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Anna Nowak-Wegrzyn, MD; Mary Kay Conover-Walker, MSN, RN, CRNP; Robert A. Wood, MD

Arch Pediatr Adolesc Med. 2001;155:790-795.

Background  Food allergies may affect up to 6% of school-aged children.

Objectives  To conduct a telephone survey to characterize food-allergic reactions in children (defined as those aged 3-19 years in this study) with known food allergies in schools and preschools and to determine mechanisms that are in place to prevent and treat those reactions.

Design  The parents of food-allergic children were contacted by telephone and asked about their child's history of food-allergic reactions in school. The schools the children attended were contacted, and the person responsible 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 school. The offending food was identified in 34 of 41 reactions, milk being the causative food in 11 (32%); peanut in 10 (29%); egg in 6 (18%); tree nuts 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 13 (32%), vomiting and/or diarrhea in 4 (10%), and hypotension in 1 (2%). Also, 15 (36%) of the 41 reactions involved 2 or more organ systems, and 6 (15%) were treated with epinephrine. Fourteen percent of the children did not have a physician's orders for treatment, and 16% did not have any medications 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 tables, 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 least 1 school reaction within the past 2 years. Thirty-six percent of the reactions involved 2 or more organ systems, and 32% involved wheezing. Every effort should be made to prevent, recognize, and appropriately treat food-allergic reactions in schools.

From the Division of Allergy & Immunology, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY (Dr Nowak-Wegrzyn); and the Eudowood Division of Allergy and Immunology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md (Ms Conover-Walker and Dr Wood).

Corresponding author and reprints: Anna Nowak-Wegrzyn, MD, Division of Allergy & Immunology, Department of Pediatrics, Mount Sinai Medical Center, Campus Box 1198, One Gustave L. Levy Place, New York, NY 10029-6574 (e-mail: anna_nowak-wegrzyn{at}mssm.edu).

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