Annotated abstract*1

Abstract

Approximately 6%-8% of children have a food allergy, and the number of children with food allergies in this country is increasing. Food allergies are the leading cause of anaphylaxis outside the hospital setting, with 150-200 deaths occurring each year. The symptoms of a food allergic reaction can vary from mild to life-threatening and typically occur within two hours of exposure. A study of school children reported that reactions occurred an average of 9.8 minutes after exposure. Eight foods are responsible for 90% of food allergies: milk, eggs, peanuts, tree nuts, wheat, soy, fish, and shellfish. Peanuts were responsible for 63% of 32 deaths from food allergies. Prevention requires avoidance of the allergen, and treatment is epinephrine, available as an auto-injector (eg, an EpiPen®). Fatalities are typically due to delay in or lack of treatment. In a study of 13 children who experienced food allergy anaphylaxis, only two of six children who died received epinephrine within an hour of exposure, while six of seven children who survived received epinephrine within 30 minutes of exposure. Management of children with food allergies is a concern for school nurses. Often there is no plan for how to treat the child if an allergic reaction occurs, and epinephrine is frequently stored in a place not easily accessible. In a survey of 104 elementary schools, 55% had 10 or more children with a food allergy, but only 16% had emergency plans. Food is common in schools, not just in the cafeteria or lunch room but also in the classroom for snacks and projects. The purpose of the study described in this article was to clarify elementary school nurses experiences with the occurrence, prevention, and management of food allergies in school. A telephone survey was carried out with 400 randomly selected school nurses from across the country. The results of this study found that 94% of these school nurses had at least one student with severe food allergies and an average of approximately 10 children with food allergies in their schools. Peanut allergy was the most common food allergy. The school nurses provided a wide range of strategies to try to prevent exposure, with development of Individual Health Plans (87%), plans for field trips (81%), and staff training (78%) the most common strategies. Staff training was typically developed by the school nurse (74%) and provided to a wide range of staff. EpiPens® were kept primarily in the school nurses office (90%), and 19% reported that students were allowed to carry their own EpiPens®. In addition to the school nurse, a range of staff are able to administer EpiPens®, including teachers (65%), administrators (63%), coaches (28%), and office staff (8%). One concern noted by the authors is that EpiPens® are typically stored in the school nurse's office, but school nurses are often employed part-time or assigned to multiple buildings, limiting the ease of access to the EpiPen® at the time of an emergency. School nurses also need to be encouraged to use resources available to provide standardized training. Resources are available through the Food Allergy and Anaphylaxis Network (FAAN) (http://foodallergy.org/actionplan.pdf) and the Massachusetts Department of Education (http://www.doe.mass.edu/cnp/2002/news/allergy.pdf). Children with food allergies are followed by PNPs, who prescribe the EpiPens® needed by these children for emergency care. PNPs need to work closely with families, school nurses, and educators to ensure that these children have the appropriate management plans developed for potential emergencies that might occur at school and other places, as well as at home.