Canadian Journal of Public Health

, Volume 96, Issue 4, pp 250–253 | Cite as

The Effect of Income on Anaphylaxis Preparation and Management Plans in Toronto Primary Schools

  • David W. Frost
  • Catherine G. ChalinEmail author



Outcomes of serious allergic reactions are worse at school than at home. Prompt administration of epinephrine is the first-line treatment for anaphylactic reactions, and the EpiPen® device is not subsidized by Ontario public health insurance. This study examines the relationship between the proportion of low-income households in Toronto neighbourhoods and the adequacy of anaphylaxis management plans in primary schools.


A survey was administered to principals of primary schools. It addressed the areas of: prevalence of food allergy, the presence of EpiPen at school and staff training in its use, and exposure prevention policy. The results were correlated to 2001 Canadian Census data for percentage of low-income households in each school’s area.


Children with reported severe food allergy attending schools in areas with greater than 20% low-income households were less likely to have medication at school than those in neighbourhoods with less than 20% (relative risk 2.2, 95% confidence interval 1.1–4.4). Other aspects of the anaphylaxis action plan, including staff EpiPen training and parental provision of information to the school, showed no significant correlation to income. Overall, about 50% of schools have their entire teaching staff trained to administer the EpiPen.


The lack of medication at school for anaphylaxis is a limiting factor in optimal anaphylaxis management in the school setting. Government support in the purchase of EpiPen in low-income households may be indicated.

MeSH terms

Anaphylaxis income children epinephrine 



Les conséquences des réactions allergiques graves sont plus néfastes à l’école qu’à domicile. L’administration prompte d’épinéphrine est le traitement principal en cas d’anaphylaxie. Cependant, l’auto-injecteur EpiPen® n’est pas subventionné par le régime d’assurance-maladie de l’Ontario. Nous avons examiné la relation entre la proportion de ménages à faible revenu dans des quartiers de Toronto et la qualité des plans de traitement de l’anaphylaxie dans les écoles primaires.


Nous avons administré une enquête aux directeurs d’établissements. L’enquête a inclus des questions sur la prévalence des allergies alimentaires, la présence de l’EpiPen à l’école et la formation du personnel pour l’administrer, ainsi que les consignes pour limiter l’exposition aux allergènes. Les résultats ont été corrélés avec le pourcentage, tiré du recensement canadien de 2001, de ménages à faible revenu dans chaque quartier.


Il était moins probable que les enfants avec une allergie grave dans des quartiers ayant plus de 20% de ménages à faible revenu aient eu d’EpiPen à l’école que ceux vivant dans les quartiers ayant moins de 20% de tels ménages (risque relatif = 2,2, intervalle de confiance de 95% = 1,1–4,4). D’autres aspects du plan d’action contre l’anaphylaxie, y compris la formation du personnel et la fourniture d’information par les parents, n’ont montré aucune corrélation significative avec le revenu. En général, tout le personnel a reçu la formation pour administrer l’EpiPen dans 50% des écoles.


Le manque de médicaments contre l’anaphylaxie est un facteur limitant pour le traitement de l’anaphylaxie à l’école. Il se peut qu’un soutien gouvernemental à l’achat de l’EpiPen soit nécessaire pour les ménages à faible revenu.


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Copyright information

© The Canadian Public Health Association 2005

Authors and Affiliations

  1. 1.Department of Public Health Sciences, Faculty of MedicineUniversity of TorontoTorontoCanada

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