Management of anaphylaxis in schools: Evaluation of an epinephrine auto-injector (EpiPen？) use by school personnel and comparison of two approaches of soliciting participation

School personnel from randomly selected schools in Quebec were approached using a 1) partial or 2) full disclosure approach and were assessed on their ability to use the EpiPen？ and identify anaphylaxis.343 school personnel participated. In the full disclosure group, the participation rate was lower: 21.9% (95%CI, 19.0%-25.2%) versus 40.7% (95%CI, 36.1%-45.3%), but more participants achieved a perfect score: 26.3% (95%CI, 19.6%-33.9%) versus 15.8% (95%CI, 10.8%-21.8%), and identified 3 signs of anaphylaxis: 71.8% (95%CI, 64.0%-78.7%) versus 55.6% (95%CI, 48.2%-62.9%).Selection bias is suspected as school personnel who were fully informed of the purpose of the assessment were less likely to participate; those who participated among the fully informed were more likely to earn perfect scores and identify anaphylaxis. As the process of consent can influence participation and bias outcomes, researchers and Ethics Boards need to consider conditions under which studies can proceed without full consent. Despite training, school personnel perform poorly when asked to demonstrate the EpiPen？.Food allergy is a serious condition affecting 3.9% of children in the United States [1], and can lead to systemic life-threatening symptoms or anaphylaxis [2]. There is currently no well-established curative treatment for food allergy and management relies on avoidance and therapy with epinephrine for reactions caused by accidental exposures [3]. We and others have shown that despite increasing societal awareness of the potentially fatal consequences of food allergy, accidental exposures continue to occur [4-8] and about 10% of fatal food-associated anaphylactic reactions take place in school [9,10]. As school represents a situation where parents must rely on other caregivers to respond to a severe allergic reaction, school personnel must be able to recognize anaphylaxis and know how to administer epinephrine using an auto-injector device such as the EpiPen？ [11]. A delay in epinephrine a