Effectiveness of a Provincial Law to Improve Epinephrine Use for Anaphylaxis in Schools in Alberta, Canada: A Pre-Post Study

Effectiveness of a Provincial Law to Improve Epinephrine Use for Anaphylaxis in Schools in Alberta, Canada: A Pre-Post Study | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 12 February 2026 V1 Latest version Share on Effectiveness of a Provincial Law to Improve Epinephrine Use for Anaphylaxis in Schools in Alberta, Canada: A Pre-Post Study Authors : Joseph Najem [email protected] , Alexandre Ton That , Connor Prosty 0000-0001-6790-220X , Ann Clarke 0000-0002-3112-9646 , Judy Morris , Jocelyn Gravel , Roderick Lim , … Show All … , Edmond Chan , Ran Goldman , Andrew O'Keefe , Jennifer Gerdts , Derek Chu 0000-0001-8269-4496 , Julia Upton 0000-0001-5320-4232 , Elana Hochstadter , Jocelyn Moisan , Adam Bretholz , Christine McCusker , Xun Zhang , Jennifer Protudjer 0000-0002-3888-8688 , Elissa Abrams 0000-0003-3433-1986 , Elinor Simons , Andrew Dixon 0000-0003-4722-3298 , and Moshe Ben Shoshan Show Fewer Authors Info & Affiliations https://doi.org/10.22541/au.177088632.20497900/v1 164 views 86 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Introduction The 2020 Protection of Students with Life-Threatening Allergies Act, obligates schools across Alberta, Canada to hold a common use stock of at least one epinephrine autoinjector (EAI) and to maintain a protocol for the prevention and management of anaphylaxis Herein, we assessed the effectiveness of this policy by comparing pre-hospital EAI use before and after implementation of the act. Methods The Cross-Canada Anaphylaxis Registry (C-CARE) enrolls patients presenting to a participating emergency department with anaphylaxis defined as the involvement of ≥2 systems and/or hypotension. Specific to this project, we extracted data on pediatric patients recruited from the Stollery Children’s Hospital in Edmonton, Alberta from 2016-2024. Data were collected on demographics, comorbidities, symptomatology, pre- and intra-hospital management, and outcome of anaphylaxis by standardized chart review. Multivariable logistic regression was used to assess pre-hospital EAI use for cases occurring at school before versus after the enactment of the Act on January 1, 2020. Evaluating pre-hospital EAI use in Quebec and Ontario and antihistamine use pre versus post act in Alberta were used as negative controls. Result Of the 59 cases of in-school anaphylaxis identified over the study period, 52.5% occurred post-Act. The median age was 13.0 years (IQR=9.5-15.8) and 40.7% were male. EAI use in schools was greater post-act versus pre-act (64.5% versus 35.7%, aOR=3.82, 95%CI=1.24-11.7). There was no difference in pre-hospital EAI use pre versus post 2020 in Quebec and Ontario, that did not use the act (aOR=0.72, 95%CI=0.31-1.70). There was no difference in pre-hospital antihistamine use pre versus post act (aOR=0.31, 95%CI=0.07-1.41). Conclusion Implementation of the provincial policy was associated with an increase in pre-hospital EAI use in cases of pediatric anaphylaxis occurring at school. These preliminary results support the effectiveness of policy interventions for anaphylaxis management. Supplementary Material File (pediatric allergy and immunology manuscript2.docx) Download 58.76 KB Information & Authors Information Version history V1 Version 1 12 February 2026 Copyright This work is licensed under a Non Exclusive No Reuse License. Authors Affiliations Joseph Najem [email protected] McGill University Faculty of Medicine and Health Sciences View all articles by this author Alexandre Ton That McGill University Faculty of Medicine and Health Sciences View all articles by this author Connor Prosty 0000-0001-6790-220X McGill University Faculty of Medicine and Health Sciences View all articles by this author Ann Clarke 0000-0002-3112-9646 University of Calgary Cumming School of Medicine View all articles by this author Judy Morris Hopital du Sacre-Coeur de Montreal View all articles by this author Jocelyn Gravel Centre Hospitalier Universitaire Sainte-Justine Departement de Pediatrie View all articles by this author Roderick Lim London Health Sciences Centre Children's Hospital Pediatric Critical Care Unit View all articles by this author Edmond Chan The University of British Columbia View all articles by this author Ran Goldman BC Children's Hospital View all articles by this author Andrew O'Keefe Memorial University of Newfoundland Faculty of Medicine View all articles by this author Jennifer Gerdts Food Allergy Canada View all articles by this author Derek Chu 0000-0001-8269-4496 McMaster University View all articles by this author Julia Upton 0000-0001-5320-4232 The Hospital for Sick Children View all articles by this author Elana Hochstadter The Hospital for Sick Children Paediatric Emergency Medicine View all articles by this author Jocelyn Moisan Emergency Medical Services of Outaouais View all articles by this author Adam Bretholz Montreal Children's Hospital View all articles by this author Christine McCusker Mcgill University Department of Pediatrics View all articles by this author Xun Zhang McGill University View all articles by this author Jennifer Protudjer 0000-0002-3888-8688 University of Manitoba Department of Pediatrics and Child Health View all articles by this author Elissa Abrams 0000-0003-3433-1986 University of Manitoba Department of Pediatrics and Child Health View all articles by this author Elinor Simons University of Manitoba Department of Pediatrics and Child Health View all articles by this author Andrew Dixon 0000-0003-4722-3298 Stollery Children's Hospital View all articles by this author Moshe Ben Shoshan McGill University Faculty of Medicine and Health Sciences View all articles by this author Metrics & Citations Metrics Article Usage 164 views 86 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Joseph Najem, Alexandre Ton That, Connor Prosty, et al. Effectiveness of a Provincial Law to Improve Epinephrine Use for Anaphylaxis in Schools in Alberta, Canada: A Pre-Post Study. Authorea . 12 February 2026. DOI: https://doi.org/10.22541/au.177088632.20497900/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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