Food-allergic reactions in schools and preschools

Background: Food allergies may affect up to 6% of school-aged children. Objective: To conduct a telephone survey to characterize food-allergic reac tions in children (defined as those aged 3-19 years in this study) with kno wn food allergies in schools and preschools and to determine mechanisms tha t are in place to prevent and treat those reactions. Design: The parents of food-allergic children were contacted by telephone a nd asked about their child's history of food-allergic reactions in school. The schools the children attended were contacted, and the person responsibl e for the treatment of allergic reactions completed a telephone survey. Results: Of 132 children in the study, 58% reported food-allergic reactions in the past 2 years. Eighteen percent experienced 1 or more reactions in s chool. The offending food was identified in 34 of 41 reactions, milk being the causative food in II (32%);peanut in 10 (29%); egg in 6 (18%); tree nut s in 2 (6%); and soy, wheat, celery, mango, or garlic in 1 (3%) each. In 24 reactions (59%), symptoms were limited to the skin; wheezing occurred in 1 3 (32%), vomiting and/or diarrhea in 4 (10%), and hypotension in 1 (2%). Al so, 15 (36%) of the 41 reactions involved 2 or more organ systems, and 6 (1 5%) were treated with epinephrine. Fourteen percent of the children did not have a physician's orders for treatment, and 16% did not have any medicati ons available. Of the 80 participating schools, 31 (39%) reported at least 1 food-allergic reaction within the past 2 years and 54 (67%) made at least 1 accommodation for children with a food allergy, such as peanut-free tabl es, a peanut ban from the classroom, or alternative meals. Conclusions: It is common for food-allergic children to experience allergic reactions in schools and preschools, with 18% of children having had at le ast 1 school reaction within the past 2 years. Thirty-six percent of the re actions involved 2 or more organ systems, and 32% involved wheezing. Every effort should be made to pre vent, recognize, and appropriately treat food- allergic reactions in schools.