Going off to summer camp can be a scary experience for children, but it can be even more nerve-wracking for parents of kids with food allergies. New UVA Health research reveals the most cost-effective way to keep those children safe.
For most summer camps, stocking a supply of epinephrine – a common treatment for allergic reactions – rather than leaving it up to campers to bring their own is a safe strategy with the lowest overall cost for everyone involved, the UVA researchers found.
"Stock, unassigned epinephrine in schools is well studied. Residential summer camp is different from the school setting in a lot of ways, but we found that, for most camps, having a supply of stock epinephrine is likely beneficial," said researcher Kathleen A. Noorbakhsh, MD, MS, a pediatric emergency-medicine expert at UVA Health. "Anaphylaxis is a life-threatening emergency, and rapid administration of epinephrine is the best treatment for it. We know that when kids with anaphylaxis receive epinephrine early, they have better outcomes than when it is delayed."
Food Allergies at Summer Camps
More than 20 million American children go to summer camp each year, and up to 15% of those have a diagnosed food allergy. But only 40% of campers with food allergies bring their own epinephrine autoinjectors. These injectors can be the difference in life or death if the child experiences anaphylaxis.
Because of the growing prevalence of food allergies, many schools have found it cost-effective to stock their own epinephrine. But Noorbakhsh and her colleagues wanted to see if this would be the best strategy for summer camps, where there can be even more opportunities for life-threatening allergic reactions.
The scientists looked at different potential solutions, including having camps stock autoinjectors or nasal spray; having nurses on hand to administer epinephrine with a syringe; and leaving it to campers to bring their own autoinjectors, or some combination of those options. The researchers examined these scenarios through a hypothetical cohort of 10,000 children to determine which would be most cost-effective, not just for the camps but for everyone involved: the camps, families, insurance providers and society as a whole. This included potential costs such as preventable hospitalizations and days missed from work.
The researchers found that, for most residential camps, the most cost-effective solution would be to stock two twin packs of epinephrine autoinjectors and to have the campers leave their autoinjectors at home. This would come at an estimated overall cost of $4.33 per camper, based on the hypothetical model. (Two-packs of epinephrine autoinjectors typically cost several hundred dollars when not covered by insurance, and they have a shelf life of 12-18 months.) This strategy is the most financially smart for large camps and those with high numbers of campers with food allergies, the researchers say in a new scientific paper outlining their findings.
For camps that cannot afford to keep autoinjectors, stocking a supply of epinephrine in some form while still allowing children to bring autoinjectors may be the most "economically favorable" policy, the researchers report.
For camps with fewer than 100 children and those with very low rates of food allergies, having campers bring autoinjectors could remain the most cost-effective option.
Epinephrine Availability
The investigators note that the increasing rates of food allergies in children and the availability of lower-cost epinephrine options may make it more cost-effective for camps to stock epinephrine in the future, even if campers continue to bring their own. Further, a growing number of states are requiring camps to have epinephrine on hand, so researchers will need to continue to monitor the issue.
Noorbakhsh and her colleagues ultimately conclude that there is no one solution that is best for all camps. But the University of Virginia School of Medicine researcher hopes the new analysis provides useful insights that will help protect children across the country.
"I would love to see more camps stocking epinephrine in a way that suits their specific camp environment and families advocating for that," she said. "Summer is a lot more fun when you are prepared."
Findings Published
Noorbakhsh and colleagues have published their findings in the scientific journal Pediatrics . The research team consisted of Carissa Bunke, Natalie Schellpfeffer, Harvey Leo, Andrew Hashikawa, Kenneth J. Smith, Barry Garst, Tracey Gaslin and Noorbakhsh. The researchers have no financial interest in the work.
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