Clinical Report—Management of Food Allergy in the School Setting

Food allergy is estimated to affect approximately 1 in 25 school-aged children and is the most common trigger of anaphylaxis in this age group. School food-allergymanagement requires strategies to reduce the risk of ingestion of the allergen as well as procedures to recognize and treat allergic reactionsandanaphylaxis. The role of thepediatricianorpediatric health care provider may include diagnosing and documenting a potentially life-threatening food allergy, prescribing self-injectable epinephrine, helping the child learn how to store and use themedication in a responsible manner, educating the parents of their responsibility to implement preventionstrategieswithinandoutside thehomeenvironment, andworking with families, schools, and students in developing written plans to reduce the risk of anaphylaxis and to implement emergency treatment in the event of a reaction. This clinical report highlights the role of the pediatricianandpediatrichealthcareprovider inmanagingstudentswith food allergies. Pediatrics 2010;126:1232–1239 INTRODUCTION Anaphylaxis is a severe, potentially fatal, systemic allergic reaction that occurs suddenly after contact with an allergy-causing substance.1 Food allergy is a common cause of anaphylaxis.2 The Centers for Disease Control and Prevention recently reported an 18% increase in food allergy among school-aged children from 1997 to 2007; 1 in 25 children are now affected.3 Results of studies of children with food allergy indicate that 16% to 18% have experienced a reaction in school.4,5 Allergic reactions or treatment for anaphylaxis also occur in children whose allergy was previously undiagnosed ( 25% of cases of anaphylaxis).5,6 Fatalities were noted to be overrepresented by children with peanut, tree nut, or milk allergy and among teenagers and those with underlying asthma. Preschool-aged children may experience food-induced anaphylaxis more often than older children, but the majority of foodallergic reactions in preschooland school-aged children are not anaphylaxis,7,8 and deaths are rare.9 In case series of fatalities from food allergy among preschooland school-aged children in the United States, 9 of 32 fatalities occurred in school and were associated primarily with significant delays in administering epinephrine.10–12 The purpose of this clinical report is to highlight the pediatrician’s role in management of food allergy in the school setting and emphasize prevention and treatment of food-induced anaphylaxis.13 Management of infants, toddlers, and preschool-aged children who are cared for in myriad settings poses additional challenges (eg, infants may suck on Scott H. Sicherer, MD, Todd Mahr, MD, and THE SECTION ON ALLERGY AND IMMUNOLOGY