous year, and 97% had never used more than two epinephrine devices in a single day. However, ten percent of nurses reported that epinephrine was unavailable when required for an anaphylactic event. In particular, schools without stock supply were 4.42 times more likely to report epinephrine unavailability (p<0.001).
Conclusion
These findings show keeping stock epinephrine at school has clear utility, and its availability is widespread across schools; however, most schools still require personal epinephrine devices. The high rate of unused, expired devices suggests excess supply of personal epinephrine autoinjectors.
