The US Peanut and Tree Nut Allergy Registry: Characteristics of reactions in schools and day care

Objective: Severe food-allergic reactions occur in schools, but. the featur es have not been described. Study design: Participants in the US Peanut and Tree Nut Allergy Registry ( PAR) who indicated that their child experienced an allergic reaction in sch ool or day care were randomly selected for a telephone interview conducted with a structured questionnaire. Results: Of 4586 participants in the PAR, 750 (16%) indicated a reaction in school or day care, and 100 subjects or parental surrogates described 124 reactions to peanut (115) or tree nuts (9); 64% of the reactions occurred i n day care or preschool, and the remainder in elementary school or higher g rades. Reactions were reported from ingestion (60%), skin contact/possible ingestion (24%), and inhalation/possible skin contact or ingestion (16%). I n the majority of reactions caused by inhalation, concomitant ingestion/ski n contact could not be ruled out. Various foods caused by ingestion, but pe anut butter crab projects were commonly responsible for the skin contact (4 4%) or inhalation (41%) reactions. For 90% of reactions, medications were g iven (86% antihistamines, 28% epinephrine). Epinephrine was given in school by teachers in 4 cases, nurses in 7, and parents or others in the remainde r. Treatment delays were attributed to delayed recognition of reactions, ca lling parents, not following emergency plans, and an unsuccessful attempt t o administer epinephrine. Conclusions: School personnel must be educated to recognize and treat food- allergic reactions. Awareness must be increased to avoid accidental exposur es, including exposure from peanut butter craft projects.