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Acute and preventive management of anaphylaxis in German primary school and kindergarten children
Magdalena Kilger1, Ursula Range2, Christian Vogelberg3
1Pediatric Department, TU Dresden, University Hospital Carl Gustav Carus Dresden, Dresden, Germany. magdalena.kilger@gmail.com.
Insights
Anaphylaxis management in children is often inadequate, with underuse of adrenaline and incomplete emergency kits. Enhanced education for school and kindergarten staff is crucial for improving care and ensuring child safety.
Area of Science:
- Pediatrics
- Allergy and Immunology
- Public Health
Background:
- Anaphylaxis is a severe, life-threatening allergic reaction.
- Real-life anaphylaxis management in children, particularly in educational settings, is not well understood.
Purpose of the Study:
- To investigate the real-world management of anaphylaxis in children within kindergarten and school environments.
- To identify common symptoms, triggers, treatment practices, and emergency kit contents.
Main Methods:
- A questionnaire-based study was conducted among parents, school teachers, and child-care providers in Dresden, Germany.
- Data were collected from 86 primary schools and kindergartens, with 6352 questionnaires returned.
Main Results:
- Anaphylaxis prevalence was 1.5% in the study population (87 cases).
- Foods, particularly tree nuts and peanuts, were the most common triggers.
- Under-treatment was observed, with low adrenaline use (1%) and incomplete emergency kits; staff knowledge gaps were identified.
Conclusions:
- The study suggests significant under-treatment of pediatric anaphylaxis, especially concerning adrenaline administration and emergency kit preparedness.
- There is a critical need for improved education for school and kindergarten staff regarding anaphylaxis management and emergency kit utilization.
Background:
Anaphylaxis is a severe, life-threatening situation. However, little is known about real-life anaphylactic management in children, especially in kindergarten and school settings, where a large number of anaphylaxes take place.
Methods:
Parents, school teachers and child-care providers of 86 primary schools and kindergartens in the city of Dresden, Germany, received questionnaires to report their experience with anaphylaxis in children. The main foci of interest were symptoms, allergens, sites of occurrence, acute treatment and emergency sets.
Results:
Out of 6352 returned questionnaires, 87 cases of anaphylaxis were identified. Prevalence was calculated at 1.5%. Average age of the patients was 7 years, 58% were boys. The majority of reactions occurred at home (67%/58 children). Fourty seven percent (41 children) had recurrent episodes of anaphylaxis. Eighty two percent (71 children) showed cutaneous symptoms, 40% (35 children) respiratory symptoms, 29% (25 children) gastrointestinal symptoms, and 3.4% (3 children) cardiovascular symptoms. Fourty seven percent were classified as mild reactions. Foods were the most common cause (60%/52 cases). Out of these 52, tree-nuts (23%/12 cases) and peanuts (16%/8 cases) were the most frequent triggers. Sixty percent (52 cases) of reactions were treated by a physician, 35% (30 cases) were treated by non-medical professionals only. Fifty one percent (44 children) received antihistamines, 37% (32 children) corticosteroids, 1% (1 child) intramuscular adrenaline. Sixty one percent of children (53 cases) received an emergency kit. Content were corticosteroids (70%/37 cases) and antihistamines (62%/33 cases). Adrenaline auto-injectors were prescribed to 26% (14 cases). Concerning school and kindergarten-staff, 13% of the child-care providers had no knowledge about the emergency kit's content, compared to 34% of teachers.
Conclusions:
This study might support the impression of severe under-treatment of anaphylactic children in the use of adrenaline and prescription of incomplete equipped emergency sets. Knowledge of school and kindergarten staff must be improved through enhanced education.
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