英国不到一半面临食物过敏风险的学生被开肾上腺素“解毒剂”

在线发表在《儿童疾病档案》上的一项全国处方数据分析发现，在英格兰，不到一半的面临严重且可能危及生命的食物过敏反应（过敏性休克）风险的学童被开了解毒剂——肾上腺素自动注射器，简称 AAI。

　　

在线发表在《儿童疾病档案》上的一项全国处方数据分析发现，在英格兰，不到一半的可能出现严重且可能危及生命的食物过敏反应（过敏性休克）的学童被开了解毒剂——肾上腺素自动注射器，简称AAI。

 

尽管英国和欧洲药品监管机构建议高危人群应始终服用 2 种 AAI，因为某些反应需要服用不止一剂或允许错误使用，但情况仍然如此。 

 

研究人员估计，每 10 起过敏反应中就有 1 起发生在学校，因此为所有学校提供“备用”设备会更安全，并为大多数地方卫生资助机构节省数百万英镑。

 

平均而言，英国每个班级都会有一到两名儿童存在食物过敏风险，许多学校要求这些学生在校园内留下过敏原信息，以防他们忘记带入学校。

 

患有食物过敏的儿童并非总是需要服用AAI。研究人员分析了具有全国代表性的临床实践研究数据链（CPRD Aurum）中常规收集的初级保健数据，这些数据涵盖了2008年至2018年间被诊断患有食物过敏的儿童和青少年（5-18岁）。

 

他们发现，在CPRD地区患有食物过敏的学童中，不到一半（44%）至少服用过一次过敏性休克药物（AAI），只有三分之一（34%）的学童重复服用过AAI。在已经出现过敏反应的学生中，重复服用AAI的比例分别为59%和44%。

 

为了提高所有学童的使用率和安全性，英国于 2017 年修改了立法，允许学校无需处方即可获得“备用” AAI 设备，以备紧急情况使用——当学生自己的 AAI 不易获得或没有处方时。

 

但只有大约一半的学校这样做了，可能是因为成本太高，每台设备通常超过 100 英镑，而 NHS 补贴的两台设备价格约为 10 英镑，研究人员表示。

 

因此，一些地方卫生资助机构（综合护理委员会，简称ICB）已试点向当地学校提供备用的抗抑郁药（AAI），供所有儿童使用。因此，研究人员希望比较这种方法与以指定患者为单位，在学校为学生开具AAI处方并留存的潜在成本。

 

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.”