November 12, 2026
Study shows most schools still require families to supply their own
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
For more information about treating anaphylaxis, or to find an allergist in your area, visit AllergyandAsthmaRelief.org. The ACAAI Annual Scientific Meeting is Nov. 12-16 in Phoenix. For more news and research from the ACAAI Scientific Meeting, go to our newsroom and follow the conversation on X/Twitter #ACAAI26.
About ACAAI
The American College of Allergy, Asthma & Immunology (ACAAI) is a professional medical organization of more than 6,500 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. Founded in 1942, the College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy, and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org. Join us on Facebook, Instagram, Threads and X.
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.
