Study suggests schools hold spare epi-pens for children not prescribed one

Less than half of schoolchildren in England who are at risk of a serious and potentially life-threatening allergic reaction to food had been prescribed an adrenaline autoinjector, analysis of GP records has shown.

Providing spare pens in schools for use in any child suffering anaphylaxis would be a safer and cheaper option, the team from Imperial College London found.

UK regulators recommend that anyone at risk should have access to two ‘epi-pens’ at all times.

Yet the study of GP records and NHS prescribing data showed 44% of school-aged children with a food allergy had at least one adrenaline autoinjector (AAI) prescription.

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The data from the 2023/24 and 2024/25 academic years showed only 34% had repeat AAIs prescribed.

In pupils aged five to 18 years with previous recorded anaphylaxis, rates were 59% and 44%, respectively, the study published in Archives of Disease in Childhood reported.

Despite legislation allowing schools to obtain, without a prescription, ‘spare’ AAI devices for use in emergencies, only around half of have done this, the authors said.

This may be due to cost, which often exceeds £100 a device, yet the subsidised NHS tariff is around £10 for two devices, they added.

With one in 10 episodes of anaphylaxis occurring in schools, providing schools with ‘spare’ devices at no cost would be safer and save most local health services millions, they estimated.

Nearly two-thirds (63%) of pupils prescribed AAIs with a food allergy were dispensed more than two AAIs at an estimated cost of over £9m in 2023-4, the analysis showed.

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Given the spike in prescriptions that can be seen at the start of the school year, most were most likely provided to keep on school premises, suggest the researchers.

Some integrated care boards (ICBs) have piloted the provision of spare AAIs to local schools for use on any child.

Extrapolating from this, if spare AAIs were to replace the supply of named-patient AAIs to remain on school premises, it could save at least £4.6m or 25% of the total national expenditure for AAIs, they calculated.

The estimated cost of providing spare AAIs to every school was £4.5m.

Figures from the National Child Mortality Database shows that 76% of fatal allergic reactions in children involve modifiable factors, including delays in treating with adrenaline.

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‘There can be little doubt that if ICBs were to limit dispensing to two unexpired AAIs per pupil at any one time (and so no longer provide additional AAIs on a named-patient basis just for school use), then providing spare AAIs to schools (at no cost to the school) would be a cost-neutral strategy for the vast majority of ICBs – and one that is likely to improve emergency access to AAIs and therefore safety,’ they concluded.

This article was first published by our sister title Pulse