This is despite recommendations by the UK and European medicines regulators that those at risk should have access to 2 AAIs at all times, since some reactions need more than one dose or to allow for incorrect use.

And with 1 in 10 episodes of anaphylaxis occurring in schools, providing all of them with ‘spare’ devices would be safer and save most local health funding bodies £millions, estimate the researchers.

On average, every UK school class will have one or two children at risk of anaphylaxis to a foodstuff, and many schools require these pupils to leave an AAI on the premises, in case they forget to bring one in.

Children with food allergies are not always prescribed AAI. The researchers analysed routinely collected primary care data from the nationally representative Clinical Practice Research Datalink (CPRD) Aurum for children and young people (5-18) diagnosed with a food allergy between 2008 and 2018.

They found that less than half (44%) of schoolchildren with a food allergy in the CPRD had been prescribed at least one AAI, and only a third (34%) had repeat AAIs prescribed. Among pupils who had already experienced anaphylaxis, rates were 59% and 44%, respectively.

To boost access and safety for all school children, UK legislation was changed in 2017 to allow schools to obtain, without a prescription, ‘spare’ AAI devices for use in emergencies—when the pupil’s own AAI is not readily available or they haven’t been prescribed one.

But only around half of schools have done this, possibly because of the prohibitive cost, which often exceeds £100 a device, when the subsidised NHS tariff is around £10 for two devices, suggest the researchers.

As a result, some local health funding bodies (Integrated Care Boards or ICBs) have piloted the provision of spare AAIs to local schools for use on any child. The researchers therefore wanted to compare the potential costs of this approach with that of prescribing AAIs for retention on school premises to pupils on a named-patient basis.

They looked at NHS data on AAI prescriptions issued to primary and secondary school age children with a food allergy during the 2023-4 and 2024-5 academic years—specifically, the number of pupils prescribed more than two AAIs.

The researchers then used these data to estimate the potential annual savings if ICBs were to provide every school in England with four spare AAIs on an annual basis during the 2023-24 academic year, rather than funding AAIs to each at-risk pupil over the same time period.

Nearly two thirds (63%) of pupils prescribed AAIs with a food allergy were dispensed more than two AAIs at an estimated cost of over £9 million in 2023-4. Most of these additional AAIs were most likely provided for retention on school premises, given the spike in prescriptions at the start of the school year, suggest the researchers.

The estimated cost of providing spare AAIs to every school was £4.5 million. And the researchers calculated that if spare AAIs were to replace the supply of named-patient AAIs exclusively for retention on school premises, this would potentially save at least £4.6 million—equivalent to 25% of the total national spend on AAIs.

The researchers acknowledge that the study data only included primary care NHS prescriptions, dispensed by community pharmacies and so excluded AAIs dispensed through hospitals and private healthcare.

But they conclude: “Irrespective, 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.”

“The National Child Mortality Database shows that 76% of fatal allergic reactions in children involve modifiable factors, including delays in treating with adrenaline,” points out Helen Blythe of the Benedict Blythe Foundation, in a linked editorial.

“Prevention of Future Death reports issued by HM Coroners echo the same failures. Countries like Canada have had laws mandating allergy safety in schools for two decades. In the UK, we’re still shaking buckets to raise money for potentially life-saving medication in our schools,” she adds.

She calls for Benedict’s Law to enter the statute books. First presented to the Department for Education in 2023, this would require schools to hold spare AAIs funded by the government; training for all staff in allergy awareness and emergency response; and the implementation of a school-wide allergy policy.

“Across the country, regional pilots and local initiatives have shown that it’s possible, practical, and financially sound to equip schools with AAIs,” she emphasises. Such a strategy “would improve emergency access to adrenaline to all pupils, irrespective of whether they had been prescribed AAIs.”

Approximately 10% of inpatients are labelled as ‘allergic to penicillin’ but the vast majority have not experienced a true allergic reaction. Having a penicillin allergy label can results in patients receiving sub-optimal alternative antibiotics and this may lead to poorer outcomes and increased costs. Moreover, patients with a history of low-risk allergy can safely be offered a supervised oral challenge to determine their true penicillin allergy status.

Hegarty and colleagues described the introduction of a penicillin allergy de-labelling service in Cavan and Monaghan Hospital, Ireland.¹ In addition to penicillin allergy de-labelling, the project set out to improve documentation of all medication allergies in patient records.

The Antimicrobial Stewardship (AMS) pharmacists adapted the Scottish Antimicrobial Prescribing Group (SAPG) penicillin allergy toolkit, complying with local governance requirements. This toolkit is designed to be used by non-allergy specialists and supports the identification and removal of penicillin allergy labels in patients who do not have a history of Type 1 or Type 4 hypersensitivity reactions. They also undertook a wide-ranging education campaign on the toolkit and on penicillin allergy awareness.  This included using grand rounds, medical, surgical and ED journal clubs, pharmacy meetings, clinical nurse manager meetings and ward safety pauses.

The results showed that during the period October 2022 – July 2023 61 patients were screened. 37 were deemed eligible for de-labelling and 34 were successfully de-labelled. Of these, 20 were de-labelled in accordance with the protocol (oral challenge); 12 did not require oral challenge “as they were deemed no more likely to have a penicillin allergy than another member of the population”. Two were not de-labelled in accordance with the approved protocol (both were receiving penicillin when reviewed).

Completion of the drug allergy section on the medical records increased from 80% to 100%.  Documentation of the nature of the adverse drug reaction increased from 14% to 27% for patients with a documented penicillin allergy. Both succeeded in the aim of achieving a 10% improvement.

The authors concluded that progress had been made but further improvements were possible as there were still considerable variations in staff engagement.

Reference

1. Hegarty M, Martin D, McKenna A, Caceda B, Trautt E, Daly R. Penicillin allergy awareness and de-labelling. (Poster) EAHP Congress 2025

The laboratory-made antibody, omalizumab, is approved by the Food and Drug Administration for three indications other than food allergy. FDA is reviewing a supplemental biologics license application for omalizumab for food allergy based on this interim analysis of the NIAID trial.

In addition to NIAID funding, the trial has support from Genentech, a member of the Roche Group, and Novartis Pharmaceuticals Corporation. The two companies collaborate to develop and promote omalizumab, marketed as Xolair, and are supplying it for the trial.

The multi-stage trial is called Omalizumab as Monotherapy and as Adjunct Therapy to Multi-Allergen OIT in Food Allergic Children and Adults, or OUtMATCH. The NIAID-funded Consortium for Food Allergy Research (CoFAR) is conducting OUtMATCH at 10 locations across the United States.

The first stage of the study was designed to assess the efficacy of omalizumab in increasing the amount of food it takes to cause an allergic reaction, thereby reducing the likelihood of reactions to small amounts of food allergens in the event of accidental exposure. The study team enrolled children and adolescents ages 1 to 17 years and three adults ages 18 to 55 years, all with confirmed allergy to peanut and at least two other common foods.

In the planned interim analysis, the study’s independent Data and Safety Monitoring Board (DSMB) examined data on the first 165 children and adolescents who participated in the first stage of the trial. Using strict criteria, the DSMB found that study participants who received omalizumab injections could consume higher doses of peanut, egg, milk and cashew without allergic reactions than participants who received placebo injections.

Based on these favorable results, the DSMB recommended halting enrollment into the first stage of the trial. NIAID accepted the board’s recommendation. More detailed information about the findings will become available when they are published in a peer-reviewed journal.

Additional information about the ongoing OUtMATCH trial is available at ClinicalTrials.gov under study identifier NCT03881696.