California Expands Stock Epinephrine Options in Schools

Under updated state law, schools are no longer limited to epinephrine auto-injectors for emergency treatment. (Photo: Dana Wrubel / Just Allergy Things)

A new California law expanding stock epinephrine requirements in schools took effect Jan. 1, explicitly including preschools and broadening required options beyond auto-injectors to other epinephrine delivery devices, such as nasal sprays.

The legislation amends SB 1266, which was passed in 2014 and required public schools to stock emergency epinephrine auto-injectors. Sen. Roger Niello, who represents California’s 6th District, introduced SB 568 in February 2025 to update the law in response to advances in epinephrine delivery technology.

“It was an injection only back when the original bill was passed, and there have been [new options], nasal sprays specifically, developed and approved since, and so it broadens the definition of the delivery system,” Niello said.

Because preschools were not explicitly mentioned in the original law, some school districts were unsure whether stock epinephrine requirements extended beyond K-12 campuses.

The law “cleared up any confusion that existed,” said Niello. “The risk is the same as it is in K-12, therefore [preschools] should be treated the same.”

With the updated law now in effect, school districts are beginning to assess how the changes will affect existing stock epinephrine programs.

Los Angeles Unified School District currently provides epinephrine auto-injectors at its K-12 schools under the EpiPen4Schools program, which supplies the medication at no cost.

“We are currently determining if our school district will be able to acquire the nasal spray for free in the same manner as the autoinjectors,” said a Los Angeles Unified spokesperson.

On Aug. 9, 2024, the FDA approved neffy, an epinephrine nasal spray, used to treat allergic emergencies. The needle-free delivery system offers an alternative epinephrine option for those who may be hesitant to use an autoinjector. Other epinephrine delivery options may be available in the future, with the FDA currently reviewing the approval of an oral epinephrine film, Anaphylm.

“This new law will allow … other yet approved devices to be incorporated into California schools without extra laws,” said Sacramento-based allergist Matthew Bowdish. “Also incorporating the new language will allow for schools to be flexible if there are shortages of certain epinephrine delivery devices.”

The amendment received wide support from national food allergy organizations. The Asthma and Allergy Foundation of America sent a letter  April 4, 2025, in support of Niello’s proposed amendment. Food Allergy Research Education also issued a statement in support of the updated legislation.

Parents have also welcomed the changes, particularly the inclusion of preschool-aged children under the new mandate.

“Children at this age may not yet know they have food allergies and often do not have their own epinephrine, making this inclusion especially important for their safety,” said H. Dhillon, father of a preschool student with food allergies.

An estimated 1 in 13 children have a food allergy, according to FARE, and about a quarter of severe reactions occur in school settings among children without a prior diagnosis, according to a study published in Pediatrics.

In documented cases, stock epinephrine administered at school has been used to treat both undiagnosed students and students with known food allergies who did not have access to a usable personal prescription.

“It saves lives, quite simply,” said Niello.