PHOENIX (Nov. 12, 2026) – For school kids with severe food allergies, having epinephrine on hand at school can mean the difference between a scary moment and a life-threatening one. A new national survey of school nurses presented at the 2026 Annual Scientific Meeting of the American College of Allergy, Asthma and Immunology (ACAAI) looks at how schools stock and manage this life-saving medicine. The results showed that while keeping epinephrine on hand at school clearly helps, many families are still being asked to supply their own, even when it may not be necessary.
"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 is the only medicine that can stop anaphylaxis, a severe allergic reaction, from becoming deadly. Many schools now keep a supply of epinephrine available, sometimes called "stock" epinephrine, that any student can use in an emergency. Only 10 states require schools to stock epinephrine, but many schools in other states do so voluntarily. At the same time, schools also often require students with a known food allergy to bring their own personal epinephrine device each year. That can be expensive and hard to keep track of for families.
Researchers surveyed nearly 1,850 school nurses across the country between August and December 2025. Of those, 349 nurses, each representing one school, completed the survey.
- 87% of schools kept stock epinephrine on site, but 74% still required students to bring their own personal device as well.
- Most nurses (74%) preferred a "dual coverage" approach, keeping both stock epinephrine and personal devices on hand, while about a quarter (27%) said stock epinephrine alone would be enough. Dr. Singh notes this key point requires further study.
- 72% of schools reported that no student needed epinephrine at all in the past year, and 97% had never needed to use more than two doses in a single day. This suggests many personal devices go unused and may expire.
- Importantly, 10% of nurses said that epinephrine was not available when a student needed it during a real allergic emergency. Schools that did not keep stock epinephrine were more than four times more likely to report this problem.
Families of students with food allergies often pay for a costly new epinephrine device every year to bring to school, even if it's never used and eventually expires unopened. That adds up to expense and hassle for families, on top of the stress of managing a child's allergy. The researchers say their findings support wider adoption of stock epinephrine programs in schools, which could reduce the financial and administrative burden on families while helping ensure epinephrine is always available when a student needs it most.
Abstract Title: Epinephrine Utilization and Management in Schools: A National Survey of School Nurses
Presenter: Mahi Singh, MD
