Pertinence de la prescription du projet d’accueil individualisé pour les enfants allergiques à l’école

Abstract

BackgroundThe incidence of food allergy is increasing steadily, especially among the paediatric population. The number of individual healthcare plans (IHP) introduced in French schools to improve management of allergic children is growing. However, there is no data on the relevance of IHP for the associated allergies. AimsOur aims were to assess the relevance of IHPs (excluding asthma) and emergency kits issued for allergic children in schools. Patients and methodsA retrospective study of patients aged between 3 and 18 years issued with IHPs for food allergy during the 2018/2019 school year in eleven municipalities in the Val-de-Marne department (France). ResultsData were collected on 234 of the 1211 IHPs concerning allergies (average age: 5 years; food allergy: 90%, drug allergy: 1%, hymenoptera venom allergy: 1%). In relation to the current recommendations on the establishment of IHP for food allergies in schoolchildren, we observed over-prescription of IHPs with emergency kits, both with and without adrenaline auto-injectors (AAI), as well as under-prescription of IHPs for allergen avoidance (without an emergency kit). Numerous prescribing errors were noted: AAIs with no indication for prescription, AAIs without any associated bronchodilator (24%), emergency kits containing only oral corticosteroids. Most unwarranted prescriptions of emergency kits containing AAIs concerned multiple allergens (> 2 allergens). ConclusionsWe documented general over-prescription of IHPs containing emergency kits (both with and without AAIs). Numerous prescription errors concerning emergency kits are described. In many cases, IHPs may be simplified by prescribing allergen avoidance only. Updated recommendations on AAI prescribing procedures are necessary. New guidelines are needed concerning the contents of emergency kit without AAIs.