Under-recognition of Food Allergies in Lower Socioeconomic Status (SES) Schools in a Large Urban School District

Abstract

RATIONALE: Food allergy related reactions are common in the school environment. This study was conducted to determine whether SES impacts characteristics of food allergy related reactions and their recognition in a socioeconomically diverse population of 202,773 students, the Houston Independent School District (HISD). METHODS: A 9-item questionnaire was emailed to all HISD elementary school nurses (n=170) to address: 1) the number of food allergic students, epinephrine injectors, allergic reactions per school, and causal foods, and 2) the characteristics of reactions. School SES was based on the percentage of children in the National School Lunch Program (NSLP). RESULTS: Fifty-four percent (n=92) of school nurses completed the survey. Eighty-six nurses (94%) reported having ≥1 food allergic student(s), with one nurse representing each school. Only 43% of schools had student-specific epinephrine injectors. Schools with <4 injectors had ≥70% of students participating in the NSLP, while those with ≥4 injectors had fewer students in the NSLP (p=0.001). Peanuts (26%), cow's milk (16%), tree nuts (11%), and eggs (10%) were the most frequently reported allergens. The most common symptoms were hives, itchy rash, and/or swelling about the face/extremities. Food allergy prevalence in HISD was approximately 1.4%, with 2.3% prevalence in higher SES schools. Half of all epinephrine injectors in HISD were located in 11% of participating schools. CONCLUSIONS: The causal foods and symptoms of allergic reactions were not impacted by SES. However, lower SES schools had fewer food allergic students and epinephrine injectors, suggesting under-recognition of students with food allergies in these schools.