An Etiological Role for Aeroallergens and Eosinophils in Experimental Esophagitis

allergy awareness, avoidance measures, and treatment strategies, was mailed to the 273 schools. Multiple-choice questions were derived from suggested school guidelines for anaphylaxis. Results. A total of 104 responses were received representing 109 schools (40% response rate). A total of 39% characterized their school district as urban, 37% as rural, and 28% as suburban. Based on a school-reported estimate of 66 598 children, there was a 1.7% self-reported prevalence rate of food allergies. A total of 95 schools reported having at least 1 food-allergic student and 55% of those reported 10 or more food-allergic children. The most common food allergies were milk (81%), peanut (62%), tree nuts (32%), shellfish (28%), egg (23%), wheat (22%), and soy (7%). A total of 31 schools reported “other” food allergens including fruit, chocolate, red dye, tomato, fish, orange juice, spices, and cheese. Food-allergic children were identified primarily through official school records, and only 16% of school had written individual emergency plans. For education on food allergies, schools relied mainly on parents (52%) and in-services (47%) conducted most commonly by school nurses or principals. Avoidance measures to aid in preventing accidental ingestions included food substitution and special meal requests, nonsharing food policies, and instruction for food handlers on techniques to prevent cross-contamination. However, only 21% of schools reported instructions on reading food labels for hidden allergens. In the event of a serious allergic reaction or on administration of epinephrine, 94% of the schools reported that they would transport the student to medical facilities. The most common site for storage of epinephrine was the main office or the nurse’s office. Principals, nurses, and teachers were most often trained to administer epinephrine. No training of staff was reported by 10% of the schools. Conclusions. Schools need to formally educate their personnel on a school-wide basis. Important prevention measures such as reading labels, written treatment plans, immediate accessibility to epinephrine, and staff training on administration of epinephrine are areas that need to be emphasized. Reviewer’s Comments. This study demonstrates that most schools have at least 1, if not several, food-allergic children. It also revealed a large number of deficiencies in school policies regarding food-allergic children, such as lack of school-wide staff education, lack of avoidance measures (instructions on food labeling for cafeteria workers as well as knowledge on who has food allergies), lack of written emergency plans, lack of accessibility to epinephrine, and lack of personnel who can administer epinephrine. Previous studies have shown that even those who are responsible for administering self-injectable epinephrine often are not familiar with the correct technique for administration. Schools need help from physicians on proper policies and programs to keep food-allergic children safe from harm.