Food anaphylaxis in schools: evaluation of the management plan and the efficiency of the emergency kit

Background: Children with severe food allergies can benefit from a personal ized care project (PCP) in schools. The usefulness of the PCP and the resid ual risk of allergic emergencies are poorly appreciated. The objective was to evaluate the efficiency of the management plan and the training in the u se of the emergency kit. Methods: A telephone survey using a detailed questionnaire was performed in 45 families whose children had been previously referred to the department. The distribution of disorders was as follows: asthma, 37.7%; atopic dermat itis and asthma, 28.8%: atopic dermatitis, 15.5%; angioedema and urticaria, 13.3%; and anaphylactic shock, 4.2%. Food allergy had been diagnosed in th e 45 children by past history, and double-blind or single-blind, placebo-co ntrolled food challenges (DBPCFCs, or SBPCFCs) with evidence of specific Ig E. Exactly 75.5% of the children had peanut allergy. Multiple food allergie s characterized 46.8% of the subjects. They had benefited from a strict eli mination diet and a protocol for emergency care including a ready-to-use in tramuscular epinephrine injection. A PCP had been requested by the School P ublic Health Service. Results: Thirty-nine PCPs were implemented (86.5% of the requests). They re presented 63% of the PCPs for food allergy in the eastern region of France: one per 5800 school-age children. The retrospective period of evaluation w as 25 months on average. The types of meals were very diverse, and medicall y acceptable in 83% of cases. The place where the emergency kit was stored in the school varied. Forty reactions occurred in 33% of the children (5/6 times in the absence of a PCP), asthma in 28%, shock in 1%, and immediate s kin reactions in 11%. Reactions occurred at home in 78% of the subjects, an d in school in 22% of the subjects. The cause of the reactions was not spec ifically known in 63% of cases. Twenty-seven percent of the reactions were linked to the ingestion of food allergens. In 10% of subjects, the reaction was due to a modification of ingredients by the food industry. Conclusions: The frequency of respiratory symptoms during oral challenge te sts was confirmed by the frequency of asthmatic reactions within the follow -up period. The role of hidden allergens and of misleading labeling validat es the need for PCPs in the case of peanut and tree nut allergies, past his tory of severe reactions, multiple food allergies, reactions to a low dose in DBPCFCs, and asthmatic reactions to foods. This study provides encouragi ng data on the usefulness of PCPs and confirms the need for thorough instru ction and training of the school staff in dealing with allergic emergencies . Addition of a beta -agonist spray to the emergency kit is suggested.