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December 2006

Dear Director of Education,

Re: Epinephrine Auto-injectors

We recognize the increased efforts of school boards and schools to safeguard students at risk of anaphylaxis. These efforts are much appreciated and can help to reduce the risk of accidental exposure and ensure that proper measures are taken in the event of an emergency.

As you may know, there are currently two epinephrine auto-injectors available in Canada for the emergency treatment of anaphylaxis: EpiPen® and Twinject®. The decision to have one device or the other is one which should be made by the patient (or parent) and their physician. It has come to our attention that the Twinject® brand is not being allowed in some schools in Ontario. We strongly suggest that either product be accepted since both brands provide life-saving medication.

In many cases, the early injection of one dose of epinephrine is sufficient to control a reaction. We recommend, however, that students have a back-up dose available as a precautionary measure. Since there may be students in your school environment who are carrying a Twinject®, it is important for staff to be familiar with the product. The Twinject® includes an auto-injector for the first dose and a back-up dose that is administered manually. We recommend that students carry the device that was recommended by their physician whether it be one or two auto-injectors.

We recommend regular anaphylaxis training sessions to ensure that staff is familiar with the proper use of an epinephrine auto-injector. These sessions should include hands-on practice with both EpiPen® and Twinject® training devices. To further support training efforts, we encourage you and your school staff to visit the following sites:

Questions about anaphylaxis can be directed to the following allergy associations:

Allergy/Asthma Information Association (AAIA)

  • www.aaia.ca  / Toll-free: 1-800-611-7011
    Anaphylaxis Canada

  • www.anaphylaxis.ca / Toll-free: 1-866-785-5660
    Association québécoise des allergies alimentaires (AQAA)

  • www.aqaa.qc.ca / Toll-free: 1-800-990-2575
    Canadian Society of Allergy and Clinical Immunology (CSACI)

  • www.csaci.ca / Tel: 613-730-6272

We would be pleased to meet with representatives of school boards, public health units, and others, such as teaching staff, who are interested in learning more about the use of epinephrine auto-injectors and anaphylaxis in general. A local meeting could be organized if there is sufficient interest. Kindly contact Adil Mamodaly, Bill 3 Liaison, Anaphylaxis Canada, email – bill3@anaphylaxis.ca or call toll-free (866) 785-5660, ext. 4104 / (416) 785-5666, ext. 4104 (GTA).

The health and safety of children is a concern that we all share. We thank you and your school staff for your ongoing efforts to protect and support allergic students.


Charles Frankish, MD, FRCPC
Canadian Society of Allergy and Clinical Immunology
Charles Frankish, MD, FRCPC
Canadian Society of Allergy and Clinical Immunology

Eric Leith MD, Chair, Canadian Allergy, Asthma and Immunology Foundation
Mary Allen, Chief Executive Officer, Allergy/Asthma Information Association
Laurie Harada, Executive Director, Anaphylaxis Canada
Claire Dufresne, Executive Director, Association québécoise des allergies alimentaires
Ben Levin, Deputy Minister of Education, Ontario
Frank Kelly, Executive Director, Council of Ontario Directors of Education
Sheela Basrur MD, Chief Medical Officer of Health and Assistant Deputy Minister, Ontario
Medical Officers of Health, Public Health Units, Ontario
Louise Tremblay, Executive Director, CSACI Secretariat

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